LizzyL&DRN

We are required to take the new OB ACLS course that was developed by the Univerisity of Idaho in Boise. It's a great course. Our clinical educator went to Boise to get trained on becoming an instructor.

With a full bladder during a c/s there is much greater risk of cutting into the bladder while cutting through the layers to expose the uterus. I was recently in a c/s where the foley was not draining. We could not figure out why, it was in the right place and the doc claimed it was the new foleys our hospital bought and that she had had several c/s where this had occurred with this brand of foley. She had a very difficult time getting to baby due to the full bladder and she was very careful not to cut the bladder when going through the layers.

I had rectocele repair 2 years ago without a hysterectomy. I am very pleased with the results. I'm hardly long term only being 2 years out, but i'm still happy at this point. Not sure what other questions I can answer for you.

How many births do you do per year or per month? 250-300 per MONTH How many OB/gyns do you have on staff? 10 OBs and 1 Perinatologist How many family practice doctors delivery babies? 0 How many nurses do you have on staff for L&D for each shift? 6+ Do nurses place cytotec or do the doctors do it? Nurses always do it. Are there any nurses that refuse to place cytotec? The pregnant nurses do not place it, other than that, NO, everyone places it. Are their doctors in house during the cytotec induction? No. Is the surgery crew in house during cytotec inductions? Yes. If you place cytotec,what was required to train you to place cytotec? Education on using it, demonstrate competency in placing it. Is Cytotec used on viable pregnancies or only on IUFD? Both Do you or would feel comfortable placing cytotec? Yes, very comfortable. I have seen very few negative side effects of using Cytotec. Unfortunately, our docs do A LOT of inductions, there are frequently patients that receive cytotec 25 mcg Q4 for 24 hours or more. They often end up in C/S due to failed inductions which is a shame. But negative side effects have been rare on our unit from cytotec. Occasionally there is a baby that won't tolerate labor and needs to be delivered via C/S, but that can hardly be blamed on the Cytotec.

GOOD FOR YOU!!!:yeah: :icon_hug:

Can you print the email that stated you were not to place anyone under 24 weeks on the monitor? Can you also print out the ACOG standards of care in this situation to use as evidence in backing yourself up? Do you have a union? If so I would go to the union for some assistance. I would also consider requesting a meeting with your director and the DON with your evidence in hand to face them with. Include a copy of the policies on file. Good Luck! I don't know that i'd want to work with a doctor like that.

I think you need to learn to speak up for yourself and defend yourself. The situations that you described are quite common happenings on an L&D floor. Sometimes things are moving so quickly the last thing you can worry about is what is mom's blood type. It sounds like all you need to do is explain why you did what you did to this yelling preceptor lady. Nothing you described to me indicates you are incompetent, you are prioritizing which is what an L&D nurse has to do. You ensured the delivered pt wasn't bleeding, checked baby's vitals then went next door to take care of 10cm dilated patient? That sounds perfect to me. And I would have insisted that the primary delivery nurse give report whether or not she had another patient or not. Sounds like you are doing a fine job. I think yelling preceptor lady was mad that she hadn't been guiding her preceptee correctly, that's why she yelled at you.

Pitocin, Lactated Ringers or Normal saline, Lidocaine, Methergine, (not necessarily in room, but know where it is for PPH) Hemabate, (same as above) Cytotec(misoprostil)-same as above two Baby Meds: Vitamin K, Narcan(if mom got narcs), and Hep B vaccine if your facility does that.

I need some help from some creative people out there. I am doing an education class for teens at a local school for pregnant/delivered teen girls. This school offers the girls the opportunity to bring their infants to school with them and prepares them for graduation. The class we are doing for them is covering the topics of labor and delivery, postpartum and infant care. According to the educator there, most of these girls feel judged by most of their health care team. Such as, the pediatrician, OB doc, nurses, etc when they ask simple questions that maybe these health care workers feel they should know since they are having a baby. Anyway, this judgmental attititude has left many of these girls intimidated to ask questions for fear of more judgment. During the class I want to make up a fun game or activity to involve them in the class and instil confidence and fun. I remember I was in a class once where the instructor based the infor on a Jeopardy game. Anyone have any fun ideas for a cool game appropriate for teens? Thanks for your help.

