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beckinben CNM

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  1. beckinben

    L&D Labs

    I have never worked at a hospital or even heard of routinely checking the blood sugar of a non-diabetic mother in labor. Newborns, yes, although routinely checking their blood sugars is not recommended either, but it's still done. The only labs I routinely order in labor are a type and hold (blood type) and a CBC without diff.
  2. beckinben

    Confused about the process...

    Becoming a CNM almost always requires a master's degree. It is usually a 2 year program full time. My suggestion would be to go to the American College of Nurse Midwives website at http://www.acnm.org or http://www.midwife.org and click on the tab that says "Become a Midwife." There is lots of great information there, including links to every school that offers midwifery education. Good luck!
  3. beckinben

    WANTED: CNM shadow opportunity

    What I would suggest is that you go here - http://www.acnm.org/map.cfm - and find a midwifery program close to you. Call them and ask to talk to the program director. She may be willing to help you set something up. Most midwifery programs have a "faculty practice" where the midwifery faculty see patients and teach students. They are usually more open to students shadowing than a private practice. Good luck!
  4. beckinben

    Ugh! Delivered Baby On My Own The Other Day...

    If it was a private patient of the attending, no, he probably won't get paid for the delivery if he wasn't in the room. Don't feel bad. If he was that invested, he could have stayed in the room with his patient. He made the decision not to. I haven't missed a delivery in quite a while (probably because I stay in the room with them :)), but I had one a couple of months ago that I almost missed. I checked a patient with a history of precip deliveries - without her nurse in the room, go ahead and slap my hand - and she was 6. I left the room to ask a nurse to get the delivery cart. I walk back in a minute later and the head was halfway out. It happens to all of us. Don't worry too much about it.
  5. beckinben

    "Old" vs. "New" Midwifery Books

    Holistic Midwifery by Anne Frye is probably the most comprehensive text for out of hospital birth. There are two volumes - prenatal care and intrapartum care. Volume 1 is getting older (1998), but I've heard it's good. I have volume 2, it came out in 2004. It is very comprehensive, and I actually refer to it for some things because it is more indepth than Varney's Midwifery, which was the text I used in school. Anne Frye also has a new edition out of her book on diagnostic testing in pregnancy, which is also a good resource. The other text that many CPM-type programs use is Elizabeth Davis's Heart and Hands, which also came out with a new edition in 2004. I have that one, it is not very indepth and I think not sufficient by itself. Henci Goer's Thinking Woman's Guide to a Better Birth is a very good resource for evidence relating to pregnancy and birth. It is written for the pregnant woman, but is very valuable for health professionals as well, because of the emphasis on research and evidence. It's getting fairly old as well (1999), but I know she is in the process of updating, and I would expect the new edition is coming in the next year. Another recent release that talks a lot about evidence in childbirth is Marsden Wagner's Born in the USA. Either of those would be much more up to date than Immaculate Deception. There is a new book that as a hospital CNM I am excited to see - I found it on Amazon. I am hoping it will have some good evidence in it as well. http://www.amazon.com/Homebirth-Hospital-Integrating-Childbirth-Medicine/dp/1591810779/ref=wl_it_dp?ie=UTF8&coliid=I2V3CSZAJ5B0RG&colid=3RXIATWQJWRAE I'm wondering if money is her issue? I know old books are cheap, but if she wants to be serious about midwifery, she is going to have to prepare to shell out some money for books.
  6. beckinben

    Twins...Gest. age and induction/c-section

    We've had three sets of twins in my practice this year, and all were induced 36-37 weeks due to PIH issues. In general, though, we don't induce prior to 39 weeks. My physicians will do vaginal deliveries as long as baby A is vertex. One does vaginal breech deliveries of baby B, the other will do a version on baby B after baby A is born. But we try very hard to vaginally deliver as many of our twins as possible.
  7. beckinben

    L&D nurses? Are you all for natural births?

    And if I'm really thinking someone might deliver on the toilet, or she's worried about the baby falling in, I'll put a hat in there, just to help with that fear. Hats are good for placentas, too. Sometimes just sitting on the toilet gets that placenta right out, and the hat makes it much easier to retrieve.
  8. beckinben

    How Many C-Sections are Safe?

    Of the women I know, the most any one has had is 9 (yes, nine) c-sections. Her last was a planned section at 36 weeks due to the increased risk of uterine rupture. The baby did have some problems related to preterm birth. In the last month, I've first assisted on the c-sections of two women having repeat sections. One was the woman's fifth c-section, the other was the woman's sixth c-section. Both had placenta accreta. In case you don't know, this is where the placenta starts to grow into the uterus, which can make it very difficult to remove. This is a known complication in women having repeat c-sections because the placenta has an easier time growing into a scarred uterus. In the one case, we were able to remove it after some time. In the second, we ended up doing a total hysterectomy. One of the OBs I work with strongly prefers women not have more than 3 c-sections. I think what I take from this is that I really do my very best to avoid performing that first c-section. When I talk to women about c-sections (especially people who express the desire to have one rather than a vaginal birth), one thing I like to say is that the first one is relatively easy and safe, but they also have to think down the road, and will they be OK with limiting the size of their family due to the risks of the third or the fourth or the fifth c-section, when the risks are much greater? JMHO.
  9. beckinben

    the phrase "breaking the bed"

