NurseNora

Join AWHONN, save money on books, conferences, and classes. Get Principals and Practices of Fetal Heart Monitoring and take the online class in Basic Fetal Monitoring. The Labor Progress Handbook by Penny Simpkin has been very helpful in my practice. Take a Preparation for Childbirth class to see how it’s being taught in your area. A breast feeding class will probably be helpful as well.

In my last hospital CNAs did a lot in L&D, but not much direct patient care. Ambulating a patient to the bathroom was about the only patient care they did. They set up delivery instrument tables. Then collected instruments after a delivery, counted them to be sure none were missing, and prepared them to be taken to CSS. They restocked patient rooms and fetal monitors. All were trained to scrub for sections. After a section was finished, they again counted and prepared instruments to go to CSS. After the room was cleaned by housekeeping, they restocked it, made up the OR table and infant warmer. At one point they were also cross trained as Unit Secretaries. We called them Techretaries.

The Labor Progress Handbook by Penny Simkin is really good for physical interventions to get baby in the best position for labor to progress. Rotating the head from OP to OA. Resolving an asynclytic position. That sort of thing. It has the best description of how to find the ishial spines that I’ve run across. See if you can find a copy of Human Labor and Birth by Oxhorn and Foote to look through. It’s really expensive to purchase. It has wonderfully simple and clear drawings of the different positions of the fetus and how to identify. It also illustrates the cardinal movements for delivery from those positions. Then it also has way too much information on the application and use of forceps that you won’t need. Join AWHONN, your professional organization. You’ll receive their magazines, you’ll also get discounts on many useful books, national and local conferences, and on their Basic, Intermediate, and Advanced Fetal Heart Monitoring classes. The Basic class is online and you may want to take it before you start, although it isn’t necessary or expected. It’s AWHONN that sets national guidelines for many aspects of patient care: nurse/patient ratio for various acuity levels, frequency of assessments for high and low risk patients during different stages of labor, etc. L&D has a relatively long orientation period because there’s a lot to learn, much of it physical skills that need practice: assessing cervical dilation, effacement, fetal lie, position, and station, starting IVs, applying electronic external and internal fetal monitoring devices. Things that you have to do in order to learn them. Ask questions, ask for experiences. If you’re having trouble with lady partsl exams, ask if you can do exams on other nurse’s patients (preferably those with epidurals so you’re not causing increased discomfort). Even once you’re off orientation, it’s still OK to ask questions. Nursing is collaborative, ask another nurse to review your monitor strip, do a lady partsl exam that confuses you. We all do it. Ask your preceptor how you’re doing (not every day) and tell her what you’re feeling comfortable with and what you’d like more experiences with. Sometimes two people just don’t mesh and you may need to ask for a different preceptor. Not a request to be made lightly, but is very occasionally necessary. You’ll do great. Be patient with yourself. So many times you’ll feel stupid and that you’ll never learn it. You’re not and you will. It takes about 6 months to start feeling comfortable with the job, then something will happen and, once again, you’re wondering if you’ll ever get it. You will. In nursing school, I was starting to get worried because I didn’t really like any of the types of nursing I’d experienced. Then I saw my first baby born and knew that was what I wanted to do for the rest of my career. And I did, 45 years in L&D until I retired about 5 years ago. I hope you’ll enjoy it as much as I did.

I worked LD for 45 years and loved my last delivery as much as my first. Every once in a while you will have a period with no patients. Every once in a while you'll run out of beds (I once had a patient in early labor in a recliner in the residents lounge). One Thanksgiving we called the OR in TWICE for failed sections. Each patient unexpectedly delivered lady partslly in the OR. You'll deliver a few babies yourself. Most of the time it's a happy place, but you do lose a baby or even a mother sometimes. I taught fetal monitoring, but I was the granola nurse. When I was greeted with "Do we have a patient for you!" I knew to expect a 10 page birth plan or a lotus birth or someone refusing Vit K and Hep B. I've also cared for eclamptic women, HELLP syndrome, post kidney transplant moms, moms on peritoneal dialysis. Pregnancy and childbirth is a normal part of a healthy woman's life and goes well most of the time with nothing but encouragement from us. Sometimes it is critically dangerous. I liked never knowing just what I would find each day when I went in to work. Give it a try. I think it's the very best place in the world to work.

I also remember when RhoGam was brand new and we were still delivering lots of babies to moms who had been sensitized before it was available. I saw lots of babies with hydrops.

