pebbles1977

Thank you. Yes, I was looking for which resources are helpful in making these decisions. I know it would be nice if I could just ask you guys to tell me what to do! But I'm a little smarter than that. Sorry if it came off that way. The reason I decided to go for my master's is I really miss learning in a "school" environment. You know, you learn a lot on the job, but there's something a little more in depth when you're in class. And I also want to broaden my knowledge and the way I look at things in my career. As a staff nurse, you're pretty "task oriented" most of the time, and I like the thought of the whole picture. Now that being said, it would be hard to beat my hours (2 12s) and the compensation is pretty good for those hours I do work. I'm a bit spoiled. I suppose that is my hesitation with the midwifery program. It would be hard to go from 24 to 60 hour weeks. I think about that, then realize school and clinicals will take up a lot more of my time! So *sigh* I will figure it out. Thanks for being so helpful! I will definitely take your advice!

I need some direction. I graduated with my BSN in 2000 and have been very happy as a staff nurse since then (currently in L&D). I have always worked in Women's Health and would like to maintain my focus in that area. I am giving some consideration to the midwifery program, but hesitate because of the hours (once working). I know that there are CNS and Women's Health NP programs out there. I'd probably need to do the online route, and the WHNP is not offered by my in-state online university. I don't know a whole lot about what a CNS with WH concentration would actually do. I guess I need to know where I'd find some of these answers. The information on the schools' webpages I've visited are very, um, clinical. I'm looking for real life answers! This is a big decision of course, and I don't want to waste my time and money on something I'm not 100% sure I'll love once I've graduated and am working! So anything you guys can give me would be greatly appreciated!

Did she have prenatal care? Why did the OB stop her labor, and how? These are questions that are important to know. There are many. We can't offer legal or medical advice here, only support. But it would help to know more of your story.

On the floor where I used to work we did TAs (therapeutic abortions). At one time we did them up to 24 weeks, but by the time I left anything over 20 weeks was subject to a board review. That being said, our protocol was as follows: 240 units of pitocin in 1000 cc fluid. Start at 50 cc/hr, then up by 25 cc/hr every 8 hrs. If you had to go over 100 cc/hr you called the doc. Granted, at that time they injected urea or saline into the amniotic fluid beforehand to ensure fetocide, but the last time I checked they were no longer doing that. The standing orders read something like, call for hyperstim (we were never trained on how to recognize this, but I guess it was not an issue bc in my 4 years there we never saw it) or fluid intox (same deal there). Now that I'm on L&D I realize how much risk Pit carries, and it amazes me we never killed a pt doing those TAs. But we had a very prominent AB doc (nationally renowned) with all his research to back us up. But now that I know what I know, I don't really even follow the OB docs orders to increase pit 2 q 15. Which is against our protocol.

You can have her look up Dr. Anthony Johnson in NC. He is one of the foremost practitioners in this field. That said, I do agree with another poster that ultrasound weights can be off. She needs to seriously consider all her options and her and the father's thoughts on this issue and the ramifications before making any decision. Dr. Johnson gets a lot of referrals and does a lot of good work with TTTS, cord coags, etc. From what I've seen he does put a lot of the decision on the parents after presenting the facts, but like any MD, he's also making money off procedures. The internet is a good resource, but not a end all and be all in facts.

I went from a gyn/gyn onc floor to L&D. It was a great transistion. I knew some of the nurses from transfers to the floor and from being a charge nurse. The others I met along the way. I always knew I wanted L&D, but ended up loving gyn for longer than I expected. It worked out really well bc I got a lot of women's health/med surg skills that have actually come in handy on L&D. I think your experience will only benefit you, and any L&D unit would be crazy not to hire you at this point. Not to mention you have some confidence, probably more than most, coming from ICU. You will rock their world! Go for it!