    I rarely, rarely get the stirrups out. I probably have a 50% epidural rate (for a variety of reasons), and I still try to get the ones with an epidural into a side lying position for delivery. It's better for preventing or decreasing tears, and reduces your chances of a shoulder dystocia, but it's hard to do if the bed is broken down. I remember the days of feeling like I might drop the baby. You will get to the point where you don't worry about it quite so much. It takes practice. Yes, and the nurse and patient both laughed their you-know-whats off.:chuckle
  10. beckinben

    Direct-entry CNM programs

    If you go the more traditional route to CNM, where you attend nursing school, receive an RN license, and then continue on to a graduate program in midwifery, most people do choose to work as a RN between the RN program and the CNM program. After you graduate from a RN program (whatever type you may do), you can choose to work only in labor and delivery or a women's services unit and only care for those types of patients. However, you are, during nursing school (ASN or BSN), going to be caring for all types of patients. Most nursing students spend only one or maybe two clinical experiences in OB, and the rest in other areas of nursing. But let me tell you that the experiences you get in nursing school will absolutely help you when to get into CNM practice. As a CNM, you will still see women who have a variety of medical problems and it helps to have some familiarity with them. For example, I see many women with thyroid issues. I have women with blood clotting disorders in my practice. I see women with migraines, which calls for some experience with neurology. I even diagnosed one of my patients with a seizure disorder after she started having absence seizures during pregnancy. I order and interpret lots of different labwork and imaging/radiology tests. I get all sorts of dermatology questions ("What is this rash?") All these require me to know something about lots of different areas of medicine, not just OB/GYN. As a CNM, you will be trained to provide primary care for women. Obviously, some practices are more broad in the types of patients you will be required to see than others, but it is to your advantage to not look at caring for patients other than pregnant women (or women in general) as something that you want to avoid. Look at it as a way of gaining experience that may come in handy in the future. And with regards to the direct entry programs, even in those programs, you will still have the same basic nursing experiences as a student whose goal is a RN license. You will still do med-surg, psych, and other non-OB clinical rotations. That is because, even in a direct entry to CNM program, you will still need to take and pass the NCLEX, and the NCLEX does assume you have some training in all areas of nursing.
  11. beckinben

    the phrase "breaking the bed"

    Interesting that the nurses have that preference. At my hospital, I (virtually) never break the bed. I've really had to get the nurses used to it. I think it's easier to keep the bed clean if you break it down, but the advantages of not breaking the bed are worth it to me. If you do break the bed down, the only realistic position that moms can do are being on their backs. If you don't break the bed down, it is much, much easier to get moms on their sides, or up on hands and knees, or up squatting. I will break the bed down, though, to do most repairs. It's much easier to really get a good look at what's going on with a laceration with the bed broken down. I guess I've never thought of it as helping to not drop the baby. For me, babies almost always go straight to the mom, so I have an extra pair of hands to help hold onto them. :chuckle I hear you , though, about the end of the bed. I broke one once. :imbar I still feel pretty strongly about doing what I can to keep birth as normal as possible. And breaking the bed just feels so medical to me.
  12. beckinben

    Policy on leaving AMA w/baby?

    With both of my babies (here in the States, no less!) I had early discharge (12 to 24 hours after birth) with home follow up visits by an APN - either a NP or a CNM - provided by my insurance company. They did weight checks for the baby, checked my blood pressure, they could also draw bilirubins to send to the lab if needed. They were great with breastfeeding help with my first one. I had the metabolic screening done at the clinic, but really you could do that at home too. Imagine how much less that cost them than an extra night in the hospital, and I was soooooo much happier sleeping in my own bed and eating my own food.
  13. beckinben

    Cervical dilitation

    I have heard of this, and I will quit doing hospital births if my hospital ever tries to get one of these. This could so easily become the continuous fetal monitoring of the 21st century - more technology adopted without any proof of value. A cervix doesn't know it is supposed to be on some labor curve. Not to mention this exposes everyone to the risks of internal monitoring.
  14. beckinben

    Policy on leaving AMA w/baby?

    In my practice, if we have someone who wants to go home less than 24 hours and is medically stable, we will discharge them. What usually keeps people is that the pediatricians will not usually discharge at less than 24 hours due to the metabolic screen done at 24 hours. But I have occasionally gotten an early discharge for baby from them for a patient really dead set on going home early who talks about leaving AMA. Most of us would rather just discharge with early followup than have someone actually leave AMA, and my patients who want to leave early really do come back in for followup. Especially with our military families, they get good early followup (2-3 days after birth for baby, with home breastfeeding nurse visits) through the base in town.
  15. beckinben

    midwifery program at Parkland in Dallas, TX?

    I would suspect this program no longer exists. For one, it is not on the ACNM site. Primarily, though, the website (which has a copyright of 2003) states it is a basic certificate program. All graduates in 2010 and after must be MS or MSN graduates in order to sit for the CNM/CM board exam. Certificate programs are being phased out.
  16. http://www.childbirthconnection.org/ Great evidence-based site with PDF files you can download and print out for your students. Lots on cesarean sections - very supportive of VBAC.