babies, babies, babies.........I'm slooooooowly getting to the end of my clinical numbers. I'm hoping to have everything done in the next 2.5 months. Fingers crossed!!
I am hovering at just about 500 clinical hours done. The minimum number of hours is 675. I have just a little over a dozen births left, several newborn exams to do, a handful of postpartum visits, and about 20 peri/post menopause visits left. Two clinical assignments left to complete and submit. A handful of SOAP notes to submit.
Then........practice comps exam!
Then..........comps exam! Once I pass that, I will be AtYourCervix, MSN!
Then........boards. Once I pass that, it is AtYourCervix, MSN, CNM!
Teehee! Going crazy from school and looking forward to being done.
I have made a decision to postpone pursuing my DNP for now. I am certifiably insane from going to school for the past four + years. I need time to unwind, discover what kind of midwife I am going to be, and spend time with my family.
Showing posts with label babies. Show all posts
Showing posts with label babies. Show all posts
Monday, January 14, 2013
Wednesday, September 12, 2012
Mother-baby friendly status
I figured that my current hospital where I work as a nurse was moving to be more "mother-baby" friendly. First it was the move to all mothers of well babies having in-room mother-baby care 24hrs/day. Then it was improving early breastfeeding rates. Then, improving skin to skin in the delivery room for vaginal births.
Now, we're going to start implementing (finally!) early (within 5 minutes of birth) skin to skin in the OR for c-section mothers. Whoa baby, I just cannot wait to see how well THAT will go over (or rather, won't go over so well) with the neonatalogists who attend every c-section birth. I brought up the fact that perhaps we don't need a neo at every c-section birth? After all, most of our scheduled c-sections are very atraumatic (normal, no labor, no anticipated problems with the baby) and the baby has no problems transitioning from the birth. Why have neo there for what is essentially a normal birth? The true reason why neo is there for every c-section is that it generates income/money as a NICU consult. There -- I said it --- it's financially driven, not evidence-based practice!
It is also going to be an expectation that EVERY mother will do skin to skin with her baby within the first hour, ideally, within the first five minutes after birth - unless she outright declines or has a true medical indication why. If it is not done, there will be a drop down selection list of acceptable reasons why she does not do skin to skin. Even formula feeding mothers will be expected to do skin to skin after birth (of course, unless they have a reason why they don't want to). I'm fine with skin to skin after birth -- for women who want to do it. I am not for the forcing of women to do skin to skin if they really do not want to do it. That is just ridiculous! Hell, it's downright assault if I place a baby skin to skin (after removing the woman's gown) without her permission to do so. I always ask if I may place the baby against her skin after the birth. With most of the women, I try to ask this before they give birth. There are certain cultures who will not touch the baby at all after birth, much less have the baby lie skin to skin against them. Then there are the teen mothers (and sometimes older mothers) who find the birth fluids "icky" and want the baby to be at least wiped down before holding him/her. My thoughts are this: not every woman is created equal, nor does every woman have the same beliefs or desires for their immediate birth experience. One size does not fit all here! I hate when my facility management decides to put everyone into this one size fits all box.
Oh, and it has been super stressed to us that all breastfeeding (healthy, term) babies MUST be at the breast before one hour. Seriously? Not every single baby wants to go to the breast within one hour of birth. We have mothers who receive narcotics during labor, epidurals during labor, stressful and prolonged labors, and then we have.......drumroll........dopey babies who want to sleep after birth. I am NOT forcing a baby to the breast. In fact, I teach new mothers to NOT force the baby to the breast. It's one thing to hold the baby skin to skin against your chest/breast. The baby may very well start to do the "head bob" thing and migrate down towards the nipple and latch himself on -- all on his own -- with little to no active encouragement. Or, the baby may need some time to recuperate from the birth, maybe a little stroking of the cheek with a finger or the nipple. The fact of the matter is, not all newborn babies will latch on to the breast within one hour of age. Some...just don't. It's really not a big deal, and it does not ruin the breastfeeding relationship if a latch does not happen within an hour. Once again, I find that the hospital is trying to put all mothers and babies into this one size fits all box. We have to look at each mother and baby as separate beings. They are not the same from room to room, day to day.