A couple of years ago we had a grand new Women's Hospital built onto our hospital. They took away PP beds and added them to L&D. At the time I was working on GYN and there was a lot more PP overflow to that unit. Well fast forward to my experience on L&D. The MDs keep adding pts, but we don't have the room. It is a daily occurance that we are keeping pts PP until the 4 hr checks for lack of rooms, which would be ok but we've had pts deliver in triage when the triage RN was tied up with another pt (like severe preeclampsia, etc). We've had several seasoned RN's quit saying they will not be in charge of situations where pts are unsafe. i don't blame them. And now, I've had less than 1 yr of experience here and they're asking me to do charge and precept. I have no real problem w/charge (I did it for 4 yrs on GYN) except that I know the promises of excellent orientation for it will not come to fruition. So do you guys see similar things on your units? I know L&D is a primo place that usually has few vacancies, but we've been short staffed since I started there (and we're on our 3rd manager!). BTW, DH and I are moving soon to another part of the state, so I'm hoping to hear better things.

Well Texas, I have to respectfully disagree. I fully realize that SN's have some degree of responsibility, but they are unlicensed; therefore their instructors have their licenses on the line. So in my opinion and knowledge, if it went to court, it would fall on the instructor's shoulders if it even got that far. The SN told the instructor what she observed. Any nurse with a license has a responsibility to report such things. And also in my experience with students, they are not hands on in the ORs, just observing. So although the student does have a moral (and potentially professional) responsiblity to report it, as she did, the ultimate liability is with the licensed persons involved in the case, as well as the instructor who knew about it.

Currently DH and I are in the Raleigh/Durham area, and we've decided (due to his job situation) that a move back to my hometown is in order. This is Shelby (which is between Charlotte and Asheville). So I'm thinking of applying to Gaston Memorial. Regardless of the facility, I definitely want to stay in L&D. Do any of you have any experience w/the L&D units in the Charlotte to Shelby area? Or just the hospitals in general? I haven't lived there in about 10 years, and wasn't in nursing when I left, so I feel a little "out of the loop" as far as the hospitals go. And I can't believe we're going to be moving back there! Exciting and scary at the same time!

They are hurting bad enough! So if I can just make a call to the Dr's office for a referral, I'll definitely do that. If not, I'll maybe just go in and see her for what I was going to anyway and then have her make my referral. On the bright side, I was out at the pool today and did a lot of the stretching you guys recommended (in the water, on the steps), and the pain is gone for now! Yay! (although I know it will be back tomorrow, as I have to work a 12)

Thnaks guys! That does sound like what I have. That pain esp first thing in the am is so bad. And although it feels good to sit down for a few minutes at work, it hurts to stand up again. I'm planning on seeing my MD in a couple of months anyways, so I'll have her make a referral for me. In the meantime, thanks for the tips; I'll definitely try them out!

Here's my story: DH and I are at a crossroad. I have a profession where I could get a job in about any city. I do love L&D and the hospital I'm at. However, I'm young and can move. DH is having a hard time finding a job in the area we're in now, so we're considering a move to another big city in our state. My problem is I know nothing about the hospitals in this other city. I also don't know anyone who works in my profession there. So are there any websites where L&D (or other) nurses discuss openly the pros and cons of working there? If not, do you have any other ideas for me to find out what may be a good match? Thanks!

I think I may have this. I know as nurses, we aren't licensed to give diagnoses. But I was just wondering if anybody out there had experience with this, and if so, what as a nurse who works on her feet all day, what I may do about it? I've heard it's really hard to cure. Basically for about a year have had progressively worsening heel pain. I'm ok off my feet, but getting up from sitting on lying can be really tough. Now I find the pain radiating up my calves. So that's my story. Any advice or stories??

Does sound like the MD might have been having a bad day. Well who knows? But I know that I ask questions and always double check call orders that are close (and this one, depending on your unit, could have been close). We don't help each other by demeaning. And to say "you nurses..." that right there is derogatory. Maybe you could have said, well Dr, it's not just "us nurses" but this pt that needs direction from you, since you are the all knowing one here! J/k, but wouldn't you like to say that? Then again, isn't it funny that we don't feel ok to say these things bc we're trying to be professional, and others can just say whatever without consequence?? Btw I'd also like to know if there were call orders and if the bps were just outside the range or what. Just out of curiosity.

Thanks for all your replies! It's reassuring to know that others have seen prolonged 2nd stages w/good outcomes. I just wonder what the attending meant when he said that over 3 hrs leads to "unfavorable" outcomes often. I can imagine yes, but do you think that's often the case if the FHR remains reassuring throughout (really not even earlys or variables)? On the same note of pushing w/epidurals, we usually tell the mom when she has the urge to push to let us know. This pt let me know and she was still at 0 station. Do you think I should have discouraged her from pushing right then? She said she felt intense pressure like she "had to poop." And that's normally the feeling I think they need to start pushing. She did push pretty effectively, but that baby just had a tight nuchal cord.

