Chapsi

We get to immediately assist someone in a very personal and intimate experience and most women are so grateful for the care they receive. I often receive beautiful thank you cards from previous patients. Sometimes we are with them for a full 12 hours, and get to know them quite well. I often find my patient interactions very rewarding.

I didn't get to read all the comments yet, but, my initial thoughts: We delay the the bath for at least 8 hours. Our newborn nurse that attends deliveries for NRP performs the initial assessment, vital signs, measurements, and footprints right at the bedside in the delivery room. It is so quick and easy to do if the baby is already naked and being weighed anyway. (After the first hour of skin to skin). the only thing left to do at admission for the baby is the routine CBC that our peds order on our babies and any remaining heel sticks for hypoglycemia protocol and notifying the ped of the birth. PS 6 couplets is waaaay too many

I am an IBCLC and L&D RN. I very rarely work with moms and their breastfeeding skills, because we have a newborn nurse on our floor who does this and as labor nurses, we are extremely busy on our unit (as soon as our patient delivers, we often get a new assignment). However, if I do have time to assist my patient with breastfeeding, I feel like it gives them a fantastic head start. If a mom can establish a deep latch from the very first feed, we can help avoid nipple trauma and pain down the road, which is a huge reason for early weaning. I wouldn't say that IBCLC is very useful for labor and delivery nursing, however. RNC-OB or RNC-EFM would be more practical for this specialty.

What program did you wind up choosing? Did you learn more about Bethel's program? Any insight you'd like to share? I am researching CNM distance programs as well and Bethel is such a new program that it is hard to find any info!

Say you have a mom in labor with an epidural and she is has no cervix on the left side but has a thick lip on the right. What position would you put her in to reduce the right sided cervix? I was was told by a mentor that putting the thick cervix side up (so in this case a left lateral position with a peanut ball or pillows to prop up the upper leg) would be helpful because there would be no resistance from the bed on the pelvis and fetal head on the affected side. Last night at a birth, a well respected physician told me to do the opposite-- put the thick side down (so in this case a right lateral position). What at do you find more effective for that stubborn one sided cervix?

I agree that warming the heel well is critical. Babies have better blood flow when well hydrated, but since we often have to draw on one day old's, that isn't always the case. Maximizing perfusion to the foot will help-- elevate the head of the crib and make sure the heel is well warmed. Swaddle the baby with one heel out and lay baby on his or her side. I like to heel stick the superior (upper) edge of the heel and give one nice squeeze of the foot (keep a good grip so the baby doesn't kick and the blood spills) until you have a perfectly round large drop of blood pooled on top of the heel. Then I take my filter paper and lay it on top of the blood circle and let it saturate the paper from behind. (The printed circles are facing up so I can see the circle filling up and can adjust the angle of the paper as needed as it is filling up with capillary action). This technique is a little trickier to master because you need to lay the paper on the blood in the right spot, and it can take a while to perfect, but it works like a charm and you can get your circles filled fully quickly and easily without serum rings (because you don't need multiple drops of blood usually). Always let go of the foot and let it refill will blood fully and wipe off your puncture site with gauze between circles so that you always get a nice large round drop of blood resting on top of the baby's heel each time. This technique also reduces heel bruising because you aren't squeezing so hard-- just one nice squeeze of the heel. It takes practice, but you'll get it in no time!

Unless the provider is milking the cord (which is a no-no), physiologic cord clamping is not shown to cause polycythemia. I did notice, as a former newborn RN, that the hematocrit of babies increased from an average of 45% to about 60% and babies did appear more ruddy when our OBs began routinely delaying cord clamping for at least a minute after birth. That's great for babies' transition, circulation, iron stores! In the rare case when we did see polycythemia (too many RBCs), partial exchange transfusions fixed it (taking some blood out and replacing with volume (saline)... This was not common at all.

My fourth baby came quickly and was an unplanned unassisted home VBAC at 42.5 weeks. I was getting ready to leave when my water broke and I started pushing involuntarily and she was born 5 min later (most amazing birth ever). All I did was stimulate her, sit down with her skin to skin, call my midwife, and then start breastfeeding. My placenta slid out on its own and my bleeding was totally stable. My midwife arrived 30 min post birth and took care of us at home (I had lots of newborn and l&d experience at the time). Definitely NO cord clamping necessary. Definitely no dirty bacteria- encrusted shoe laces to tie off the cord, yuck! Just keep baby warm and with its mama and watch mom's bleeding.

I used to wear crocs but after a delivery where a blood clot went through the hole of the croc and soaked into my sock, I decided to get a solid leather-topped nursing shoe i bought timberland nurse shoes from an eBay seller for $35. They were brand new, just scuffed a little bit as an "out of box" special. They are great.

Be a team player! On our unit, we always try to jump up and help each other out because *crazy stuff happens*. L&D can be super fun and rewarding and sometimes really difficult/sad/physically and emotionally draining. I agree with "know your strips." Read the mosby book by Miller, Miller, Tucker on fetal monitoring for a great understanding of the physiologic basis for EFM so you know how to advocate for your patient with the docs. Position changes and peanut balls are your friend You very quickly get to know your patient on a very intimate level-- it's a special bond. A woman never forgets her L&d nurse, so make sure you err on the side of too much love and care. Labor is hard and nursing a Laboring woman is a very special job indeed. Enjoy. It is a rewarding (but hard) job. Also, if you think you need to eat or pee-- take the opportunity to do so whenever you can (don't put it off). You never know if you are going to get the next triage patient that winds up in the OR for the next two hours and your bladder will thank you. :)

I worked in a newborn nursery for 7 years and a very small minority of moms got postpartum home visits from a nurse. It was either the VNA or another similar local home visit agency (depending on the patient's insurance). I know that some of the nurses were also IBCLCs and would do breastfeeding visits with the moms. I don't think they had visiting nurses at the agency that exclusively did mother-baby visits, though. In our area, at least, there isn't an agency just for postpartum visits. Have you considered private practice or working directly for a pediatric or midwifery practice that would send you to visit their private clients? Home visits are awesome for new families, they just aren't always cost effective, and so it isn't the standard of care, unfortunately. I have done home visits for families as a lactation consultant and as an assistant for a homebirth midwife, and I LOVE the relaxed pace-- I can focus on ONE mom and baby couplet and address all their concerns in the comfort of their own home without worrying about my other 7 patients like I would in the hospital.