RNnL&D

i totally agree. :yeahthat: my last child was also born at home. by far, the awesomest of my births. (is that a word? ) but twins!!! way cool!

All of our L&D nurses are ACLS certified or become certified within their first year on the unit. The hospital offers a three day class that you are paid to attend, that includes a review EKG class. We recover our CS pts in our own RR. And, unfortunately, I have been in a code in OB. We did have the pt on the monitor, were doing compressions and had pulled meds before the code team even arrived. While we may never be completely comfortable performing ACLS, I feel safer knowing I have a basic idea of what to do in a code situation.

I suppose the first time a video is entered as evidence in a case against the hospital, we will discontinue the practice as well. As far as I know, that hasn't happened. I have heard of cases, at other facilities, where the video aided in exonerating the hospital staff, rather than showing any malficience.

Wow! I'm surprised by the number of facilities that don't allow taping the birth. We allow videotaping of the entire birth from any angle they want, as long as the videographer isn't in the way. One of our many forms included in the admission packet is a video/photography policy info/consent form. It informs pts and families that they must ask permission from staff before taking their picture, they will not interfere in the pt's care by being in the way, and they will discontinue video/pics if asked. It seems to be a good system for us.

but wouldn't charting "discussed risks and benefits, pt refuses iv", have the same effect?

So the other 95% get one just because. Do you have alternative routes of admin for someone who doesn't have IV access? We have standing orders for Pit IM if no IV.

See, that's how we do it. The come up, draw it up, dose the pt, on the unit. Which is why I assume we don't have a clear cut policy. It just says that the nurse may give a dose if anesthesia is busy with another epidural.

That's alot f Pit. We use 10 units in a 500 cc bag, and generally only bolus one after delivery, if that. I imagine they must have some helatious cramps with that much Pit. And to lisamct, you say most women choose to have an actively managed third stage. Are they really choosing that or is that just pretty routine and they accept it? What I mean is, many of our docs routinely give Pit after delivery and most women have no idea of it ahead of time, so they don't think to ask whether they should have it or not. It is just a few that come in asking for no Pit after delivery.

Funny, we just had this issue come up. We don't have a clear cut policy. Before, our anesthesia providers have always come up and dosed the pts themselves, if needed. The nurses have never pushed it. Interesting to see what other facilities do.

Can I just point out how ironically funny this is? If I am reading this right, you basically said "I almost died, but it wasn't that bad. I would do it again." Hmmm, interesting. Pain......... death.... hard to decide. As far as opinions and personal experiences, let me just compare the two deliveries I witnessed last night. First, beautiful, unmedicated waterbirth. Mom delivered pushing as desired with no direction from us, attached to no IV poles or monitors. Pulled her own baby up out of the water onto her chest. Second, got an epidural at 6 cm, BP dropped, 6 minutes decel to 70's, spent the rest of her labor unable to lift her legs, needing to be manuevered from side to side by the nurses due to continued variable decels, having her bladder emptied by catheter, connected to IV's, external toco, internal fetal monitor, oxygen mask. We were resolved to probably going to the OR at some point, but she finally delivered lady partslly with alot of loud coaching from us because she couldn't feel to push and the baby continued to have huge decels with each push. Baby went straight to stabilette for initial assessment. Mom got to hold her baby 30-40 minutes later. If I had my choice, for myself and for my pts, I would choose the first.

That is a really long time to bleed. Did you end up having a transfusion? I imagine your hgb must have been pretty low. Your doc is right and wrong. It's not that common but Uterine atony "just happens" sometimes. There are usually precluding factors. Think of something that either stretches the uterus beyond capacity (multiple gestation), or something that tires the uterus out (high dose Pit, grand multipara, closely spaced pregnancies). Our protocol for PPH is Pitocin IV or IM (if no IV), then Methergine or Hemabate, then Cytotec rectally if still uncontrolled. I had a Mom of seven the other day with uterine atony. It resolved quickly with a bolus of Pitocin IV and IM Methergine.

I'm surprised it's that high anyway. It doesn't seem like we see it that often. I understand what you meant, Becki. I just hate to see new studies that recommend even more intervention.

You're right. There is a simpler way. Hopefully, someday, more hospitals can get back to that. Reading other's comments, I realize we are bit different from the norm. I am glad I work in a lower intervention unit. We do have the patients who get every intervention ever invented, but we also get to experience the births with next to no intervention...IV's, external monitor, a delivery bed......

I think what RNfrom MS meant was, the only reason that might preclude a woman from having a successful VBAC would be CPD, true CPD. I agree with those who suggested finding a midwife. Being aware of the risks, you have the right to refuse a CS. No doctor can perform an operation without your consent. I hope that you are able to find a supportive provider. I agree with Heather also. This doc sounds like he's paying lip service to possible VBAC while actually planning a repeat CS.

No, not usually. You are right, it generally looks like a progressive dip. Anytime the monitor loses contact, the FHR should be confirmed against mother's pulse, to be sure. You said the resident listened. Like stood there and listened to the monitor or actually adjusted Mom's position and the EFM, then listened? IMO, before deciding on a stat CS, FHT should be confirmed, bt you're right, there's no way of knowing w/o checking maternal pulse. Don't beat yourself up about it, just make it a point from now on to compare the two. Then you won't worry yourself unnecessarily.