I'm so sorry, I meant to write 7 pulls, not pop offs!

Hi guys, As you may or may not know, I'm still in a learning curve in L&D. I just wanted to run something by you and compare experiences. Had a pt who was declared c/c/0 at 7am. She was a primip w/ an epidural and had no urge to push at that point. So we let her labor down a bit. At 7:45 she stated she had a strong urge to push (still at 0 station) so I went in to help her push. By 10:15 she was crying, stating the pain was too bad (after 2 pca epidural boluses) and was writhing away from her pushes, no longer pushing effectively. I called her MD who was in a c/s (she was tended to by the attendings). So next I called the chief resident who was also busy but promised to come to the room asap. At this point she was by my judgement at +1 or +2. The CNM covering the residents who were in conference (see where this gets fuzzy???) was available and she rounded up that chief resident and another attending. They talked c/s but I felt that it was not necessary at this point since the fhr was reassuring with no decels. So they decided to bolus the epidural and give her 25 benadryl IV to rest for 30 min. Soooo... when her attending (different attending thant the one who ordered the benadryl) came around and saw me at the nurse's station, he asked about the pt. I told him the situation and he was upset to say the least. At this point is was around 11:30. He went over this risks of a prolonged 2nd stage with me, and I told him that I understood, but I had a CNM, chief, and attending ordering this for the pt and I thought he needed to talk to them about it. Of course he didn't! So the pt finally delivered at 1300 w/VE (7 pulls!). Baby went to NICU for 2 hrs and was released to NBN, and mom had a 1st degree tear. So I guess I'm wondering what's the longest 2nd stage you guys have seen, and what was the outcome? At what point during pushing do you call the docs bc things aren't progressing??

Here's the thing: most everyone (MDs and RNs) on my unit does this. I've had several pts tell me how helpful it is (those with the epidurals). Those that don't have them, I try to only put my fingers in there sparingly, as the MDs will want a progress update. We're taught to pretty much check the pushing status regularly (although you can tell eventually how well they're pushing, right?), and if it goes over and hour with pushing, the MDs are in there wondering what's going on. If it's an epidural pt (even with a reassuring strip) pushing for 3 hours; she's automatically going to get a VE. But I digress... my original point was to ask (since this is an expected and routine practice at my hospital) which method was more used, if any. It's good to know that a lot of people don't do it at all. But for me, God forbid the attending (or resident even) walks in and I can't automatically report the station. Then again, even if I can, there fingers are in there going, Push here! Push here!

Ok, I'll try to word this as well as I can. You know how you can "help" epidural pts push by putting your fingers in the birth canal and creating pressure on the posterior wall? I was taught just to push your fingers down to "show" them where to push. I've seen RNs and MDs do it different ways, like just pushing and also stretching (moving the fingers in a sweeping motion). I always just push down when I do it, bc I don't want to cause too much swelling. Today a resident asked me (after a pt wasn't pushing effectively) if I was doing that. I said yes, and he said, now you know, just push down like *this* with a little demonstration, not *this* the sweeping motion. I said sure. Then when my manager came to help the pt push all she did was the sweeping motion and the pt had her baby within 20 min. I never got a chance to ask her or the resident the reasoning behing each, so I was wondering what words of wisdom you guys had. Side note, manager has been on L&D 26 yrs, and this is a new 4 yr resident. But I do try to respect the MDs bc they have to know all the newest research and practice guidelines (obviously not the RN stuff), as we are in a teaching facility.

I wonder if there are any studies correlating the use of pitocin to the less than desirable outcomes in childbirth. It occured to me reading this thread that maybe (and I don't know for sure) the US - and hospitals in general - uses a lot of this medication during labor. As far as CNMs, I find in our facility that they are almost (but not as quick) to use pitocin, c/s, or VEs as the OBs. It's almost like they're influenced by them. They aren't what I had in my mind that midwives would be. But then whenever we get a birth center transfer, the midwives from that facility come with the pt and stay in the room w/them til delivery. I'd love to visit a birth center and learn from them. I'm so new in L&D and already feel biased to medical interventions. Like, ready and willing to use them. I had a pt today and the OB was ready to use forceps or c/s in 45 min if no progression. My manager came in to help push and with her 20+ yrs experience and lots of prayers, that baby was born 20 min later. The OB kept saying, "I can't believe she delivered lady partslly. I had already called for the c/s." Wow.