The good news is that formula will not longer be available for supplementation unless medically indicated, along with an MD prescription, for breastfeeding newborns. So many nurses (and new mothers) think that if they are breastfeeding, the baby isn't "getting enough milk" and start supplementing with formula, filling up their itty bitty stomachs. Also, nurses (and new parents) are feeding way too much formula to these newborn babies. We had quite the discussion at work a few weeks ago, and I was trying to educate my fellow nurses on the true size of a newborn's stomach. At birth: think almond sized. That's 5-10 cc, max. Not 1/2 to 1 ounce.
I predict lots of turmoil among the nursing staff (and the medical staff too) when these new changes are implemented. There are more changes coming, other than what I have discussed. Some good, some not so good, but all in the name of being more "mother-baby friendly". We shall see.
Now, we're going to start implementing (finally!) early (within 5 minutes of birth) skin to skin in the OR for c-section mothers. Whoa baby, I just cannot wait to see how well THAT will go over (or rather, won't go over so well) with the neonatalogists who attend every c-section birth. I brought up the fact that perhaps we don't need a neo at every c-section birth? After all, most of our scheduled c-sections are very atraumatic (normal, no labor, no anticipated problems with the baby) and the baby has no problems transitioning from the birth. Why have neo there for what is essentially a normal birth? The true reason why neo is there for every c-section is that it generates income/money as a NICU consult. There -- I said it --- it's financially driven, not evidence-based practice!
It is also going to be an expectation that EVERY mother will do skin to skin with her baby within the first hour, ideally, within the first five minutes after birth - unless she outright declines or has a true medical indication why. If it is not done, there will be a drop down selection list of acceptable reasons why she does not do skin to skin. Even formula feeding mothers will be expected to do skin to skin after birth (of course, unless they have a reason why they don't want to). I'm fine with skin to skin after birth -- for women who want to do it. I am not for the forcing of women to do skin to skin if they really do not want to do it. That is just ridiculous! Hell, it's downright assault if I place a baby skin to skin (after removing the woman's gown) without her permission to do so. I always ask if I may place the baby against her skin after the birth. With most of the women, I try to ask this before they give birth. There are certain cultures who will not touch the baby at all after birth, much less have the baby lie skin to skin against them. Then there are the teen mothers (and sometimes older mothers) who find the birth fluids "icky" and want the baby to be at least wiped down before holding him/her. My thoughts are this: not every woman is created equal, nor does every woman have the same beliefs or desires for their immediate birth experience. One size does not fit all here! I hate when my facility management decides to put everyone into this one size fits all box.
Oh, and it has been super stressed to us that all breastfeeding (healthy, term) babies MUST be at the breast before one hour. Seriously? Not every single baby wants to go to the breast within one hour of birth. We have mothers who receive narcotics during labor, epidurals during labor, stressful and prolonged labors, and then we have.......drumroll........dopey babies who want to sleep after birth. I am NOT forcing a baby to the breast. In fact, I teach new mothers to NOT force the baby to the breast. It's one thing to hold the baby skin to skin against your chest/breast. The baby may very well start to do the "head bob" thing and migrate down towards the nipple and latch himself on -- all on his own -- with little to no active encouragement. Or, the baby may need some time to recuperate from the birth, maybe a little stroking of the cheek with a finger or the nipple. The fact of the matter is, not all newborn babies will latch on to the breast within one hour of age. Some...just don't. It's really not a big deal, and it does not ruin the breastfeeding relationship if a latch does not happen within an hour. Once again, I find that the hospital is trying to put all mothers and babies into this one size fits all box. We have to look at each mother and baby as separate beings. They are not the same from room to room, day to day.
The good news is that formula will not longer be available for supplementation unless medically indicated, along with an MD prescription, for breastfeeding newborns. So many nurses (and new mothers) think that if they are breastfeeding, the baby isn't "getting enough milk" and start supplementing with formula, filling up their itty bitty stomachs. Also, nurses (and new parents) are feeding way too much formula to these newborn babies. We had quite the discussion at work a few weeks ago, and I was trying to educate my fellow nurses on the true size of a newborn's stomach. At birth: think almond sized. That's 5-10 cc, max. Not 1/2 to 1 ounce.
