- If the baby is not descending, and it feels like the position is direct posterior, be sure to check all around the cervix/head. To be sure it's really direct posterior, because it could also be a brow presentation.
- Never trust a grand multip with immediate (4th stage) bleeding. They will BLEED. Especially if their uterus is "tired" from a long labor or prolonged induction.
- Be very active in management of 3rd and 4th stage in grand multips.
- Never turn your back on a crowning upon the perineum.
- Trust your gut -- if it says something doesn't feel right, it probably isn't.
- Keep lots of little snacks handy
- Oh, and coffee, lots of coffee
- Sleep is overrated
- Move quickly and efficiently in urgent situations
- Hospital beds are not comfortable to sleep on when on call (or ever)
- Sometimes you can teach a very seasoned provider something new
- I am always learning something new each day
- Thrombosed hemorrhoids are VERY painful
- A hearty breakfast in the morning after 24+ hours of call is priceless and complete bliss
- Just because you prescribe and educate on a medication, does not mean the client will take it. Or her partner, when applicable. Just keep educating. And document.
- Babies are very resilient little human beings!
Wednesday, February 06, 2013
What I've been learning
Here is just a sample of what I've learned in my clinicals:
Subscribe to:
Post Comments (Atom)
9 comments:
I am so glad I never had pph with any of my 6 deliveries, especially the last couple of ones. The more I learn, the more I realize how complicated things can get with grand multips. In my case, the surprise shoulder dystocia with my sixth when my last several big babies came out with a couple of pushes. Never a dull moment for me! (And always something new to learn :))
Love that you are learning and learning and learning.
With a momma, especially one who has had many babies, it's okay to debrief her on a disappointing birth. Tell her little details like how the baby was positioned or things she may not have known like that the placenta was big or different etc. Offer to let her see things. I once got to see the placenta and membranes, the midwife showed me the hole in the membranes where the baby came out. Coolest.
I have often heard that about bleeding with women who've had many children. (Define many??) Why exactly is this?
TDH - grand multip is usually a woman who has given birth to 5 or more children. The reason why they tend to bleed more is that the uterus has been distended multiple times due to many pregnancies, and may get boggy and not very contractile, the more pregnancies she has (in the postpartum time period). Not every woman is like this, but I must keep it in the back of my mind with anyone who has had many pregnancies.
So true, times a billion!!
Can I add a few, now that I've gotten a little bit of time behind me? :)
* (___ insert my last name here ___.)'s Law: no matter how close a woman's contractions have been, there will ALWAYS be a nice, long break -- precisely when you are waiting for one (usually midst-exam, ie to check cervix, rupture the bag of waters, etc...) awkward!!
* ordering dinner = the best way to bump up a stalled labor!
* trust your instinct --- and mama's instinct, too. Be willing to validate her worries while still reassuring of normalcy. (Very tricky sometimes!)
* Every catch is as special as that very first <3
So happy to find your blog! I'm a fellow L&D nurse and aspiring midwife. Looking forward to seeing future updates on your FNU journey. Been researching it myself, and glad to see someone else succeeding in their program! Best wishes
Isn't learning the greatest? So true about trusting your instinct. Last level in our OB rotation, I was just barely learning newborn breath sounds and was doing nursery follow ups alone. I was listening to a newborn and something didn't "feel right". He wasn't retracting, grunting but only a little and wasn't cyanotic or anything but my gut said something wasn't right. I went to fetch my preceptor, feeling like a moronic student. She didn't hear what I heard but suctioned him anyway and pulled a decent amount of fluid out. Maybe it was luck but regardless, it was my first "gut" experience and I learned that, even as a novice student, it's there and you should trust it!
So many great tips! Thanks for sharing!
All that is left now is to get your BSN!
Post a Comment