monkeybug

One of the first things we did on our unit was to teach the laboring woman how to unplug her monitors and go to the bathroom without help. We were always happy to come assist with the IV pole, but if they needed to go immediately (as is often the case when pregnant) they were welcome to proceed without having to wait on us. Bedpan? No way, unless they were laboring without an epidural but with a fetal scalp electrode. We didn't want that yanked and pulled on accidentally. And I seriously doubt anyone would get upset about a little poo in the bed. It's just part of L&D. The only time I ever got irritated about bathroom issues in bed was when I had a patient who could get up and go to the bathroom but chose not to. Instead she'd just pee all in the bed and then call us to come change the linen. And lest anyone think I'm unfairly assigning intentions to her that didn't exist, she told us what she was doing and why. She had few fans among the nursing staff. I've had some lazy moments in my life, but never to that point.

First of all, best wishes for you. I'll say a prayer for you. I worked in L&D all during my infertility escapades. I would go in for ultrasounds and blood draws before my 3-11 shifts. Looking back, I really think it would have been better for me to have been somewhere else. I don't know where, as I could never stand the thought of med surg. Maybe Walmart. It was tough, really, really tough. I dealt with a lot of anger and bitterness. Every time a teen mom would mouth off at me, or say something inappropriate about their baby, every time someone would come in high on crack and deliver, every time someone failed to appreciate the miracle they'd just been bestowed, I'd inwardly rage. Why them, and not me? Why did they get a baby when they were doing everything wrong, and I couldn't get pregnant, despite doing it all the "right" way? I was a walking tornado of anger. The other nurses that got pregnant on the unit tended to tiptoe around me, but I appreciated that they recognized my anguish. And my coworkers rejoiced with me when I got pregnant. My fertility specialist finally refused to proceed until I went to counseling, and I utilized our hospital's EAP. It really helped to talk about it. I should have done it long before I did, but my attitude towards counseling was "you're never going to make me happy that I'm barren!" (I tended towards the dramatic while hopped up on all those hormones.) Most L&D nurses will, at some point in their career, question the choices of the universe, or God, or fate, when it comes to who gets to be a mom. We just see too many unpleasant things. When the nurse is also trying to conceive, it can escalate these feelings. I don't want to discourage you from a career choice, because quite possibly you are a much more logical, kind person than I, and therefore won't feel the way I did. It was 4 years of hell for me, though, going to work every day and going home to a room that was supposed to be a nursery but was instead empty. I'm sure I wasn't the best nurse through it all. I still got great patient comments on surveys, and I still even taught childbirth class through it all, but I was a very angry, unhappy person on the inside.

I have seen a bedside committal. It actually happened pretty quickly. In small towns, the doctors and judges may be friends, and it might not take more than a phone call. At least that's the way it happened in what I witnessed. And in the end, the patient was grateful. She was hypoxic and therefore not thinking at all clearly. The idea still makes me squirm though, as I very much believe in autonomy.

I'm also a labor nurse who seriously considered homebirth. If we're so great, why did I consider it? Much as I love my coworkers, I was embarrassed about the idea of delivering in front of them. Also, due to some medical issues, I cannot have an epidural or spinal, and I thought a midwife could help me with natural childbirth. The vast majority of the patients where I worked had epidurals, so natural labor was a rarity. Not that it was pushed on them, on the contrary, this was the demand of the patients. I sought out a midwife who would assist me, but I changed my mind. Part of it was the iffy legalities, I live in a state where homebirth is a risky proposition legally speaking. When the midwife told me that if something went wrong she would, in her words, "dump you at the doors of the ER and never acknowledge that I knew you" I had some serious doubts. Don't get me wrong, I didn't have a problem with her attitude, because I knew if she attended me at home (or at a hotel, as was her usual practice) and it was found out, she could go to jail. So I stuck with my favorite OB at the hospital, and my birth was definitely a nightmare. He and my nurses did everything I asked of them. I was able to sit, walk, rock, get on a birthing ball, and reposition at will. But my baby had other ideas about my plans for a calm, natural, lady partsl delivery. My nurse had dimmed the lights, I had music, she massaged my back until I'm sure her arms were about to fall off. She fetched ice, she put cold cloths on my forehead, she encouraged me. My OB suggested a cesarean around 2am. I refused, and he said, "Ok, great, I'll be back in an hour and we'll see what's happening." By the time the hour was up, I was begging for a cesarean. I had that awful bone-on-bone pain of CPD. The baby was also having huge decels. My fears about being shy and embarrassed flew out the window. I'd have walked down the halls of the hospital naked if that was what it took to get that baby out of me. I was in agony. I hopped onto the OR table under my own power, while being gently scolded for not waiting on help. My precious child coded at delivery, and luckily, because I was at my hospital, he had a nurse practitioner, a nurse, and a respiratory therapist all to himself. Good thing, because I hemorrhaged due to uterine atony, so my nurse and OB were a bit busy dealing with me. My husband was brought into the OR even though I was under general (very unusual) because things were getting serious. We were both fine, thankfully. I don't know how my delivery would have gone if I had chosen to do it outside the hospital. No one will ever know. But I feel like I got amazing care, and, though I sometimes feel like a failure for having a cesarean, I never blame my OB because he was happy to let me decide. I'm sure if the decels had gotten deeper and more persistent he would have urged me in that direction, but it didn't come to that. I'm just glad that I had the option of the section, and the team there for the both of us.

