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

UNC_nurseL&D · Jul 31, 2008

Well, I wasn't working in L&D ten years ago, but I am now. Now, at my hospital, we put healthy babes directly on mother's chest at delivery, where babe can stay as long as mama wants. We breastfeed right away if baby shows cues. During labor moms are intermittently monitored if low risk. If they must be continuously monitored we have telemetry units so that they can still be up and walking if they want. They can eat a regular diet until active labor. Clears after that. Ice if they have an epidural. No enemas, no shaving. We use jacuzzi's, the shower, birth balls, and other positioning devices.

OB has always been way behind in evidence based practice, and I would love to see more of that used instead of the "well this is the way we've always done it" method.

As far as epidurals go, I don't feel like nurses or doctors force them on their patients (for the most part). It is usually the patients themselves requesting (somtimes demanding) an epidural (often before we even get them admitted :-) ). It seems like a lot of women today think they need an epidural to make it through labor, or just don't want to deal with the pain/the pain was more than what they were expecting. My practice is to explain pain medications before the pt is painful (if possible) and then tell them that if they want something, they will have to start the discussion with me because I won't ask them.

There are a lot of inductions and c/s. In my opinion this has to do with 2 things. Again, women of this era want complete control of the situation. Picking a day that they can begin labor allows them to plan around a busy schedule. Unfortunatley, the c/s rate correlated with elective inductions is quite high, a fact that many women are not fully informed on. And of course c/s are so high because dr's are increasingly fearfull of litigation, with good reason. The other reason for increased c/s and inductions is that a lot of the women getting pregnant these days just aren't healthy, therefore their pregnancies aren't healthy, and the baby needs to be born. With increased diabetes, heart disease, and obesity, the longer the baby stays in, the bigger the baby, and the more strain on mom's body. Again, it is unfortunate that medicine doesn't seem to be able to trust a woman's body to care for itself and the baby, but in some instances, it is right.

All in all things are pretty good in L&D now. Especially with the resurgance of midwives for normal healthy pregnancies. OB is trying to change to more pt/family centered care and is making a good effort. It's a good time to be an L&D nurse.

Salgal08 · Aug 1, 2008

Thanks for all the replies! It helps alot to hear what's new. :)

I'm just curious, do most nurses place IUPC's and rupture membranes? :nurse:

L&Doldtimer · Aug 1, 2008

Hospital I worked in 9 yrs ago we were given the responsibility to do those procedures, now the docs in my present hospital barely want us doing vag exams... They tell us from their beds if the pt. needs pain med or not! It stinks coming from a l&d unit that made you feel you were competent and trusted and going to one where you are made to "check your brain at the door"!

I am curious also-are there any other hospitals out there where the mentality still persists that the nurse is the doctor's handmaiden and the managements position maintains the "god-like" image of the docs-giving them whatever they want and no questions asked?

connie

vandermom · Aug 4, 2008

I came back to OB after almost 20 years and surprise babies still come out the same way!! Just not as many of them. One of the biggest changes I have seen is the size of the babies and their mothers. It seems that most of our moms are 200+ pounds at delivery. Probably twice as many CS but no forceps here. Vacuum is used as needed not just when there is no other choice (very bad oucomes in the 70's with the vac). CS no longer spend a week in the hospital but are out of bed, with IV and foley gone, the next morning. AND they even feed them regular diets as tolerated right from the start.

rph3664 · Aug 4, 2008

I came back to OB after almost 20 years and surprise babies still come out the same way!! Just not as many of them. One of the biggest changes I have seen is the size of the babies and their mothers. It seems that most of our moms are 200+ pounds at delivery. Probably twice as many CS but no forceps here. Vacuum is used as needed not just when there is no other choice (very bad oucomes in the 70's with the vac). CS no longer spend a week in the hospital but are out of bed, with IV and foley gone, the next morning. AND they even feed them regular diets as tolerated right from the start.

I've noticed that too. Not a day goes by where I work that we don't see a 300-pound plus mom, either and we've had a couple of 400-pounders.

It seems that the vast majority of our hyperemesis patients have morbid obesity. Has anyone else noticed this? I mean, the kind who are on Procalamine or TPNs. Our technicians always say, "How could someone be that fat and starving?" but you know what? Obese people need to eat too, especially if they're pregnant!