rndani

the rate of occurrence for amniotic fluid embolism is 1 in 80,000. The odds are SO in your favor. Last year we delivered 76% of our babies lady partslly (unassisted). You will have a great birth experience! Positive thinking brings positive results. Women are meant to have babies. Best wishes to you and your family!

When I orientated to L&D (6 yrs ago) you got 21 shifts worth. There was a book/manual you were to study on your own. It was only on days and you were assigned 2-3 preceptors. For the first month back on your "regular" shift you had firsat choice of assignments and you had an assigned "buddy". This was your go to person. Now our facility does 6 weeks or 30 shifts worth. PP use to be 4 days and is now 2 weeks. There are so many things to learn that first year--and the more you work the more you learn. One of the areas I felt the weakest after orientation was charting. My director suggested several experienced nurses and I read their charting. It helped so much. One of the best pieces of info I got and I use to this day...." Doctor Smith updated on pt status, contraction pattern and repeatitive late decels of fhr and interventions per RN: no new orders given." The no new orders is the clincher. This way you show that the provider is well informed of what the situation is and that they have failed to act. Hopefully you'll never need to use it. And remember--the providers don't sign your paycheck so don't be afraid of them.

Since this was your original post, I'd like to share with you two stories about home births that resulted in transport to the hospital. First--20yo G1P0, pushing at home for 4 hours with midwife. Brought in per patient request. Fhr supposedly in the 110"-120's. After placing a fetal spiral elecrtode, there was no fhr--they were picking up maternal pulse. She was only 7cm and had a very puffy cervix. She wanted an epidural (which she got) and 5 hours later delivered a beautiful 9#10 boy--dead. The next was a grand multip who came in by her midwife with srom and footling breech--we're talking foot out of the lady parts footling breech. The patient would not answer any of my questions, the midwife did all the talking and informed me the patient did not want a c-section. Needless to say after the on call OB came in and explained all the interventions and why we do them and the risks involved (INFORMED CONSENT) she still had nothing to say and looked at her midwife who then said " I think it may be best for you to have the c-section". I was taken aback. The patient couldn't make a decision for herself.Now on the flip side of those stories--I know of several of my co-workers (L&D RNs) that have had fantastic home deliveries. And there are many successful homebirths that occur that we at the hospital never hear about.

Having lunch with my friend who happened to be the other nurse in the OR with me that day and we ran into a family member of the patient I told you all about...they told us that the patient is doing great--a little weak, but doing great. Baby is doing well too. They thanked us for the care that we gave. It was so nice to know how she was doing and that her family was so appreciative of what we did (and we were just doing our job). That's what it's all about. The difference we all make in someone's life everyday. That's my reward. You can't measure it in money. It fills up my soul and makes it easier to take of those that don't get how precious life is. To all of you who go out there everyday and give the best care you can and do it day after day--YOU ROCK! THANK YOU! To those of you who are still in school to become nurses--DO IT! It is the most rewarding profession you can enter. ---off my soap box and exit stage left

When she looked at me and said "I don't want to die, please don't let me die" I said "I don't want you to die either. We are all going to do everything we can to make sure you see that baby of yours--your daughter who is back in that room with Dad. They're waiting for you to come back to them."I always learned from my Professors in nursing school that you develop a sixth sense--intuition--what have you. It's true. I knew this girl was going to lose her uterus when I gave the hemabate. I have had several post partum hemmorhages that lead to emergency hysts and massives transfusions. I just knew that this was too much of a blood loss. As far as handling a situation like that--you do your job. Professional and caring. We have drills on MTP and OB emergencies. I also am the "lucky" one since I have been the nurse on a few, they(managers) figure I know what I am doing and often take over on the patient and go to the OR. Also-you just dig in for the ride and chart your *** off.

Questiosn are good.Massive Transfusion Protocol. It's what is initiated by blood bank when a patient meets specifc criteria for a massive transfusion of blood and products. This pt had an INR of 2.03. Our facility initiates at 1.5. Her FDP was >40m.The emboli were located in the vasculature of the uterus. If you want to know more about AFE--just google it. There are many great articles about on the web.

I am relatively new to this board but have loved all the interesting input from everyone. I could really use some input now... Brief history: 19yo G1P0, term, no polyhydramnios, srom'd clear fluid, labor proceeded just fine got epidural at 6cm , pushed I run into the OB a few days ago and she tells me--"guess what pathology found?" Multiple amniotic fluid emboli in the vasculature of the uterus. Holy crap! I still get goose bumps! It's what sent her into DIC but her circulating volume was so low-- the DIC also kept her alive. She went home 96 hours after delivery and she is doing great now. WOOHOO! I have no doubt that she was meant to live and be there for her daughter. It was not her time. I've been a L&D nurse for 6 years and have been the nurse in several OB emergencies--MTP's and all, but after finding out about the AFE--I'm just a little wigged out. We had a maternal death a couple of years ago from one. Have any of you had an experience like that? Any feedback is much appreciated.