The very fact that Ina May has a maneuver named after her proves that dystocias can happen anywhere, even at home. I support the right of women to deliver at home, safely and legally. But we have come so far in medical advancements that we have forgotten that birth can kill mothers and babies. I've got several antique obstetrics textbooks that describe what it was like before C-sections were an option, when birth primarily occurred in one's home. Hooks to decapitate and remove dead babies, how to break a symphasis pubis to assist with the delivery of a huge baby (and how to construct a sling bed for the woman to lay in for weeks on end while she recovered). Yes, absolutely, there are way too many cesareans in this country, but sometimes they can save lives. The inventors of forceps were lauded because they saved lives. The guy that came up with a way to repair fistulas following birth revolutionized life for many women who were basically homebound forever after they delivered because of the odor and embarrassment from unrepaired fistulas. Birth seems so safe and benign now because few of us (outside L&D nurses) know anyone that died in childbirth. Yes, there is too much Pitocin. Maybe there are too many epidurals, but I bet the women who were burned at the stake for even having the audacity to ask for pain relief in labor would think we were nuts for even debating it (on that note, I highly recommend Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank, it's a very informative read).

The hospital where I delivered and worked for years did use LPNs in L&D! They were scrub techs primarily, but could also recover patients. We adored our LPNs!

If you are a nurse, I'm sure that at some point you've practiced some defensive nursing. We all know the risk of lawsuit, and in OB it's worse than anywhere else. I've seen a crunchy couple that refused monitoring and interventions have a bad outcome, and then turn to the nurse and doctor and say "But why didn't you tell me? YOU are the professional!" So it's all fine and good to say that it should be perfectly fine for the baby to go unmonitored because mama doesn't want to cooperate for whatever reason, comfort, idealism, etc., but how do you explain to a lawyer, jury, and now grieving mom that you missed those repetitive lates because the you were trying to make the patient happy. I believe home birth should be an option for low risk women who don't want to be monitored. But when you come to the hospital to deliver, you should expect monitoring. Yes, I know the statistics don't show that monitoring does much but increase the rate of C-sections, but I know for a fact it will be used against the nurse and doctor in a lawsuit. Every little gap in tracing will be pointed out to the jury and the nurse will be questioned about why the baby wasn't being monitored. It's like going to the ER with chest pain and refusing an EKG. Why even go? Stay home, and then you can be as comfortable as you want, and if something goes wrong you have only yourself to blame.

I can promise you that laughing at a birth plan with things like "ask me before you circumcise my child" has NOTHING to do with the C-section rate. The decision to proceed to the OR is made by the baby, the doctor, the mother, or some combination of the three. This forum is supposed to be a safe place to vent and laugh. And I don't know any nurse with more than 2 years of experience without a gallows sense of humor. It's the only way to survive. I could either snicker inwardly at the ignorance, or I could bang my head against the wall and then quit. I adored intelligent questions and input when I was a labor nurse. I wanted patients who cared about themselves and their babies. What I didn't need was someone who got a canned birth plan off the internet and then went no further. They read somewhere about how the nurses and doctors were going to try to kill them and their babies, and they believed it. Did they go to the free childbirth class offered by the hospital (that I usually taught)? Of course not, that would take time and effort, and involve acquiring knowledge. Much easier to assume things and print something they found on a blog.

