mauiiRN

First of all, good for you for looking to improve your skills to better help your patients! Second, a lot of things will come in time. Five months is not that long to be in L&D. Pay attention to other nurses and how they work with patients, things they say, and their behaviors. You will learn a lot this way. Keep in mind, everyone works with their patients differently. I know nurses that quietly encourage patients, saying things like, "that's great, keep going, keep pushing, keep it up, you've got it, that's the spot, right there," etc. Others count to ten, then offer some encouragement after the contraction. Others are like cheerleaders, really loud and cheery. I tend to ask my patients what is working for them. I will say, "how does the counting to ten work for you?". Some courses may help- I took a doula course which was amazing for boosting my confidence. One thing I learned over time is that "you cannot save everybody from everything". Basically a woman has to find her own energy and motivation to push, and not everybody will push well no matter what you do! Some might benefit from a rest, a small nap, or some juice, then to continue. Try changing positions, or encouraging her to visualize her baby descending, or holding her baby in her arms. Keep trying! It will get better :)

I have only been an L&D nurse for a year and a half but it's long enough to have seen some fetal losses. In our L&D, we only admit patients who are over 20 weeks, otherwise they are sent to emerg. We do not do D&Cs on our floor, but we do induce if the fetus (over 20 weeks) is deceased. We also work with women who present in labour and the fetus is not yet old enough to survive outside the womb. We also have infants that pass during the labour itself or shortly after. In terms of terminology, I believe Ontario's definitions are different from the States (and maybe from other provinces too). Where I work, if the infant/fetus is over 20 weeks and 500 grams, it is not considered an abortion whether it is spontaneous or induced, it is considered a preterm delivery. If the infant is born alive and dies, it is considered a neonatal death. If the infant is born still, it is a preterm stillbirth. Before 20 weeks, it is considered a "therapeutic abortion" if the pregnancy is terminated, for medical or social reasons (including ectopic pregnancies, ancephaly, etc.). Most of our patients, if they are stable, choose to go home as soon as possible. We do not do any standard psych eval, but we certainly look for clues that may be apparent while the patient is in hospital. They are provided with contact info from social work and chaplaincy, and they have a follow-up with their Obstetrician at 6 weeks. Our postpartum care for patients is similar to a live birth- vital signs, fundal height, lochia, LOC, perineal care, etc. I would say the medical care does not depend on trimester, but more on the complications surrounding the loss- whether there was an abruption, infection, comorbidities, etc. We learn a lot on the job, and I am lucky to work in an environment with LOTS of support from coworkers. One thing I highly recommend, if you will be working in the field, is to take a perinatal bereavement course. Here in Ontario, we have many courses offered by PBSO (Perinatal Bereavement Services of Ontario) and they are amazing. One of the most important things I learned from the course is that the amount of grief a mother/father/family feels does NOT depend on the gestational age of the baby but from their attachment to it. Some individuals may become very attached as soon as they learn they are pregnant and may have much difficulty coping with an early loss. Others may not become as attached and may not grieve as strongly even with a later loss. Also, silence and presence are very powerful. You don't always have to be saying or doing something. In Ontario, nurses can study for their Perinatal Nursing certificate, which is a post-graduate certificate. It is not ob/gyn specific, but covers maternal and fetal health during the whole perinatal period, and I assume it includes a bereavement course. Hope those answers help you, and good luck in your nursing career!

We use misoprostol frequently in our unit for PPH. Here is info I have obtained from an obstetrical research program we use: Sublingual administration has the most rapid onset and highest peak; Peak concentration is achieved faster with oral and sublingual administration than with lady partsl or rectal administration; The initial increase in tonus is more pronounced after oral than after lady partsl administration; Rectal and lady partsl routes have a slower but longer effect than oral and sublingual. So, you can give Cytotec PO, SL, PR, or lady partslly. Sometimes our docs give 400mcg SL and 400mcg PR simultaneously.