symmetry

I think it's extremely valuable to have had med-surg experience before moving to post partum because you'll have the confidence to deal with complex medical issues that post partum patients will occasionally have. Also, many times post partum units have gyn surgery patients who are more likely to have those complex issues. The last couple of years seem to have been slow in OB, at least where I am, but I see it picking up. Keep trying, and when interviewing emphasize the diverse patient load you've cared for in med-surg. With your background, and a short orientation period, you would quickly pick up what you need to know for post partum patients. For an experienced med-surg nurse the orientation with a preceptor shouldn't need to be more than 2-3 weeks at most. So, the argument that you don't have post partum experience seems like it could be countered with assurances from you that you are a quick learner and have a strong desire to get into that area of nursing. Think of your year of med-surg as a very good advantage to have. Good luck!

I work days on a Newborn Nursery unit as an RN. Our hospital has several LCs and at least one is scheduled every day shift. Unfortunately we never have an LC on nights. In general, night shift nurses at our facility seem to be less interested in supporting breastfeeding. Our policy is not to give formula to breastfeeding babies unless there is a medical reason or if the parents request formula. I think nurses can feel pressure to give formula (especially on nights) if the baby is nearing a 10% weight loss or hasn't had a void in 24 hours. Some of our patients want formula fed overnight and the night shift nurses are only too happy to comply. I don't think there is much education given by night nurses regarding why that's a bad idea. The day shift nurses and LCs work well together to promote breastfeeding but these nurses have had the benefit of this collaboration for a long time. Night shift nurses have to deal with feeding issues on their own. I really feel if there were LCs consistently on night shift breastfeeding promotion among night shift nurses would improve. LCs generally aren't asked to work nights. There are so few of them that they hold the power to say "I'll only work days". I do feel frustrated handing off a patient to a night shift nurse who I know doesn't care about breastfeeding when I've worked all day to get her baby to breastfeed. And yes, "eye-rolling" does occur during report, trust me.

A severe PP hemorrhage can cause Sheehan Syndrome where decreased blood flow to the pituitary gland may affect prolactin production, suppressing lactation. A mild case of Sheehan Syndrome can cause a delay in milk production. In this case, frequent breastfeeding or pumping can stimulate the number and sensitivity of prolactin receptors to take advantage of the small amount of prolactin available. There is research suggesting that adequate amounts of milk can be produced among mothers with varying levels of prolactin and that the body's autocrine control of milk production may be able to compensate for a hormonal environment that is less than optimal. I would encourage your patient to breastfeed frequently and watch the baby's diapers and weight, especially after being discharged. The pediatrician should be alerted to Mom's hemorrhage situation so they'll be aware to watch the baby more closely for inadequate weight gain.

I have enjoyed precepting new grads also and usually they're great. In my experience the first clue that things may not work out is the that fact that you feel frustrated. Seriously, lying about what she did or didn't do---how can you trust her now? I agree you should notify your manager and educator and keep a record of each incident. They'll probably need it.