eden

I would d/c IV fluids if they are tolerating things well and put the IV to a lok. You can flush Q4H to keep access for 24 hours per the orders.

My large teaching hospital uses them. I love them and as much as they burn I'd say they work well for 8/10 women who try them. I've given them at all stages of labour and even during pushing. I've had one pt who loved them so much we probably did them at least half a dozen times before I left my shift. I tell my patients that it does burn but that it is over in less then a minute. I tell them it's not a drug so don't need orders and that in my experience it helps 8/10 women. I sell them on it by saying that if it works for them awesome, we can keep doing it and if not we tried and can move on to other things.

If it is insane we manage the best we can and do those who require our most immediate attention first. That is we discharge early and do priority PHN visits if baby/mom meet the criteria and if we are back logged on labouring beds we have shut off Pitocin for our inductions in favour of those who are actively labouring. We also divert to other city hospitals. With my last baby I was in early labour for several days and they were going to keep me and do an ARM augment but then 3 emergency deliveries came in so they sent me home ( and I agreed) as I was 5 minutes from the hospital. I came in on my own the next day and had my delivery been imminent at the time I was originally there, they would have dealt but they definitely would have been very thinly spread.

I have no problems with most of your initiatives. I think it's silly to have to sign a consent form for formula, so long as you are talking to mom about her choice it's fine. We do give out a pamphlet on formula feeding to moms who choose to do so. Our hospital is baby friendly, we do have formula in the back for those that can't/won't breastfeed. We however do not have any pacifiers in our facility nor do we have a nursery. I don't see what the problem is with rooming in, many places do it. Before we went this route we took it to the public and rooming in is what was wanted. We allow dad or a support person to stay with mom over night and help so it's not like they are alone. The only ones that grumble are the ones who want to leave the baby with us and go for a frequent and "quick" smoke and are annoyed that there is no one to stay with the baby. If you are well enough to go for fresh air then you are well enough to have baby with you. If the mom is unwell that's different and they can either have dad/support person there to care for baby or alternatively we take a staff member to special care to look after baby if mom is alone. We get very few complaints about the model and before anyone says I don't know what it's like, I've delivered twice with this model of care including a difficult forceps delivery and will be doing it a 3rd time shortly.

I'm in Canada too but code pink is infant abduction here as well. Glad you survived your first code.

Sometimes we turn it off but more often then not we either keep it at a steady rate without increasing it once good labour patterns are established or we half it to see if labour keeps going on it's own.

I am a Canadian L&D nurse. I started in medicine and cardiology to get skills experience then applied for anything related to L&D, postpartum, gyne or NICU. It took a year and a half of applying but I did eventually get a call back ( I swear the manager was just sick of looking at my name:laugh: so she hired me). In reality I think what helped is that I applied for so many positions that the manager knew it was somewhere I really wanted to be and I wouldn't just up and go try something else. That was 9 years ago and I still love it though a move may finally pull me away. Good luck.

Under 20 weeks ER, over 20 weeks if it is pregnancy related to OBS and over 20 weeks but an MVA or something of that nature mom must first be cleared in the ER then come up to us as happened to me when I was 35 weeks. I was in an MVA and wanted them to do the US or at least a dopplar but nope they said I was the patient and the baby was not yet a concern ( who ended up being perfectly fine). I was so mad since I was A&O X3 and only had muscle sprains/strains. I mean I could see if I was you know unconscious or disoriented but that is how they triage pregnant women here. Also the Er has no problem calling down a resident for advice though, if they think it is OB related.

Thanks for the links, that is really most helpful. It was a hep B clinic in this scenario, as it is given in the 4th grade here not at birth. I didn't realize that it would be an issue since it was a routine vaccine but I definitely see your point and will keep this in mind for future interviews

I am an OB nurse but am looking to get out of the hospital and into public health. I had an interview and it went well except I feel like I bombed one question. Please help me figure out where I went wrong in my answer. In the scenario I was supposed to be doing a vaccine clinic at a school. An hour before I leave I get a call that there is lice in another school, someone in the community has an STI and we need to make contacts will sexual partners to be tested/treated, I get a notification to do a well baby visit. Now which on these is top priority? I said 1) The STI in the community 2) getting notification to parents about the lice 3) rebook the school vaccines for another day if necessary, or do it later that day 4) do the well baby visit the following day so long as all is well with it. Was my priorities in the right order?

I am also in Canada. At my facility we can prime, program, start and adjust the rates. It is a 2 nurse check to adjust and start the pumps. We can also do top ups but if we have given 2 and they are still uncomfortable then we call back anesthesia. Before we can do top up we have to be signed off by an anesthesiologist.