I predict lots of turmoil among the nursing staff (and the medical staff too) when these new changes are implemented. There are more changes coming, other than what I have discussed. Some good, some not so good, but all in the name of being more "mother-baby friendly". We shall see.
Sunday, January 15, 2012
Babies and births
I have had such a super duper busy week! I started back in my classes (go advanced courses! WOOHOO!!) and had a mega busy week at work as well.
Holy schmoly, the number of Friday the 13th babies was just insane! I was in on four different (all vaginal) births that day as either the primary nurse or as a second nurse for the birth. Can I just say -- holla! -- to all those new babies born on an "unlucky" day. Happy sweet birthday to each and every one of you!
Let's see, what else happened this week........ stat c/s (always get the heart pumping), a set of twins, took care of a mom having triplets (who was just the sweetest thing!) -- I can't wait to see these triplets when they're born. Participated in a neonatal code (I hate them, they always make my hands shake).
Just lots of and lots of "stuff" going on in L&D this past week. I would like to place my order for a nice, relaxed week this week, pretty please? I somehow doubt that will happen.
Monday, December 19, 2011
Breastfeeding Flash Mob: "You may not do that here"
Breastfeeding Flash Mob told that they cannot nurse in public.
A direct quote from the article:
Basically, 11 women came together in the mall to form a breastfeeding flash mob. This is the state of Michigan, where public nudity laws does not apply to a woman breastfeeding her child. However, apparently there are no laws the specifically "allows" women to breastfeed in a public location (one of only five states to NOT have a law in place to "allow" breastfeeding women to nurse in public places).
A direct quote from the article:
When she asked, "So, you don't allow nursing in the mall?" a mall manager replied: "Not in public, we don't."
Basically, 11 women came together in the mall to form a breastfeeding flash mob. This is the state of Michigan, where public nudity laws does not apply to a woman breastfeeding her child. However, apparently there are no laws the specifically "allows" women to breastfeed in a public location (one of only five states to NOT have a law in place to "allow" breastfeeding women to nurse in public places).
Seriously, are we still having this same argument?? Seriously? If you are offended by seeing a woman breastfeed, then don't look. Would you make a woman feeding her child a bottle go hide in a bathroom or closed off area?
When will the five remaining states get with the modern day and create laws that protect breastfeeding women and their right to nurse their babies in public?
Here is a link to breastfeeding state laws and the breakdown of specific laws regarding breastfeeding: Breastfeeding Laws NCSL
I highly encourage you to become active in supporting breastfeeding for all women, in every state. Repost this blog post, write your own blog post, repost the article link (top of this post) on Facebook, Twitter, whatever pubic forum you choose. This is just ridiculous that this day and age women still have to fight for their right to nurse their baby in public.
Saturday, August 13, 2011
Births
I've had several, sweet, wonderful, delicious births in the past week. At least one each shift! I'm in heaven. Truly, in heaven.
No fetal distress.
No c-sections.
Some pitocin augmentation (but that is the nature of my unit......hurry up and get them done.) Needless to say, I am NOT aggressive on the pitocin increases. Especially when the woman is not wanting an epidural, is coping well with her contractions, and is making regular cervical changes. Sorry doc, nope. I'm not going to keep increasing the pitocin in those instances!
Excellent skin to skin contact with moms and their babies.
Fantastic initial breastfeeding sessions.
Yeah, life is good.
No fetal distress.
No c-sections.
Some pitocin augmentation (but that is the nature of my unit......hurry up and get them done.) Needless to say, I am NOT aggressive on the pitocin increases. Especially when the woman is not wanting an epidural, is coping well with her contractions, and is making regular cervical changes. Sorry doc, nope. I'm not going to keep increasing the pitocin in those instances!
Excellent skin to skin contact with moms and their babies.
Fantastic initial breastfeeding sessions.
Yeah, life is good.
