JessiD

I have seen it often in smaller babies, but never in a term infant. One of my patients progressed to pushing while still intact. The sac did not rupture until the head was pretty much even with the ears, when it did rupture everyone in the room 'took a shower' in amniotic fluid. It was pretty gross. But I have always heard it was good luck to deliver en caul. When I deliver I want to have a natural delivery and membranes remaining intact makes contractions much more tolerable, so I am against AROM for myself. I would love to deliver en caul but would hate to give everyone a 'shower' if my membranes rupture during pushing.

If it is just the hospital attorney you are meeting with and the hospital is not the plantiff this will be the best time for you to judge how much the hospital is going to support you in this case. If the plantiff's attorney is not there there is no reason to bring your own attorney. If the hospital attorney does not seem supportive politely tell them you will need to find your own council to assist you with decisions and you will be happy to meet with him once you do so. If you find your own attorney at a very early stage in the preceedings it may give a false impression that you are guilty or have something to hide. Be honest about everything. And like magz said if you dont remember say that. If you know you did what you were supposed to do tell them you 'Followed a reasonable standard of care.' If you have followed a reasonable standard of care AND can prove that there is nothign they can do. I wouldnt take your own attorney to a first meeting. But I do not know the situation. If its really bad, and you know you were negligent it might be a good idea. If not I would hear the attorney out and give them the information they want.

I am sure you have already had the meeting by this point, but a meeting the the attorney doesnt call for an attorney of your own neccessarily. I have met with a hospital attorney before and it was nothing more than me telling exactly what happened in a situation. He just wanted the facts written down. But I had followed a reasonable standard of care and the event was unavoidable and did not happen while I was at work. It was just a pt I had cared for on numerous occassions during a 2 month stay. If at any point you become uncomfortable with the situation then you can ask the not speak further until you have an attorney.

And I dont mean the pediatrician determines it for each case, but there would be a standard set by the peds of the facility as when and when to delay cord clamping or which peds like clamping and which do not.

We have had excelled results with skin to skin contact both during the immediate postpartum period for well babies and throughout the NICU stay for NICU babies. some studies show the benefits of delayed cord clamping as a 'mini transfusion' but I have heard a lot of pediatricians complain about polycythemia and increased biliruin levels when there is delayed cord clamping. One pediatrician actually asked a dr to stop delaying cord clamping while she dried the baby because that OBs deliviers had a significantly higher rate of extremely high bilirubin levels. Delayed cord clamping serves a purpose but Its a trade off, an extra boost of blood can likely lead to jaundice which upsets some parents a lot. If the baby is expected to need blood work, etc it helps in building a reserve for this expected blood loss. I think delaying cord clamping should be left up to the discretion of the attending pediatricians in the facility.

Not so much coming from our antipartum untit but we have had a lot of preterm pts come in and we just cant cant seem to get them stopped, or they have already progressed to transition, or have ruptured membranes. We usually get a trickle, but it seems pretty busy with these pts lately. Yesterday we actually had 2 different pretermers arrive about 5 minutes apart, both delivered within the hour.

Dont give up. I did my practicum in nursing school in L&D, but moved after graduation so I did not have a job in L&D right after graduation. I worked in NICU for about 10 months before transferring to L&D. I talked with the nurse manager of L&D shortly after I was hired at the hospital and I cross trained to their unit. I would occassionally work shifts there when I had low census in NICU or just as an extra shift for OT. Because I was only crosstrained policy stated I was not able to function totally as a L&D nurse, but I cared for patients throughout labor until pushing, recovered pts after deliveries, and acted as baby nurse. That way I became familiar with the unit. When a position because available I quickly made the ransition to that department. I then oriented as a full L&D RN, which didnt take long because I already had been trained to do the majority of things. I dont know if your hospital does crosstraining but it is an excellent option as a way to 'get your foot in the door'. Just make sure you do a good job and are willing to learn things outside of what is expected of you. Ask to be taught additional things even if you arent actually aloud to do them by yourself. And hint about your interest in a transfer every once in a while just to make sure they know you want to do more than just be crosstrained. But the reason why there are rarely any openings is L&D is a calling and once you are there you likely stay for a while. If you truly believe it is your calling keep pursuing it. And if you REALLY want it badly enough, look in surrounding towns. Once you get that experience in it is easier to find positions elsewhere. L&D is very specialized and takes a lot of training so some hospitals dont want to 'waste' the money on trainig a new grad when they can hire someone with experience while others are desperate because of the shortage and can justify the expense.

It sounds like your unit is very unsupportive. If the nurse said she was going to be his assistant it was fitting that she was helping him by massaging the uterus. Although, it would have been good for you to be involved in that sort of situation instead of standing back filling out bands. That ways you could prepare yourself for situations like that in the future. It is important to show initiative in situations like that to show you are able to jump in during emergencies and do what needs to be done. I dont understand why should would have to tell your preceptor, whey was your preceptor not in the room during the delivery and after to help teach you how to respond. There is a lot to learn during orientation to L&D and it is important that your preceptor is there to teach you. It is also just as important for you to seek out those learning opporutnities and make the most of the ones you are given. Because if you make it off orientation there will likely come a day when you are in the room without someone to help you and will need to know how to respond. Do not get discouraged by their negative comments but use them as incentive to show them that you really can do it and become a successful L&D nurse. I seemed to have the opposite problem on my orientation. I had completed my practicum at a hospital that had very complicated pts and high risk deliveries so I felt well prepared after graduation. I moved and the hospital I work for now treats pts with complicated conditions, but we do not have ICU level pts laboring. My preceptor told my nurse manager that I was difficult to teach because I seemed to know everything already. It made it somewhat difficult for me as well because I knew a lot of the basics, but I needed to learn how to be a nurse not a student nurse and to make decisions for myself. The nurses tried to release me too quickly because I caught on and I felt somewhat robbed from my orientation. I feel comfortable taking care patients now, but I was somewhat overwhelmed right after I got off orientation. You have to really love what you do to be a good L&D nurse. You have to jump in and act quickly in situations. Dont be afraid to ask questions, because that is the only way you will learn. But do not stand back during your orientation. Take full advantage of that time and try to get as many experiences in as possible while you have someone there to 'hold your hand' through it all. If you have not already transferred into postpartum, go back to your unit and tell your preceptor you are willing to do anything and work your booty off to prove it.