I know! If I had a dollar for every time I had a primip tell me she was going to poop--I'd never have to work again!:chuckle

We use Cytotec for induction and have very strict guidelines for it's use. The patients are brought in at 2345 and typically receive two 25mcg doses (placed 3 hours apart) and then are started on pit @ 0700. Exclusion criteria includes a parity >5, Bishop score of 7, multiple gest, contractions more than 5 in 30m. Cytotec works great with early gestation demises and with pph. We have been doing more foley inductions. Anyone's thoughts on these? How well do you find that they work?

I do not like assissting with circs because I don't like to see babies strapped down to a board and had what is cosmetic surgery performed on them. Emla cream is great but doesn't take all the pain away. I refuse to do it because it hurts my soul to see it done and the providers don't like a crying nurse in the procedure. The facility I am at has a wonderfully supportive envirnoment and because I go above and beyond in other areas of work, it is a trade off that is acceptable to all involved. :)

As usual, Deb wrote the perfect answer. Our facility is the same--the less checks the better. However--we had this one MD (she only does GYN now--thank God!) who would write an order for us to do a SVE Q1hr regardless of ROM. Not surprisingly, many got a fever, baby got tachy and we did a section for distress and she ws home in bed by 11pm. If you did not call her with an update each hour she would hunt you down and then write you up! :angryfire

Our Ob's do circs typically in the am or on their lunch break. Some of the in-house docs will do them in the middle of the night if they're up. There are a few midwives in the community who do them but only at their clinic (costs less than the hospital and no they don't like doing them but let's face it--it is a money maker). There are no peds who do circs at our facility and only a couple FP's are trained to do them. Assisting with circs is typically the role of the CNA but there are RN's who assist as well. Not me though--I draw the line there and am very fortunate that my managers and director back me up.

At our facility, if there is a history of drug use in the mother in the past 2 years, we ask for a UDS on mom. As for a UDS on baby--it is mandatory! We have very specific guidelines (no pre natal care before 20 weeks, etc). I have yet to see a baby go home with the parent when it tested positive for anything stronger than cannaboids. The baby is placed in "protective detention" and abstinence scores are done frequently and often the babies are placed on some sort of medication for their withdrawls. There is a zero tolerance for meth at our facility.

As a place to check statistics--check with JCHACO. They might be a good starting place or can maybe point you in the right direction. Our "new" birth center opened 6 years ago and providers wanted LDRP rooms. We do about 400+ births/month. We have 42 LDRP rooms. It can be done--it's not passe' at all. Our nurses are trained to do at least 2 of 3 jobs. Labor, post-partum , and nursery. We're allowed to pick our own assignments so most of the time there is a great continuity of care on a day-today basis.

I'm from the Portland,OR area and all of the hospitals here are posting record numbers. I was wondering is this a trend everywhere or is it some freak baby boom for us? We are a Level IIa, have 42 LDRP rooms and average 380-400 babies a month. In May we had 435 and June was 479. On several occassions we had to send patients to our med-surg floor because we needed birth rooms. Just curious if other facilities are brimming with new families.

That sounds really great. We call ourselves a LDRP. The patient/family stay in the same room for the entire stay, but once they're "recovered" they are put in a post partum group of 4-6 couplets which has a post partum nurse and CNA. The labor nurse moves on to another active patient or induction after she gives report. I'd love to stay with my patient through the rest of the shift!

Wow! I couldn't have written a better reply! Just a quick question for you Deb--how long are you alloted for recoveries at your facility before turning the patient and baby over to a post partum nurse? Do you have a written policy on IUPC placement? Do you arom? Nurses do not arom at my facility unless a fse is medically necessary and we do not place IUPCs. Our recovery time is 90min. This includes full baby assessment, meds, bath, teaching, breastfeeding, get mom up to bathroom and room cleaned and yes, charting. Oh and we only get a second nurse in the OR if there is significant fetal distress.

As a nurse, I chart exactly what I did (lowered head of bed, applied suprapubic pressure, etc.) I also chart time of code light pulled, who responded, who did what and of course length of time of dystocia. I also chart to "see provider note". The provider needs to chart what manuevers they did. Also, read the provider note because you might be really surprised how some providers try to set the nurse up in their charting (this applies to all emergencies or less than optimal outcomes). As someone who is frequently on our unit's emergency team, I am amazed at how many rooms I go into that are doing McRobert's with the head of the bed still up. I even saw this on a "maternity ward" episode. I was screaming at the tv "put the head of the bed down, put the head of the bed down!" I also am surprised at the seeming reluctance of many providers at my facility to cut an episiotomy during a dystocia. Anyone else seen this at your facility?

At my hospital new grads (most of which have associates degrees) start around $19-21/hr. Eve shift diff is $2 and nocs is $4.50.

This isn't really common where I work. However, I did take care of a pg 13yo and then again when she came back @14.5 w/her second. I also took care of a 13yo who delivered at home @29wks and let the baby die. That was one of the most difficult days ever.

I've been an L&D nurse for 6 years and have seen conscious sedation during labor done once. It was a nullip who had a significant history of child abuse and regressed back to it in front of our very eyes. Her husband had no idea what was going on. The midwife consulted with the CRNA and they both agreed the conscious sedation along with a heavy epidural would be to the patient's benefit. She labored down and delivered a baby girl in thankfully 4 pushes. Nursery was standing by and the baby transitioned quickly and was back in the room before morning.