Can it not also be a HIPPA violation? She had no business going in your room, she had no medical reason to go in there right? She wasn't involved in your care. But she was the manager of the unit, so I don't know.... maybe not. Other's thoughts on this???

Think of it this way. Learning Labor and delivery was one of the most stressful things I've ever done. Not sure how others feel about that. But from my perspective you are undergoing a huge amount of stress already. If I were you I would come to work, take the best care of your patients that you know how, protect your license and wait it out. The clicks don't always last and if they truly alieanated you, they are probably doing it to others also. Problems will likely arise from it and the manager will need to take a more professional stance on it and address it. (we went through a similar situation with clicks, it worked itself out) You probably don't want to learn labor in an environment such as what you're in anyway. Forcing you to undergoe an evaluation in those circumstances is truly unbelieveable. You should have forced her to pay you for an hour of your time. I probably would have gone to HR for that or told her absolutely not. I was a gyney patient on my floor, my manager needed to give me some new employee handbook and I had to sign for it. She asked my permission to conduct that type of business while I was a patient before. I too had someone who wasn't involved with my delivery walk in while I was in stirrups. It was pretty aggravating, but I was so tired I didn't say anything. I'm sorry for your tough time.

We have LVNs that work in Postpartum. We do however have one that has her NRP cert so we use her to "catch" babies sometimes in labor and delivery. We have also used our LVNs to work alongside an RN in our triage department. It takes a special LVN to work in triage. The ones we have are excellent. They start IVs, do discharge teaching, hook pts up to monitors and draw blood. I love working with them!

In our unit, NICU staff attends the c section. After they confirm the baby is ok, a "baby Nurse" comes and takes the baby to the nursery to weigh, check temp and give eyes and thighs and the newborn assessment. All this is being done while surgery is being finished up with mom. Once mom is done and comes to PACU, mom and baby are reunited. Usually at our facility ratios in PACU are 2:1 anyway. Obviously if the baby is having issues like grunting, low blood sugar, etc the baby nurse will stay with the baby.

At my facility, they don't order Vistaril, they order Ambien for the same reasons. I think it's more for patient comfort. There isn't a whole lot of reasons to wake the provider for a cytotec induction if everything is going well, unless she becomes active. I think patients are generally pretty anxious when there for induction. It's nice for them to get a good nights sleep before the labor starts.

Could it be a molar pregnancy? That's a great brain teaser...Make sure you post the answer once you find out for sure. Thanks.

I had a VERY experienced nurse RUSH a patient back from triage stating she was Complete. When I checked her, she was actually 1 CM! She was just completely effaced and it was very difficult to feel. That wasn't fair of that nurse to tell you that you didn't know what you were doing! You did just fine, and so what that it took 40 min for her to deliver! At least he was there for delivery and didn't miss it. You did fine, don't beat yourself up. Mom and baby are fine right? That's what matters. GOOD JOB!!

Do ELECTIVE terminations really occur in the hospital setting in the absence of defects that are not compatible with life??? We do not do these. We terminate due to defects that would not allow the baby to live and that is all. I have not even seen an abortion due to Down's syndrome and it is my understanding they do offer this to women. I am ok with caring for a pt undergoing a termination due to fatal anomalies but absolutely would not participate in an elective termination.

We have a 5 bed triage unit, each bed enclosed by curtain only. We keep fetal monitors next to the bed sound turned up to protect patient confidentiality. If no FM is being used there is a little radio next to the bed that we turn on. We are staffed ideally with 2 RNs but lately due to budget constraints 1 RN and sometimes 1 LVN. Our LVNs are really great, they hook pts pt to monitors, get VS, start IVs, due admissions (except assessment), due discharge teaching if pt is going home etc. Anyway, if we are stuck in there by ourself we only see 3 pts at a time. Others wait in waiting room and we always get brief hx before sending pts to waiting room. If someone needs to be seen more rapidly and 3 beds are full, I call charge nurse to triage that pt. 8 patients and 1 RN is sooooo unsafe! You should have the ability to send patients to waiting room if need be. It's your license and you have to do what is safe for patients, 8 is a ridiculous number! I'm not sure how your unit runs, but I frequently have pts in triage in a holding situation while they are waiting for a bed and in active labor. AWHONN standard is 2:1 with active patients.