I don't know how hard it is to get a visa, it didn't seem too bad for my american friends. You don't need to be a midwife to work in L&D here though the experience will certainly help you get a job in the area. Good luck figuring out where you want to go.

I am in Canada 1. Midwives deliver babies unless its a forceps or csection - Here it is up to women whether they want a midwife, GP or OB 2. Most women never even see a doctor- See above 3. We don't induce mothers unless its medically necessary or they are over 42 weeks- Here they will induce after 41+3 unless medically necessary 4. IV's and fluids are not routine- Same here 5. Babies don't go to the nursery unless they are really sick or bathed until they are over 24hrs old- same here and the bath is delayed and is done anytime after 2 hours but before discharge 6. Mothers & babies are kept together all the times- same here

I would say if it's your dream job do it. I had already been working on my unit for several years before I had my first and the only thing that was dfferent was that once I was visibly pregnant, they stopped having me work with the IUFD's as they do for all pregnant nurses( for the sake of the patients and not our own comfort, though I was very glad to have a break from them while I was super hormonal). I delivered all of my babies on my unit and wouldn't have it any other way, if you've seen one lady parts, you've seen em all and there was nothing less then prefessionalism from my colleagues. I certainly had no desire to go to another hospital where I was unfamiliar with the staff and the policies/procedures.

Well there was no mention of that in her story but that could be a possible explanation.

I frequent a few different message boards and on one, a woman says she gave birth to twins. Her story just seems made up to me. She says she had several u/s during the pregnancy and never knew it was twins- this I have seen before so that is not what I find suspicious. What I find suspicious is that she said one twin weighed 11 lbs, the other 3 lbs. These were not identical twins, they were fraternal boy/girl so it's not like this was a case of tts. I've been in obstetrical nursing for many years and seen some odd things but never this big a weight discrepancy with full term twins so what do you think/know have you seen this before or do you think this is being made up?

They are a safe option if you are low risk, that being said I was low risk and would never consider a home birth, too many what ifs for my liking. I loved being around the colleagues I knew and trusted but then again I work at a low intervention facility when a section rate less then 20% so I would rather take my 20% chance of section ( never had one) with an nicu down the hall should there have been an emergency ( and there was both times for me). I may have more thoroughly considered home borth if there was a higher intervention rate but even then I doubt it because even if I had a stillbirth or NND in the hospital, at least I wouldn't have to question myself for the rest of my life if I could have saved my baby had I been closer to help. Do I think it's a safe option, yes. Should women have access to homebirth with qualified personel, yes if they are low risk but it's just not for me.

We are supposed to only have 3-4 mom/baby pairs but if it is busy then yes, we have as many as 6. It sucks when we do because they don't get all the attention they need but at the same time a stable mom and baby is not the priority, a labouring mom must be the priority on an LDRP.

I was in L&D for 5 years before I had my first and it made no difference in the care my patients got before/after I gave birth personally. It annoyed me if the family made a comment but they were few and far between. The only difference I see is that now some of the moms will ask me what worked best for me, did I like the shower/tub, did I get an epidural ect. Also I always had sympathy when a mom had a forceps delivery but now since I had forceps with my second, I wince when I see that on the board because there is nothing like the insane amount of pressure that comes with a forceps delivery.

Yes the 5 units is as 3rd stage management, I have never in 10 years seen a dose that small cause any sort of hypotension. It's standard here.

We do either 5 units IV or 10 units IM, that's it. We only hang a bag if mom is having significant bleeding after that small dose. Hanging a bag on everyone really seems overkill to me. With what we give we certainly don't have a large number of PPH's and we have never had a woman who initally refused pit continue to refuse if she is losing too much blood.

Be patient. I started out on a medical unit on advice from my preceptor. It was not the job I wanted but what it did was give me strong critical thinking skills, developping judment and practicing a much wider range of skills then what I use on my LDRP unit. For example we frequently had central lines and when one popped up on our low risj ldrp, everyone but me freaked because they had never used a central line. I worked ther for a year and a half, gaining experience while applying for a labour position and while it wasn't my dream job the experience was invaluable so no regrets.

When I first started on my unit, someone forgot to warn me about one of the family practice doc's. I did a cervical check on her patient and she went on a rampage. I told her if she didn't want me doing checks she needed to be here at all times with her patient like a midwife was. She was the only person I know who didn't want anyone else checking her patients, midwives excluded who stay with their patients at all times. Any other Ob would bite your head off for not checking before calling them with an update or new orders.

Nothing. The baby is the parents gift.

Walking, position changes, birth ball, hydrotherapy ( tub or shower), sterile water injections, massage, counter pressure. There are so many wonderful things that can help a med free birth. Hands and knees is an awesome position and also hot water bottles/heating pads or warm blankets are also great.