What do you want your OB patients to get from childbirth class?

RNmommy · Mar 28, 2005

As a mother-baby RN, I would like my patients to have realistic expectations of the newborn. Newborns like to eat, A LOT. Every 2-3 hours is for 7 day olds :) Babies tend to enjoy most of this eating between the hours of 2200 and 0500. Therefore, instead of having a parade of visitors all day while your baby is mostly sleeping, try to get some rest. Babies don't always cry "for a reason" that parents can fix. Sometimes they just cry. Yes, they all like to be held. No, they are not being spoiled. Breastfeeding is only "easy" for about 1 in 20 new moms. It takes work and you have to be dedicated. No, your baby is not starving or dehydrated. If a supplement is medically indicated, we'd be the first to point it out. Almost all breastfed babies get a little jaundiced. Unless we need to treat the baby with bililights, the jaundice is not bad. Yes, we do need to check the baby's vital signs at midnight (or every 4 hours) because babies can go bad really fast. Yes, I do need to check your fundus, bleeding and bottom. I know that the doctor "just checked" but we don't share the same license. And lastly, USE THE CALL LIGHT!! Do not send someone to the nurses station every time you need something.

Mahnikuh · Mar 28, 2005

RNMommy, what's the point of a fundus check? (I know they're medically necessary, I just want to be able to explain why).

Also, teaching the Moms to do the fundus checks themselves a feasible possibility? i.e., let her do the more aggressive pushing and let the RN just check once for whatever you're looking for?

RNmommy · Mar 29, 2005

In the early PP period, a manual fundal check is necessary to assess the tone and height of the uterus. If the uterus is atonous, there will be excess bleeding and possibility of hemorrhage. Additional pitocin (or methergine) may be required to keep the fundus firm. Uterine height can indicate a full bladder, sub-involution, clot formation or retatined placenta. To really get a good assessment of the pts bleeding pattern the nurse should assess the fundus while visualizing the lady partsl flow. Pad checking is not nearly as relaible, especially with the at risk patient. For these reasons, we are required to assess the fundus hourly until the first spontaneous void. Then q shift. We do teach the patients to do self fundal massage but it is still considered part of our shift assessment and therefore needs to be completed. I have seen patients fill with clots over 24 hours post delivery. These patients will usually "trickle" but a rising fundal height is a dead give away.

Mahnikuh · Mar 29, 2005

Thanks for the info! Very helpful!

FrumDoula · Apr 6, 2005

As someone who is in the process of becoming a Lamaze-certified instructor, (though also not a nurse), I would first off like to applaud the first poster's comments. SBE, you are brilliant as always. :)

If your students could leave with two thoughts, I would love to see them leave with:

1. That pain is not the same as suffering.

2. That a fed nurse is a happy nurse, so bring along some munchies for the staff. I'm telling you, I've endeared myself to nurses before by bringing some food along as a doula! :) Nurses get hypoglycemic, too!

By the way, which organization are you certified through? Although I love Lamaze, I am also an increasing fan of Pam England and Birthing From Within.

Alison

BETSRN · Apr 6, 2005

As someone who is in the process of becoming a Lamaze-certified instructor, (though also not a nurse), I would first off like to applaud the first poster's comments. SBE, you are brilliant as always. :)
If your students could leave with two thoughts, I would love to see them leave with:
1. That pain is not the same as suffering.
2. That a fed nurse is a happy nurse, so bring along some munchies for the staff. I'm telling you, I've endeared myself to nurses before by bringing some food along as a doula! :) Nurses get hypoglycemic, too!
By the way, which organization are you certified through? Although I love Lamaze, I am also an increasing fan of Pam England and Birthing From Within.
Alison

The minute a laboring couple brings food, it is an immediate red flag that they are going to have a pretty complicated birth plan. Bradley couples usually bring food along and all ahve birthplans that start out with pretty much the same opening sentence.

Nurses can always find food. Do NOT tell your couples this. It is ridiculous!

I hope you were kidding.................................

rpbear · Apr 6, 2005

I know that most birthing classes teach the natural method of childbirht, this is great, but it is not allways the way things turn out. I think that more epidural teaching needs to be done in the classroom. I am not at all pushing epidurals, but in the middle of hard labor when the mom "can't take it anymore" is not a good time to discuss the risks and procedure of the epidural. People don't hear what you are telling them and they will sign the consent form just to make the pain stop. Then when the pain stops they don't understand why I have to put in a foley and why they cant get up and walk. Hello, I just told you all of this before you signed the consent form and said you understood everything I said! Even if they have no plans of having an epidural, this along with c-sections needs to be covered in class just in case things don't go as planned.

