What's changed in the last 10 yrs in L&D?

mommy2boysaz · Jul 11, 2008

Oh, my gosh! Where to start??

Where I work, things are completely different than 10 years ago.

It's become more of an assembly line mentality. Induce, section when the induction fails, do what is required for mom and baby and send them home. (Oh, I forgot! Administer epidural upon admission.)

OK, that might sound a little negative. It's not always that way and not everywhere.

It's just that 10 years ago we did RARE epidurals, RARE inductions, and few cesareans. Now all are common. I don't think any of these changes have been beneficial as a whole for moms or babies.

Seems we've forgotten that God created a pretty efficient way for babies to be born all by themselves, WITHOUT much help from us! We want to be in control of everything.

Sorry for the rant! If these things were already happening where you are before you had your children, then it might not be much of a change for you.

Good Luck and Best Wishes on rejoining the work-force!

Salgal08 · Jul 11, 2008

Thank you!

-And I also agree that God created an efficient way for babies to be born :nuke: :up: .

NurseNora, BSN, RN · Jul 29, 2008

Where I am we don't seem to be doing more epidurals or inductions. We are doing more sections because 10 years ago we did VBACs. You'll find some JACHO driven changes in the documentation and procedures, but babies basically come out the same way they used to.

L&Doldtimer · Jul 29, 2008

Frankly, I think the architecture is a bit messed up-something that size coming from an opening that size is a bit unnatural to me. Personally, I think epidurals are the best thing to happen to labor and delivery-as long as they aren't done way too early and done so they work well. I love it when mom is still comfortable enough to enjoy her delivery and the baby afterwards. Anything I can do to ease my pts pain, I am all for. I am NOT saying stick the epid in and then sit at the desk and wait-I am at my pt's bedside turning her and explaining what to expect with pushing and so on.

At least we don't use IV alcohol for PTL anymore....:wink2:

hoppermom3 · Jul 29, 2008

I will say that the births we strive to provide for our patients are much better than the births that I had 9, 12, and 15 years ago. our providers and nurses are very committed to allowing mom to make choices and to supporting them.

Things I have never seen done to our patients that were done to me: shaving, NPO throughout labor, strapped down to delivery table, not getting to see healthy newborn for 2-3 hours after birth, not being allowed to ambulate (or even get out of bed to void with baby #3), no breastfeeding support.

I know that things vary from hospital to hospital and region to region, but my own experience is that evidence based practice is best for moms and babies.

rph3664 · Jul 30, 2008

I will say that the births we strive to provide for our patients are much better than the births that I had 9, 12, and 15 years ago. our providers and nurses are very committed to allowing mom to make choices and to supporting them.
Things I have never seen done to our patients that were done to me: shaving, NPO throughout labor, strapped down to delivery table, not getting to see healthy newborn for 2-3 hours after birth, not being allowed to ambulate (or even get out of bed to void with baby #3), no breastfeeding support.
I know that things vary from hospital to hospital and region to region, but my own experience is that evidence based practice is best for moms and babies.

Did they give you an enema too?

When I was born, all that stuff was routine but things have definitely changed. Where did you have your kids that those things were done that recently? My friends who have kids didn't experience any of that unless it was necessary.

Salgal08 · Jul 30, 2008

Are they not doing many VBAC's now? Wow, there were so many when I was working (in the '90's).

Also, I'm embarrassed to say I'm not really familiar with "evidence-based practice", I suppose it is what it says it is- interventions that have been proven to be effective based on solid evidence? Is that sort of right? :)

Elvish, BSN, DNP, RN, NP · Jul 30, 2008

We do a lot of VBACs at my hospital. :yeah:

Everybody who want one and qualifies at least gets a TOLAC.

Think it must depend on where you are, what the docs are comfortable with, and whether there is anesthesia/OR available if needed.

Evidence-based practice is pretty much what you said it is: practices (may be interventions, but not always) that have been borne out by outcomes to be clinically best for the patient. (I'm tired & heading to bed or I would look up an 'official' definition of it. :) )

Selke · Jul 31, 2008

On the positive side, I see doulas in many places. Many more nurses are aware of labor support techniques. There is more awareness of breastfeeding. Hospitals finally got rid of those stupid gowns they'd have family members wear in L&D ...

Cable TV started those pregnancy and birth shows, which have caused more problems than they are worth, IMHO. Except for House of Babies, with Shari Daniels and the midwives at the Miami birth center -- they show normal unmedicated births and teach the audience something new each episode.

FemmeRN · Jul 31, 2008

We do a lot of VBACs at my hospital.
Everybody who want one and qualifies at least gets a TOLAC.

I know VBAC, but what does TOLAC mean? I'm a new grad on Mother/Baby, and still trying to get a handle on all the acronyms!

thx

Elvish, BSN, DNP, RN, NP · Jul 31, 2008

TOLAC - trial of labor after cesarean...basically you get to at least try to labor and delivery lady partslly. If, for whatever reason it doesn't work, you have a repeat section.