I remember the spontaneous delivery of a molar pregnancy in the early 70's. She was not quite 20 weeks and looked term with large twins. I don't remember how many large specimen containers we filled with those small white ovoids. I don't remember doing a curettage afterwards, although we may have. The physician just said they'd follow her HCG levels closely for a couple years to see if it returned, she was advised not to get pregnant during that time.

Once they're moving around and passing gas, they can go back to using straws. You just don't want to add gas until they're able to get rid of it.

I was a labor nurse for 45 years, no way am I a Type A personality. I'm more of a gow with the flow kinda gal. Everyone has mentioned things going wrong, and that does happen, but the majority of the time things go well. Birth is not a disease, it is a normal physiological event. Yes we are always on the lookout for bad things to happen, but most of our work is about promoting the normal course of labor. We need all types of personalities in labor. If you think that's the area for you, go for it.

I have cared for two women with AFE, now called Anaphylactoid Syndrome of Pregnancy, both moms died, both babies survived. I called a code for the first one-AND NO ONE CAME. People thought it was a joke. "Code Blue, Delivery Room 1." We had to call it again. Hers happened at delivery. The other one happened at the time of AROM in the labor room. We did a perimortem section right there with the father refusing to leave. The baby had 8/9 Apgars. The code team came for that one, different hospital thirty some years later. After that, we started keeping the Perimortem Section set on the code cart.

Scrub dresses that snapped at the neck and tied at the waist. Once an anesthesist left the patient to wander around the room, stopped by me to "check the chart" and stuck his hand in the back of my dress between the snap and the tie. "Walter, get your hand out of my dress!" Silence fell as the entire surgical and pediatric team turned to look at us. He never bothered me again, but nothing more was said to him as sexual harassment wasn't recognized as a problem. The only females allowed to wear pants were the few female doctors. IV alcohol for preterm labor. Dose calculated by weight,but it worked out to about 1L the first hour, then a maintenance rate of about 150ml/hr for at least 24 hours. The patients started to giggle, then cry, then vomit, then pass out and be incontinent for he rest of the treatment. Physohex baths for all newborns. Breast fed babies were allowed to nurse 3 min per side the first time, add one min per side with each feed to prevent sore nipples. It didn't work. Bag Balm for nipple care. Deladumone to dry up the milk for bottle feeding moms. It didn't work. Auscultating FHR q15min during labor because there were no fetal monitors yet. Taking Mom to X ray for pelvimetry to check for CPD if labor was not progressing. Yes, I delivered a few babies between X ray and L&D. Start the Pit at 5ggt/min and increase by 5gtt/min q15min, using the roller clamp to adjust he rate. More than once, it was time to increase the rate by the time I finally got it adjusted. A full pubic and perineal shave on admission and a soap suds enema. It was a big deal when we mov d to mini preps where we left hair on the mons. Now, most women come in preshaved. Demerol 50 mg Largon 20 mg q3h for pain in labor. We used a fair amount of Narcan on the he babies. Sometimes we added Scopalomine to the he Demerol and Largon for "twilight sleep". Those who got that often really acted out, but they had retrograde amnesia so didn't remember much. Paracervical block for labor pain, watching FHR fall and waiting for it to, hopefully, come back up as baby metabolized the giant dose of lidocaine it picked up from the mother's bloodstream. Handheld Penthrane masks. Some places are now starting to use N2O2 masks for labor pain, it hear good reports about it. Labor room to delivery room to recovery room. Leather wrist restraints on the delivery table so mom wouldn't reach for the baby and contaminate the doctor. General anesthesia or spinal blocks (rarely saw a true saddle block) for delivery. Mom flat for 8 hours after delivery if she had a spinal to avoid a spinal headache.

We called it a brain patch. I'd forgotten that.

A hydatidiform mole is a pregnancy. The placenta just takes over and grows abnormally into small white grape-like clusters. They grow quickly and the uterus becomes much larger than it should be according to dates. Since there is no fetus, she wouldn't be feeling fetal movement. martymoose, I've taken care of a 52 year old woman in labor. She was not amused. Her teenaged children were horrified that mom and dad were still doing it.

Hopefully the. Educator will be interested in your thoughts on your learning style, and assessing your learning needs.

Be a good example and do it yourself. Mention how much more easily the baby went to the breast than with this oman's first section when they were separated. Tell patients your facility is just starting this and ask them to write to your director if they liked it, make sure your Director shares this positive reinforcement with all staff. Be sure you show new staff members how to get charting done while doing STS with their patients. It's easier to teach new people how to do it than to get oldsters to change, but with time, it will become the standard for everyone.

Ask to sit in on some preparation for childbirth classes to learn about some helpful coaching skills. I forgot to mention that one.