Thanks,

Molly

BETSRN · Apr 6, 2005

I know that most birthing classes teach the natural method of childbirht, this is great, but it is not allways the way things turn out. I think that more epidural teaching needs to be done in the classroom. I am not at all pushing epidurals, but in the middle of hard labor when the mom "can't take it anymore" is not a good time to discuss the risks and procedure of the epidural. People don't hear what you are telling them and they will sign the consent form just to make the pain stop. Then when the pain stops they don't understand why I have to put in a foley and why they cant get up and walk. Hello, I just told you all of this before you signed the consent form and said you understood everything I said! Even if they have no plans of having an epidural, this along with c-sections needs to be covered in class just in case things don't go as planned.
Thanks,
Molly

While we all like to think that couples will choose the "natural" way and avoid most medicinal pain relief options, sadly, I do not think that is the way it is today. I am in a low intervention/midwifery friendly hospital and all our docs very mush prescribe to the low intervention philosophy. Even in my place, however, most mothers coming through do NOT want to go the natural route. They want pain relief often too soon (for what we think is too soon) and they want no pain. I think most couples go to classes today just to be able to say they went to class. If they were truly invented in learning, more would choose the longer class series and less would choose the weekend or one day class.

I can only speak for myself but in my classes I spend a good eal of time on interventions and their use reasons for, etc. I would rather my couples be informed BEFORE and have time to ask questions rather than be uninformed and disappointed with their experience.

We do our couples NO favors by not including this in our class information. People make far better choices when they have the material to digest IN ADVANCE as opposed to ahving to make these decisions when they are in pain that they never dreamed possible.

We don't push epidurals either, nor do we overuse interventions (we do not place foleys with epidurals) like FSE's, IUPC's and the like. But in reality these may be part of the birth and I would rather have my clients know beforehand so that they have less stress during their labors. besides, they can advocate better with their docs and midwives at appointments if they know what is out there.

SmilingBluEyes · Apr 6, 2005

The minute a laboring couple brings food, it is an immediate red flag that they are going to have a pretty complicated birth plan. Bradley couples usually bring food along and all ahve birthplans that start out with pretty much the same opening sentence.
Nurses can always find food. Do NOT tell your couples this. It is ridiculous!
I hope you were kidding.................................

ROFL I never object when a birthing family member brings me a mocha-latte from Starbucks, however ......and they do that a lot. (I feel utterly flattered they get to know me enough to know how much I love this drink lol). :)

I think people are just trying to be nice and usually I will form a pretty good bond with them in the course of the labor. That they bring food or coffee is very nice, but surely not necessary. I just am very warmed by the thought, and that is always what counts. :)

Jayla · Apr 6, 2005

I'm a PHN and work with healthy start pts--I educate a lot of pregnant moms and this is such an wonderful post! Really helpful information!

As far as epidurals, I want to teach my patients more about this, but we don't have a lot of material about it at my clinic. Does anyone have suggestions on good teaching material regarding pain control during labor (preferably in english and spanish)?

Also, any good L&D videos out there (again, english and spanish would be helpful) that don't cost a fortune? I'd love to pop a tape in during a home visit and let them see the real action--especially first time moms.

thanks!

BabyRN2Be · Apr 6, 2005

Not only everything that SmilinBluEyes mentioned, but I also vehemently add that every birth is different and that it doesn't go like the script in "A Baby Story" (I loathe that program as well as "Birth Day"). You know, you watch the hospital scenes as mom comes to hospital (in active or prelabor), she gets checked, an epidural is ordered, cute little banter with the hubby is shown while they break down the bed, and two pushes later, voila, a baby! All done in half an hour!

I've actually had a few doula clients tell ask me what's wrong when they've been in labor for 5 hours. I tell them that nothing is wrong and ask them why do you feel that labor is going wrong? I get the answer, "Well, I thought this would take half an hour like it is on TV! That's why I didn't sign up for the epidural because I can stand any pain longer than half an hour!" :rolleyes:

I also encourage everyone to make this their birth, and do whatever they have to do to make it special.

kmrmom42 · Apr 10, 2005

I'm a PHN and work with healthy start pts--I educate a lot of pregnant moms and this is such an wonderful post! Really helpful information!
As far as epidurals, I want to teach my patients more about this, but we don't have a lot of material about it at my clinic. Does anyone have suggestions on good teaching material regarding pain control during labor (preferably in english and spanish)?
Also, any good L&D videos out there (again, english and spanish would be helpful) that don't cost a fortune? I'd love to pop a tape in during a home visit and let them see the real action--especially first time moms.
thanks!

Not cheap but very comprehensive two video set that I think is invaluable.

http://www.injoyvideos.com/IJOneVolOneVer.cfm?id=200

If your organization can afford two sets it is available in Spanish and English and it contains information about pain medication for childbirth, including epidurals.

You can get lots of good informational materials from Childbirth Graphics

http://www.childbirthgraphics.com/

and from ICEA http://www.icea.org/bkmks.htm

I have some information on my website about epidurals. You can check that out. I haven't updated my website since I started back to school for my MSN. I will be finishing this week (YAY!) so I expect to be putting some time into it in the near future. I hope the links are alll working but I can't promise anything.

http://kmrmom42.angelcities.com/