Saturday, April 16, 2011
Mother-baby friendly hospital
My hospital is trying (oh so slowly) to become a Mother-Baby Friendly hospital. Why are we operating in the dark ages of not being Mother-Baby Friendly? Because the way we do things is the way we have done things. It's so hard to change habits that have been ingrained into so many health professionals over so many years!
It's still like pulling teeth (without anesthesia) to have postpartum/nursery nurses accept -- without pulling a million excuses -- that mothers and babies can room in together without separation. Yes, we're still fighting that fight. The postpartum/nursery nurses will blatently make up reasons why a mother cannot have her newborn in the room with her upon their transfer from L&D to postpartum (we are two different floors of the hospital).
We have specific rules/guidelines of what babies may not transition in their mother's room. It's the truly at-risk babies, basically. Things that make the most sense: post-resuscitation, meconium fluid requiring intubation at birth, babies with cardiac or respiratory anomalies, low apgar score at 5 minutes, maternal narcotic administration within one hour of the birth, etc.
We are eventually going to move to a mother-baby care model that puts every baby with their mother from birth, unless they truly medically cannot - or if the mother requests nursery care for the initial first few hours.
We are also moving towards having totally open 24/7 units (L&D and mother-baby) with no restrictions on the number of visitors or the times that visiting hours occur. We currently are set up on L&D as 24/7 visitation, no more than 3 people in the birth room at one time. Children under age 12 are welcome, as long as they are siblings of the newborn, and are accompanied by another adult to care specifically for that young child (take them out of the birth room if they get scared, etc).
We are going to change to 24/7 open access, unlimited number of visitors per room. Yikes. With how busy our unit is, and the doors being locked (and you need to buzz and have a staff member open the door each time you come and go), this is not going to go over well with our staff. I say, if we go to unlimited access, just get rid of the locked doors. Come one, come all to the sacred event of birth! (Sorry, that was actually some sarcasm. Many "visitors" on L&D are there to gawk and not actually help the birthing woman/family. It's a big pet peeve of mine. If you're here - you need to help support the mom!)
The current visitation on postpartum is such: primary partner (the one with the ID band from the birth, usually the father) is 24/7 access. All other visitors are 12 noon to 8pm ONLY. That will change to all visitors, 24/7 access. Oh my, that will NOT go over well with the mother-baby staff AT ALL.
Let me just let you know some stats about my hospital:
*4500+ births per year
*High poverty demographic population
*High teenage birth demographic
*Very high number of outpatient visits to L&D -- we see EVERYTHING if you are pregnant. We do outpatient NSTs and other testing, as well as outpatient Rhogam injections (no matter how far pregnant you are or were).
*Outpatient visits exceed 1000 each month
*Births are 350-400 per month
*We also have long term antepartum patients with pregnancy complications. Don't know the number offhand per month, but it's a lot.
*Many patients are high risk (preeclampsia, preterm labor, PPROM, multiple drips, unstable diabetics, post-seizure eclamptics)
Needless to say, this is not your average low risk hospital unit.
Yes, we do need to work on becoming more mother-baby friendly. However, I oppose the 24/7 open door unit policy with unlimited numbers of 'visitors'. Apparently the entire hospital (even the ICU & NICU!!!!) is moving towards this same type of 24/7 open unit, unlimited visitor policy. So, technically it's not just the women's health/OB departments.
Your thoughts? Opinions?
It's still like pulling teeth (without anesthesia) to have postpartum/nursery nurses accept -- without pulling a million excuses -- that mothers and babies can room in together without separation. Yes, we're still fighting that fight. The postpartum/nursery nurses will blatently make up reasons why a mother cannot have her newborn in the room with her upon their transfer from L&D to postpartum (we are two different floors of the hospital).
We have specific rules/guidelines of what babies may not transition in their mother's room. It's the truly at-risk babies, basically. Things that make the most sense: post-resuscitation, meconium fluid requiring intubation at birth, babies with cardiac or respiratory anomalies, low apgar score at 5 minutes, maternal narcotic administration within one hour of the birth, etc.