Well, hopefully the hospital does have some sort of VIP thing. If not, I'd hate to have the staff (no matter how carefully checked out) resent her for taking the place of other pts that needed care by reserving extra rooms. If their days are anything like ours are lately, there aren't rooms to spare! I agree w/the other posters that said a private (home) birth might work well. Or maybe a birth center. Of course then she'd have less people to serve her... Or not! BC she can afford to have whatever she needs. I have been so cynical of her and her fake marriage/now famous pregnancy, but I can understand what other posters have said. And I'd love to take care of her; I treat all my pts exactly the same, just like I would a celebrity.

We have an opportunity to win a chance to take this course for free (drawing names out of a hat of those interested). I love taking classes, so I put my name in. The thing is I had never heard of it until it was offered (it's the advanced life support for obstetrics). Has anyone on here taken it before? If so, what could I expect if I "won?" Because I was thinking if it was worth it, even if I didn't "win," I may save up the $$ to take it next year. Thanks!

Well, I hate to speculate when I don't exactly know your situation, but from my experience on L&D, MDs get a bit frustrated when the start something and it's not working. Then again, the "baby's not moving as much" thing might be something to look into. Maybe they meant the heart rate was dropping? Either way, you have every right as a patient to get a copy of your medical records, and I would recommend that. It could set your mind at ease and also give you something to study and consider while you pursue your nursing career. Now, most institutions that I know require a few hoops to jump through to get the records, but you should have them. You should NOT even have to give them a reason why, just you want them. Look at the nurses' notes and see what was going on. I'm glad everything turned out ok in the end, but you need some closure and answers. My gut says the FHR dropped, in order for them to call and emergent C/S, but who knows? Go find out.

Both of mine are from today. The first is MD related. I was assisting in a delivery (started out as baby nurse, but then turned to a VE situation). SOOOO.... NICU was tending to baby, and there was a 3rd degree tear the MD was working on. She first needed cytotec. That was in the room, no prob. Got it for her. Then methergine, then wait, no I don't need it (after I already got it). Then, I need an Allis. Ok, ran to the OR area and got one. Then, I need more lidocaine. Got it, came back. Then, we need some fentanyl. Ooohh kayyy, got it. Then where's the other allis? Hello, you said you needed one! At this point I really wanted to just say, hey, you're worse than the patients who after you leave the room (when you just asked if they need anything else), they hit the call bell bc they forgot something. The requests kept coming and I finally got another nurse in there to assist bc NICU was gone and I had to tend to baby. Gotta love interns, huh? OK, the second one, well, it's going to sound crass and harsh. But this is a rant/vent thread right? So no flames please! My 24 yo G2P1 with twins and an oral fixation. Every hour she wanted a sucker. No matter how many times I told her we didn't have any, she still wanted one. Each time I'd offer her a popsicle, and she'd of course want that. Now that's not bad, but what's bad is the horrible thumb sucking habit she had. All. Day. Long. with the thumb in the mouth (unless it was the popsicle). I just wanted to say, lady, if you paid more attention to that oral fixation you had, you might not be wanting a BTL after 4 kids at age 24! I'm so bad. But I'm also humans, and these thoughts do cross your mind!

Please direct me to a thread if this has already been discussed! I saw an ad for Inside Edition or some such show a few days ago and wanted to catch it. It was "the real reason why cameras aren't allowed during deliveries." Our institution won't allow photos, still or moving, during deliveries, and no cameras or anything in the OR (although people sneak them in all the time). They say it's to lessen the distractions of the staff, keep people out of the way, etc. But the families are always saying, "so it's so we can't have a record if anything goes wrong, right?" What experiences/reasons do your facilities have? Any lawsuits, etc?? Of course I'm not asking for exacts, just *this may have happened* or could have, or we're preventing these things this way.