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, unfo...

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...

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 ...

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 s...

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 persona...

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...

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 ever...

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 do...

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...

Scary. How about we let the cord stop pulsating, and let the placenta comes when it's darn good and ready? Golly, I must work in a low intervention unit. You know, the only retained placentas and manual removals I've seen were caused by impatient...

Yes, it is related to the high rates of Pit and hyperstim. You really need a protocol with clear max dose, and protocols for decreasing Pit in the event of hyperstim and/or fetal intolerance. A baby with lots of deep variable decels is telling you he...

I haven't seen the literature, but just from experience, I think you hit the magic level (around 10 seems to be what works with most of my pts) and increasing beyond that doesn't seem to make a difference.

I'm curious what your rates of PPH are with Pitocin rates that high. It sounds very dangerous to me.

I feel, at my facility, that the nurses have this autonomy. We use 10 u Pit premixed by pharmacy in 500ml bags. Our low dose protocol is 1mu q 30 to a max of 20. High dose is 2 mu q 30 to a max of 24. We seem to be pretty conservative with our Pit c...

We open it after delivery of the placenta at physician request. Some docs and midwives do not use it. And as not all of our pts get IV's....... How can you determine the need for Pitocin after delivery, before they deliver? Yet, another just in cas...

So, help me understand, if a pt refuses an IV, then abrupts with no warning and loses her baby, the hospital is essentially telling her it is her fault because she didn't want an IV? It would be interesting to see hwo many bad outcomes there are just...

Nope. Only pts desiring medicinal pain relief, those on Mag, pitocin, antibiotics, etc. Our low risk pts do not have to have them. It is a rare occurence that an emergency arises where you can't get an IV in quickly. I understand the just in case rat...

Our peds prefer 2 doses of Amp prior to delivery, with the second being at least one hour prior to delivery. The unassigned pedi group tends to keep untreated/under treated babes 48 hours, while some of our regular peds will dc at 24 hours if Mom des...

Excellent point. :yelclap: