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CEG's Latest Activity

  1. CEG

    Airforce Reserves Nursing

    As far as where you serve, you would be assigned to a particular unit at a particular location, so you would have to plan on going back each month to that locations for your drill. With regard to deployment, my understanding (I am previous Army going AF Reserve so not 100%) is that you have a sort of "on call" period, I think they called it a "bucket" where you are subject to deployment. From what I was told, most of the people who have deployed from my gaining unit did it voluntarily, but I am sure not all of them. Of course any time you are in the reserves you are subject to deployment-- obviously that is the purpose of having the reserves! But I think they have worked hard to provide some sort of order/predictability. Sign on bonus depends on the job you take in the reserves. Some positions are harder to fill and therefore pay a better bonus that others. It also seems to be in a constant state of change, so you would best ask a recruiter. If you check out the GI Bill website you will see the rules-- I earned mine on active duty so it was a little different and I am not sure how it relates to reserve service. The Army definitely has programs like STRAP that pay for education while you serve, I am sure the air force has equivalent ones. If you haven't already, I would start talking to a recruiter. The process is very long. Good luck!
  2. CEG

    Looking for a good CNM school in Georgia State

    Emory is your only regular option. Very pricy but seems to be a great program. Otherwise the distance programs- Frontier, Case Western, maybe some others. I don't know if it is still there, but I used the website allnursingschools.com to look for grad programs. Good luck! Not to be a downer, but Georgia is not a great state for midwifery practice. In my opinion, midwives here tend to be utilized as physician extenders. Mostly they are hired by physician practices to increase patient volumes and do the low risk deliveries. There are very few (but they are out there!) providing midwifery care or midwife only practices. It is mostly ob-model care with a midwife touch-- myself included unfortunately.
  3. There are plenty of reasons not to bathe- temperature regulation (leading to blood sugar problems, etc), bonding, breastfeeding, leaving vernix on the skin, and more. Reason to bathe-- so the staff does not have to glove and gown. Seriously-- I very often touch, hug, etc my patients and I have no way of knowing what they have on their skin and hands. How about mom that just held her unwashed baby. You bathe the baby but mom still has the "contaminants" on her but I have never seen anyone glove up to take mom's pulse or bp. "Just" having baby under the warmer has plenty of negative effects. We need to understand that less is more in OB.
  4. CEG

    Postpartum pit

    Our hospital tends to run in whatever is left in the ubiquitous labor augmentation bag and one more bag. I am a CNM and most of my patients decline routine pitocin :) I recommend it in the case of risk factors, but since most of my patients avoid other interventions as well, their risk for hemorrhage is lower.
  5. CEG

    Midwifery and abortions

    Nurse midwives are a type of midwife, there are several other flavors as well. Probably less likely to perform abortions or work in abortion services than nurse midwives are as the other types of midwives will typically practice in out of hospital/independent settings.
  6. CEG

    Midwifery and abortions

    It does depend on the state- some states including the one where I practice, prohibit anyone but physicians from providing abortion services. Other states, like where I was previously, allow midwives to perform certain types of abortions. To clarify the above post, Nurse Midwives ARE advanced practice nurses and are licensed independent providers. Some states require formal collaboration with a physician, others do not. Midwives provide women's health and primary care across the lifespan. This includes prenatal, well woman, gyne, vaginal deliveries, and often first assisting in c-sections and other surgeries. My facility does not provide abortion services but I often counsel my patients on termination as an option in my current position as I might see a gyne patient who is unexpectedly pregnant or a new ob who is unsure if she wants to continue her pregnancy.
  7. CEG

    Questionable staffing in L&D vs Nursery

    As far as baby not going to the nursery- that is consistent with evidence and is best practice. Going to a nursery is not good for anyone- detrimental to breastfeeding, bonding, increases infection risk and security risk, etc. It is recommended however that a second nurse is available at delivery to be responsible for neonatal resuscitation. So if you mean truly alone, that is a concern.
  8. CEG

    NPO/clear liquid status during labor - evidenced-based?