My dear grandmother was truly from the backwoods. Think Deliverance. She had some interesting terms. Deaf was pronounced "deef" with a long E. Vomit was always vomick. One I hear a lot (from nurses and patients, it's definitely a regional thing) is "eat up with" as in "He is just eat up with poison ivy." It means he has a very, very bad case of it. "They opened her up and then just closed her right back because she was just eat up with the cancer." A daddy had a question about his baby's umbilical cord, but he kept calling it his "unbiblical" cord. I wondered what heretical ideas that poor cord stump had espoused. Epidural is another word that is absolutely mangled. The absolute best, though is "happydural". I've also heard "opadural" "empadural" and "spinal tap".

I would have a very difficult time biting my tongue and taking that. I feel for you!

I'm from the Deep South, and have lived here my entire life (except for travel gigs) and I have NEVER heard it pronounced that way. Maybe she was eccentric.

Oh, man, I used to have an exhaustive list of terminology for the female reproductive organs, collected over many years. Some of the ones I remember: Pocket book Rose Cat Monkey Angina (I guess their lady parts hurt) My Business My Stuff

In nursing school I did clinicals in a small hospital that had some interesting charting I've never seen anywhere else. I wonder if anyone else has heard of it? At the end of the shift, say 3-11, you'd chart, "2200 Stable hrs.-----A Nurse, RN" to indicate, I suppose, that the patient was still breathing at 10pm. I even witnessed someone from medical records bring a chart to a nurse and tell her to finish out her shift. She'd made an end of shift note, but because it didn't say "Stable hrs (hours)" it wasn't complete. I've worked in many hospitals across the country, and never again have I run into this notation.

When our employee surveys indicated incredibly low morale and extreme dissatisfaction with management, we were forced to attend meetings where we (the staff nurses) had to come up with ideas about how we could improve things. I think they missed the whole point. I've left the hospital, but from what I hear from my friends still there, things are going down hill fast.

But again, how is THIS ambulatory care center preventing anyone from abortion? Or birth control? Is every health care operation supposed to take care of this? Do you expect an orthopedic surgeon's office to provide murder on demand too? I know it's a crazy thought, but maybe this huge donation of money to health care is a good thing, even if you don't care for their beliefs.

I've been working M-F for almost 2 years, and I'm still undecided. I love having weekends and holidays off. Knowing I'll be off every single Christmas Eve and Christmas Day is awesome. (Thanksgiving I could do without, I spend that with the in laws:cheeky:) I do miss having days off to get things done. I have to take time for doctors appointments and hair appointments and vet appointments when I used to just schedule them on my day off. On the whole, I'm a fan of M-F. Nothing is perfect, but it beats calling home on Christmas Day from work to tell everyone Merry Christmas.

I find it difficult to believe that this hospital is the only place a woman can go in NYC to get rid of her "little problem." I'm in a smallish city in the south, and we even have an abortionist. He's quite a charmer, too, one of the most repulsive individuals I've ever had the misfortune to meet. When the Koch brothers are marching into Planned Parenthood and dragging women out of the stirrups by the hair, then I might understand how them giving money to this hospital is limiting women's rights. So the woman has to go to the health department or PP to get her condoms or pills after she gets a cut sutured here. The options are there, just not there. Why is it such a heinous intrusion on a woman if she can't kill her baby in one locale but can in another? Abortions aren't done in any of the ambulatory care centers here, either, thankfully.

Typically they use Pitocin for inductions. It doesn't suppress lactation, but it does affect the physicality of breastfeeding. Pit causes retention of fluids (and we tend to give lots of fluid in L&D) which flattens out the nipples. I had extreme difficulty with breastfeeding. The lactation nurse looked at me and said, "Ah, pit nipples." Excuse me?? All my years in L&D, and I never thought of this being an issue. But if the breasts are fluid overloaded along with the rest of the body, the nipples tend to disappear making it hard for the baby to latch. Sorry she had such a rough time.