I would explain my rationale for putting O2 on the patient, and hold the strip in front of MDs face and force him to acknowledge the late decels. If he still wanted me to remove the O2 I would say "I will be charting in the patient's medical record that MD stated to remove O2 and is aware of late decels." Generally they don't like it when they know you will putting your concerns in the medical record. Then I would climb the chain of command if needed. And honestly, when the MD left the room I would be putting O2 back on. Maybe he thinks she "looks sick" with it on, but if there is any chance at all that it will help the baby, why not have it on. I also like the idea of making him write a written order to remove the O2, and explaining he needs to do this because he's going against hospital and ACOG guidelines and the standard of care which is what he is held to.

Based on your description the indication for the c section was probably failure to progress and/or cephalopelvic disproportion. What it means when they say "anterior lip" is that cervix can only be felt on the anterior portion and cannot be felt on the posterior area. We frequently describe this to the pt's as being 9 1/2 cm dilated to put it in perspective for them. If they will not dilate further than this and baby is not engaged in the pelvis it can be an indication that the baby will not fit. As far as having a VBAC for later pregnancies goes.....second babies are frequently bigger than first babies so unless they think the baby is smaller the second time around she probably would not be a candidate. It is also true what the previous poster said about the direction of the incision. A "classical" incision is made in the vertical position and is not generally done here in the US. A "transverse" incision is done horizontally just above bikini line. A patient with a previous "classical" incision in the uterus is not a candidate due to risk of uterine rupture.

Rio, I wasn't actually there that night but according to the nurses that were working the flight crew did say "we don't have OB experience" . Also according to the nurses that were working that night, the flight crew was saying they wished some of us would come work for them to accompany them on transports like this. Mind you....we are all ACLS certified but very few of us have ER or ICU experience. My director is looking into forming a maternal transport team like the NICU has. Thanks for your reply.

We recently had a case where a pregnant woman was being transferred to another facility when she started to seize during the flight. The flight crew which according to them "had no OB experience" decided to stop at our facility to make sure the baby was ok. We ended up admitting the patient and dealing with her seizures, but here's my question.....Are there flight teams that are OB trained? Do they hire high risk OB nurses to accompany these patients during maternal transports?

Many hospitals have an "abusive physician policy." Check if your's does and if this falls into the category. I know mine does and we had a new doc trying to see how far he could push things. Our nursing director and chief OB doc put a stop to it rather quickly. We are educated professionals and deserve to be treated as such. I agree with the nurses that say "put her in her place" It can be done rather easily, just preferably not in front of a patient. Next time she's out of line just tell her so. Of course there is always the passive aggressive repeated 3 am phone calls to her to ask for things like Maalox or to tell her her laboring pt just srom'd or something simple like that. :wink2: But "putting her in her place" would probably be easier.:chuckle

So do all the other interventions and if baby heart rate doesn't come up....Tell her to PUSH!!! The most important thing is a healthy baby and mom, and you got that so good job! This happened to me the other day, G3P2 came in complete and +2, intact membranes, doc was called and was on his way. Only thing holding that baby in was the intact membranes, when we realize this baby is having big late decels. I had 4 nurses in the room, so I broke her water and had her push. Doc was in room for delivery but didn't have time to catch. Screaming, baby, 8/9 apgars. And doc wasn't mad.

I have seen this many times as an admitting diagnosis. Its the new way the docs are assessing the risk of preterm delivery and preterm labor. I think there is thinking that PTL and incompetent cervix are somehow related. We had a pt admitted recently with cervical length of 0.5 cm (should be 4 cm), Was transferred to antepartum side after Mag sulfate therapy was completed, started laboring about 3 hours later and went to 10cm almost immediately it seemed. 25-27 weeks. We also had a pt once that was with us for weeks on Mag for PTL, she broke threw at 33 weeks and delivered. Her next pregnancy 1 year later, doc did a cerclage at 15 weeks and she carried to term. Interesting stuff!