    Not to split hairs, but the introduction of fetal monitors was not evidence-based. There was no evidence in support of their use, they were simply marketed and sold. They were originally intended for high risk women and somehow evolved to near universal use. Now the evidence has shown that they actually worsen outcomes, but we are stuck with them. They aren't even FDA approved having been grandfathered in. This is the case for many ob practices including routine episiotomy, prophylactic forceps, c/s for breech, etc. Only when we stop starting things that aren't evidence based will be break this cycle.
  9. CEG

    2 Wks Postpartum Bleed in ER

    I was thinking the same thing about retained products and milk supply. The only other thing I would add would be a manual exploration of the uterus might be necessary if you were remote from being able to do a D & C. If nothing else you could explore the uterus and perform bimanual compression. Obviously this would be very painful for the patient.
  10. CEG

    NPO/clear liquid status during labor - evidenced-based?

    It is not evidence-based to have patient NPO. Both ACOG and the Anesthesiology professional organization have policy statements supporting clear liquid intake in labor. D5 is also not evidence based- tends to result in hypoglycemic babies. I have done this research but don't have time now to look for the files. In any case as someone else posted the majority of cases performed under GA are emergencies where people have not been NPO. The risk of aspiration is really very low. I chose to eat and drink as desired during my own four deliveries. Also, it's not a matter of comfort. Going 12, 24 or more hours without food is torturous for a pregnant women and results in problems. When a pregnant woman comes into triage with ketones we scold her for her dietary habits then restrict her intake in labor.
  11. CEG

    Leaving facility AMA...

    Why wouldn't they d/c baby? Why shouldn't a healthy mom leave 4 hours after delivery?
  12. CEG

    Interesting thoughts on autonomy

    I attended an interesting lecture on this recently at the ACNM annual meeting. The speaker (Dr Andrew Kotaska) concludes that in maternity care we often provide coercion rather than consent. "Your baby is breech, you must have a c-section" is what women hear. It's all well and good to say it is the patient's responsibility to find the provider to give her what she wants but 1) she hasn't been told that c-section is not necessarily the best option-- no INFORMED consent, just consent 2) providers who have the skills to do vaginal breech are very limited 3) she may be restricted by insurance or geography about who she can see 4) there's the possibility that she will go into labor and show up pushing her breech baby and no one will have the skills to deliver her safely My only hang up is that because no one I work with does breech delivery, I cannot get good experience and therefore have no skills so I can't fairly offer it to patients since it isn't safe. But then I feel I have a responsibility to be able to safely deliver that patient who comes into the ER at 3 am with a butt on it's way out. But how can I get the skill... I guess I will have to move to Canada or England:) OT: but eowynmn, I wanted to let you know that continuous monitoring on cervidil is a good idea as it can cause uterine hyperstimulation and fetal distress throughout the entire time it is in. some babes react poorly to it even with no contractions registering or being felt.
  13. CEG

    March of Dimes: Less than 39 weeks

    You must have had a run of bad luck... or the results of the stress of unnecesary inductions on babies. The evidence shows that the risks to babies (of stillbirth, what we are inducing to avoid) go up slightly until 42 weeks when they climb a bit more sharply, not 40.
  14. CEG

    Frontier vs Emory University

    If you are in Atlanta and think you will live there or in the surrounding area when you work I would consider Emory for that reason. I relocated to the area and had a very hard time finding a job because there are so many Emory grads who precept with practices and then get hired on. The midwifery community as a whole has been very friendly, but getting to know people while in school is so helpful. Has I stayed in the area where I went to school I had several job offers without even applying but when I moved it took me more than a year to find a job. I also think Emory has a really top-notch program. I have been very impressed with what I have seen from them. I think Frontier is great (certainly has a great reputation in the midwifery community) but I would miss the in person aspect of the training and the day to day class attendance (but I know distance learning is not for me!) The difference in cost between Frontier and Emory might be made up in salary if you find a job more quickly as a result of going to Emory. Have you looked into National Health Service Corps, military scholarships/stipends, etc? I have about $140K in student loans so I know how you feel- also a 2nd career midwife.
  15. I sometimes still tear up at nice births. Especially if I know my patient well. Especially when I was pregnant.
  16. CEG

    L&D nurses - can you look at my birth plan?

    Sorry, I should clarify the doula should be ready to remind her or spouse to remind the HCP about the delayed cord clamping. Although as a CNM I have no problem with a doula reminding me of something important like that.