I worked for years with a dear, sweet nurse who, well, just wasn't right, as we say here in the South. If the unit was peaceful and all the planets aligned correctly, she was a joy to be around. If something went wrong (and often whatever was wrong wasn't apparent to the rest of us), then she would simply lose it. She also had it out for a coworker. She was convinced that Suzy Coworker hated her and was out to get her. Suzy actually only started to dislike her after years of weird behavior by the nurse in question, let's call her Baby Jane. In the years I was there, I personally heard Baby Jane threaten to bring a gun to the unit more than once. She would begin screaming at the least provocation. If the unit got stressful, and it often did, then we were in for an even worse day because we had to tiptoe around her. Management was repeatedly made aware of her comments and behaviors. After one paranoid outburst that included a suicide threat and a threat to get a gun, Coworker Suzy left our unit. We lost an awesome nurse. I was appalled at how little was done. She stormed out of a mandatory class after screaming looney bird stuff and threatened to get a gun, and she was sent to Employee Assistance. Not long after that, she said on the unit that she should just bring a gun. I promptly went to the manager. She was sent to Employee Assistance again, once, and then was back on the unit. In all seriousness, many of us had plans for what to do if she did bring a gun--hiding places, escape routes, etc. We were told, "You can't force someone to get help." I became even more upset when I learned that none of this was new. Years before most of us arrived on the unit, she acted out part of a suicide threat on the unit. She was supposedly taken straight from the unit to the psych ward, and a week later was back caring for patients. I'm not saying that someone who is suicidal should not be allowed to work, not at all! It was the threats to bring firearms (that we knew she owned) and the vendetta against Suzy that had us all concerned. We all breathed a sigh of relief when she retired. And while most of the recent retirees came back to work float, she was not offered that option. So I guess management finally did something. We all wanted the best for her, we all liked her, some of us probably even loved her, but she made work very unpleasant and unsettled. I wouldn't hold my breath on management doing much, unless the threatened nurse makes a big stink, and the one being threatened is seen as more valuable.

I think you handled it well, but that doesn't mean she got the answer she wanted, and it could affect your job prospects. Illegal or not (and it most definitely was), if you don't get the job, how in the world could you prove it was due to religion? She can always say she didn't think you'd be a good fit, someone else was more qualified, etc. In some areas of the country, and in some facilities, your religion can definitely give you a huge leg up. If it's an LDS (or Seventh Day Adventist, or Catholic or whatever) facility, some nurse managers are honestly going to prefer the idea of a nice Mormon (or SDA or Catholic or whatever) over an equally qualified Wiccan or whatever. And in this job market they can be choosy.

LOL, I can imagine the disgust on the face of the doctor, if he's like many I've known over the years. One of our best OBs was also one of our most handsome, too. The patients (and nurses) would swoon over him. Want to get him out of a patient's room at the speed of light? All it took was for a patient to flirt. He could not stand it! I always felt bad for him. He was very proper, and this sort of behavior made him terribly uncomfortable. He was a great guy, very devoted to his wife and kids, and brilliant, but some of our, um, most interesting clients would basically throw themselves at him.

Are you really, really sure you want her to become your mother-in-law? Will he change his ways after he gets a wife, or will you, too, be hostage to her wants and whims? Regardless of how awful she is, if he doesn't put a stop to it then he's just as bad.

If you're going to work on your BSN, then I'm guessing you're an ADN. In many facilities, ADNs are not eligible for leadership positions. Have you considered that this might be why some people are getting promotions and you aren't? As for someone not speaking to you, maybe you looked busy and she didn't want to bother you.

Faith is a wonderful thing, and may be all that some families have to get them through. You can be honest about the situation without killing their faith. I've seen a situation similar to this a couple of times. Once was a neonate who'd been deprived of oxygen for a long, long time. The family was insistent that the healthcare team was wrong, and if they could only get the baby transferred to a "better" facility then it would be fine. The doctors acquiesced, and the baby was transferred. The family got the same news at the new, "better" hospital, and probably got even less hand-holding there as it was a huge teaching facility. The baby passed shortly after transfer. I cannot imagine losing a child. And if I could see that child's body "breathing" and feel its warmth, I'm sure it would be even harder to accept death. If this were an adult, I'd find it easier to feel like they needed firmness and no nonsense, but this is their baby.

This is why it is so important to carry malpractice insurance. It's incredibly affordable, and they will provide an attorney (with most policies) if you have to go before the board. It's too late for this event, but he should definitely consider getting a policy for the future. And I've seen nurses with much bigger issues with the Board than this go on to have successful careers. Unless he just really wants to quit nursing, he shouldn't throw in the towel now.