What's it like at your hospital??

[shortstuff31117]

I've just started my L&D training, and I really do love it for the most part. I like the doctors but I don't like how they do things. Seems that everyone gets pit, and the epidural is really pushed on the pts. If a pt. comes in say 2cm, the doc will often come over and break their water, and start pit. The pts. can have only water, no juice or jello or popsicles or anything.

When I was in school, the hospital I did clinical at was the total opposite. We sent pts. home until they were in active labor, they could eat, we didnt push the epidural or pit them to death.

I do like the fact that we put baby on mom's chest right away, and dont take baby until mom says, and baby stays in OR the whole time til mom is done too.

I'm just wondering what it's like at other hospitals. I don't think I'll last at this one. Maybe a year to complete my training. I feel like I'm missing out on things that I will have to learn at another hospital, like intermittent monitoring and seeing a labor proceed naturally.

[SmilingBluEyes]

It does indeed vary by hospital.

One hospital I used to work at, I LOVED how they did things:

Natural labor was supported and encouraged. But then, they had several midwives on staff as well as family practice docs------much less likely to push the pit and epiduralize everyone at admission. I liked working w/these folks.

They were given clear liquid trays. Meaning, they got to eat/drink whatever could be "seen through".....juice, sodas, broths, jellos, etc. I hate that where I work now, they allow basically "ice chips" and nothing else. I gave a pt a popcicle and got reamed for it by the charge nurse-----anesthesia has a COW if they eat or drink ANYTHING but ice chips. Well I am sorry, but laboring for 10-24 hours takes ENERGY-----and ice chips just do not cut it!! I imagine vomiting and asiprating stomach acid is not much better for the airway than a bit of juice might be....but hey what do I know.

Internal monitors were not used unless ABSOLUTELY needed---and were used very judiciously, not lightly. And you called the provider and said WHY you felt they MUST be used before putting them in. Some places, IUPC are like a MANDATE for all laboring patients. I have actually been taken to task for not having an IUPC on a pit patient whose contractions were easily legible and was making 1-2 cm/hour dilation progress. I told the dr I saw no need to risk infection putting in an IUPC on someone like that and she got all huffy with me----but did not put one in, thankfully. But that I have to argue something like this which should be common sense? Darnit, I hate that. Nothing like a nice wick for infection for convenience sake. Blech.

Pts were allowed to have their babies in a whirlpool or tub, if the provider was comfortable with it. And most were---if they were midwives, anyhow. What a beautiful place to have a baby if you want to-----it's a peaceful birth. Lots of places, pts are stuck in stirrups and on their backs (so not the optimal position for birth) and push forever......They never leave the bed. Why? cause they are on pitocin and epiduralized and have tubes/catheters all over the place.

I worked with providers who allowed and encouraged laboring down after a patient became complete. No mandated pushing just cause the cervix was dilated all the way. If a pt had no urge to push, she did not push. She pushed when good and ready---or when baby was VERY low (mainly epidural folks for whom an urge was slow or never to come). Pushing time was greatly reduced---as well as maternal exhaustion. And fewer perineal tears were the result. Where I work now, the doctors get really stinky when you tell them you want to labor down a patient. WHY FOR HEAVENS SAKE? OHHHH yea that is right---you have a date on the golf course, silly me. Again, you see this mostly w/OBs for some reason. Most Midwives and many family practice docs are much more respectful of the labor and birth processes and the time they take. I have fudged dilatation to many a dr to allow for some laboring down. (e.g. calling her a "rim" when she is actually complete). Yes, I hate lying. But I hate more making moms push for 3 hours needlessly.

I could go on and on---these are just examples that arise immediately in my mind. Just know: It's not the same everywhere. I have worked in 4 different hospitals (and only hospitals, not birthing centers) and I have seen it vary a LOT by place. I have found in a place where there are no midwives or few family practice docs, "9-5 obstetrics" are really pushed and I dislike it. If you are not happy where you are, you may have to move on to a place where there at least are midwives or a birthing center that allow for a variety of experiences and where the personnel there respect the mom's choices and the natural labor/delivery process. It's not the same everywhere. I wish you luck and peace in your career choices.

[SmilingBluEyes]

Oh and IMO, there is nothing much more beautiful than a natural labor and delivery process in those that choose them. I miss seeing more of this where I work now. Yes, it is much more work and time-consuming for nurses---and I think that is part of the problem. So many places, nurses are expected to take on 2 or more actively-laboring patients. That allows very little time to be a true measure of support for people laboring naturally. I think this is part of what is behind the push for inductions and epidurals. Having a laboring patient epiduralized and on continuous central monitoring (esp with internal monitors that read everything so accurately) makes it easier to manage a greater patient load and justifies loading up nurses with multiple labor patients. Sure, this saves time and makes it more convenient for "some" nurses and doctors. I find it a shame, really. I love a good, actively-laboring patient coming into my care. I feel energized by the experience, even if exhausted in the end. The satisfaction I feel is complete, however. I think that is what I was called to do.

But in many places, this is just so rarely seen. Very sad.

[LDRNMOMMY, BSN, RN]

SmilingBluEyes- I would LOVE to someday work at a hospital like the one you used to work at! Where I work is very much like the hospital you work at now.

What really gets me is the way stable babies are "handled" (I can't think of a better way to put it). They MUST go to the nursery within 1 hour of birth. It is the Pediatricians that require this and not the nursery staff!!!! Patients have to get special "permission" to keep their baby with them until they leave for postpartum this must be cleared prior to going to the hospital to deliver. :angryfire They are then separated from their babies for a minimum of 2-3 hours. It is their policy to get 3 temps >97.5 after a bath. If the nursery is hopping it is way longer. It just seems so unecessary to me. Family centered care my @ss!

I delivered at a military hospital and they had the right idea. My daughter was placed on my chest right away, I didn't have to give her to the nurse until I was ready! She had her bath in L&D and was wheeled in her bassinet with me to post partum. The only time she was away from me was when she an assessment in the nursery. They did not have a well baby nursery so she stayed with me the whole time and it was wonderful!

I know I am not staying where I am at forever, it is refreshing to know that not every hospital is like the one I work at!

[htrn]

My hospital is the same way. I do have to say that we aren't ALLOWED to put in FECG/IUPC, have to call the doc for that. And one doc will not, under any circumstances, not even if she is a VBAC on pit at 30mu and unable to pickup ctx due to obesity, put in an IUPC.

We do pit many, many patients. My induction this am had been scheduled since the middle of OCTOBER!!!! so her husband only had to take one day off instead of three. Very few inductions are for a legitimate medical reason. Maternal requests, maternal discomfort, post dates at 40 1/7 wks, etc......

Most of the time if a mom delivers without an epidural it's because she didn't get to the hosptial in time for one, otherwise, it seems like they all get them.

This has kind of pushed me into going through the hoops to go back for my CNM, would like to start next fall at the latest.