earthangel30

They do an H&H in the am. about 24 hours after surgery. lot of help that would've been by then. I feel sorry for some of the girls that come to maternal child without any med-surg experience before hand. That's what has helped me (about 10 years of it) and also saved the life of my patient. Needles to say the afore mentioned doctor who usually walks around with a snub nose actually conversated with me the next time i saw her and actually made somewhat of a joke. I guess she realized i saved her A** as well.

Ok now ya'll know i've only been at this post partum thing here for a few months...... but i thought i'd share an interesting case with you all to share my new found knowledge for those that are as ignorant about these things as I was/am. You know the things you can't read in a book anywhere......... Ok, coming in for night shift at 7pm. Getting report on patients to include a post op c-section from 8o'clock that morning. Nurses report the patient has had NO bleeding and were as we were getting report, getting the patient out of bed to ambulate in the hallway to "see if anything would come down" . This is your basic scheduled c/s, still on the lr with 20u pitocin x's 2 liters etc. etc. well i go in to assess her and she rates her pain a 7/10 ( a bit unusual for our duramorph patients). gave some tordol, assessed her to be firm @umb. peri pad looked like it was just out of the package- bone dry. checked on her a few more times over the next few hours- still doing fine, pain control better after the tordol, still no bleeding at ALL!! by 11:30pm.... patient was diaphoretic. no other complaints. no temp. well lets check your fundus again. firm @2+u !! Gee this blood has got to be going somewhere??!! had an L&D nurse come check internally for clots. - couldn't find none, and took gloved hand out without a smear or a drop of blood on the glove. Luckily oncall ob/gyn was in house doing a delivery and she came over- gave me a hard time about my assement of the womans fundus- but once i explained the patients increase pain and the fact that she has had NO bleeding she remarks "well i'll go ahead and check her inside even though she's firm @U".... (i'm thinking- screw you- no she's not). anyways after digging around a bit, and finally putting her finger through the os- POP-GUSH......... 500cc blood loss on the bed......... needless to say she didnt say much to me- i'm thinking its a doctor thing - that maybe she screwed up somewhere along the line. I heard later on that the next night she was telling the nurses that this should've gotten caught very early on (l&D, and certainly before the passing of a 12 hour shift before I got there in the evening). apparently when they do unlabored c/s- the doc manually dilates the cervix to allow for the passing of any bleeding after surgery. She never did this as she was called to another case emergently. Just one of those things you dont read in your nursing books anywhere or that they dont teach you in orientation. needless to say something you dont see very often. But just to say- in the future- if your c/s patient has NO bleeding post op- call right away. Hope this helps someone............

I have two small children as well. Although i am presently working as an rn. I am very interested in pregnancy/childbirth. I can tell you (as one who has used a doula). They are a great resource, and maybe even just a great and chepear way of getting your foot in the door and seeing if this is something you really want to get into. Your work basically your own schedule- that is as we all know that babies come any time of night or day, but mostly how many cases you take on. Most doulas i've talked to make about $200 a delivery. for more information you can find the website at http://www.dona.com (doulas of north america). they have all sorts of links as well that'll be helpfull. From what i've put together i think it comes down to about $500 to get certified. (books, classes, certification dues etc etc etc).

Thanks everyone for your responses. Timonrn- how do you all usually staff for your 32 bed ob and your gyn/medical floor? Just curious to see how different places run things. We are a 15 bed unit and at night we'll have one nurse for up toe 5-7 pts on his/her own (depending on the supervisor for the night i suppose), 2 nurses for up to 12 pts and sometimes to a full house. evenings we usually have a third nurse (lpn) which is a great help. As for the redhead/nurse bleeders i can certainly attest to that fact!!! red heads definetely and nurses i'd say yah only cuz i had my first one last week who also happened to be a L&D nurse to boot.

Another question...... I used a Doula with the birth of my second son and am considering becoming a doula myself. To my knowledge there have been no doula-attended births in the hospital i'm working at and i'm not quite sure how it would be received by the nurses/doctors/hospital. Have any of you L&D nurses had doulas attend any births and how did it go? I'd like to hear your opinion

Some of you may remember my post from back in november. Well i made the plunge after being a med/surg/tele/icu nurse for approx. 9 years. I'm currently working post partum and just about loving most of the nights that I'm working. After just a very short orientation, I was thrust into my night/CHARGE position. But a few hemorrhages and PIH's later I'm still alive and so are my patients!!! Of course all my days/nights on orientation we had very slow days and not very much going on but it has been absolutely CRAZY ever since. sometimes getting 4-5 new moms during a 12 hour shift and along with those of course a few bleeders etc etc. Our unit is a 15 bed unit with gyn surgeries as well. Anyone else out there get a lot of problems wtih their gyn surgeries post op? I've taken care of a few now (remember i started working in november) that have low bp/s (70-90's systolic)and low uop that the docs just give iv boluses (ns/LR) or "just watch". which makes me nervous of course as a previous ICU nurse. And a few that have developed MI's and Pulmonary edema post op. Seems to me they would correct some of these womens low h/h's preoperatively? What sorts of advice do y'all give your new moms with babies that seem unsatisfied with just colostrum and are keeping mom awake all night? The nursery nurses here have been telling me to cup the baby wtih sugar water - but as of my first breastfeeding class last night they are looking to get more strict with their policy re: sugar water. Also- how soon do y'all get your moms out of bed after sections? I'm a bit more liery of getting them up at night after having a 250lb+ woman almost go out on me in the bathroom. Also I've been trying to find literature regarding epidurals- particularly having a few moms with numbness/tingling several hours post epidural. Should i be concerned or is it related to the amount of epidural they used during labor/delivery? thanks again for any/all information y'all can offer