We are eventually going to move to a mother-baby care model that puts every baby with their mother from birth, unless they truly medically cannot - or if the mother requests nursery care for the initial first few hours.
We are also moving towards having totally open 24/7 units (L&D and mother-baby) with no restrictions on the number of visitors or the times that visiting hours occur. We currently are set up on L&D as 24/7 visitation, no more than 3 people in the birth room at one time. Children under age 12 are welcome, as long as they are siblings of the newborn, and are accompanied by another adult to care specifically for that young child (take them out of the birth room if they get scared, etc).
We are going to change to 24/7 open access, unlimited number of visitors per room. Yikes. With how busy our unit is, and the doors being locked (and you need to buzz and have a staff member open the door each time you come and go), this is not going to go over well with our staff. I say, if we go to unlimited access, just get rid of the locked doors. Come one, come all to the sacred event of birth! (Sorry, that was actually some sarcasm. Many "visitors" on L&D are there to gawk and not actually help the birthing woman/family. It's a big pet peeve of mine. If you're here - you need to help support the mom!)
The current visitation on postpartum is such: primary partner (the one with the ID band from the birth, usually the father) is 24/7 access. All other visitors are 12 noon to 8pm ONLY. That will change to all visitors, 24/7 access. Oh my, that will NOT go over well with the mother-baby staff AT ALL.
Let me just let you know some stats about my hospital:
*4500+ births per year
*High poverty demographic population
*High teenage birth demographic
*Very high number of outpatient visits to L&D -- we see EVERYTHING if you are pregnant. We do outpatient NSTs and other testing, as well as outpatient Rhogam injections (no matter how far pregnant you are or were).
*Outpatient visits exceed 1000 each month
*Births are 350-400 per month
*We also have long term antepartum patients with pregnancy complications. Don't know the number offhand per month, but it's a lot.
*Many patients are high risk (preeclampsia, preterm labor, PPROM, multiple drips, unstable diabetics, post-seizure eclamptics)
Needless to say, this is not your average low risk hospital unit.
Yes, we do need to work on becoming more mother-baby friendly. However, I oppose the 24/7 open door unit policy with unlimited numbers of 'visitors'. Apparently the entire hospital (even the ICU & NICU!!!!) is moving towards this same type of 24/7 open unit, unlimited visitor policy. So, technically it's not just the women's health/OB departments.
Your thoughts? Opinions?
Monday, October 04, 2010
Birthin' them babies
Was it a full moon last night? It sure felt like it! It was the night of precipitous births. I literally caught one baby, then went in to hook another mom up to the monitor when she also precipitously delivered! There were several more moms who walked in/wheeled in and quickly gave birth to their babies as well. There were so many that I lost count of the total in the unit. At least 5 or 6 within an hour or so. We were slammed.
Lots of babies keep the nurses in business!
Oh, and can I say, "high five" to the mom who was told she needed a repeat c/s, but instead VBAC'd successfully. Your body was made for birthin'!!!!
Sunday, July 04, 2010
Happy 4th of July!
Happy 4th of July everyone! Happy birthday to all the "firecracker babies" that will be born (or have already been born) today!
Here's to lots of happy births!!!
Sunday, March 14, 2010
Safety zones & stepping out of them. Yes, you can teach an old dog new tricks!
I did something that I occasionally do: I stepped out of my safety zone.
What, you might ask, is my safety zone? And just what do I mean by stepping out of it?
I am *one of those nurses* who feels like I can do a better job of doing some portions of normal newborn baby care under the radiant warmer. (Shock of all shocks! Yes, ME!) Not all of the newborn care, mind you, just some of it. Mostly the footprints. That's because we used to have this messy ink pad and paper system.
We know have this inkless system, which I am growing to actually LOVE. The more I use it, the more I love it. I didn't love it so much when we first transitioned to it. It was awkward. I can't find a picture of it, but let me describe it to you.
There is a cardboard sheet, about 5x7 inches. There are 3 rectangles on it: the far left is small, for the mother's index fingerprint, and the other two will fit for each newborn footprint. On the top side it's inkless. On the back side, there is black ink. You press the foot against the top side, with the paper you want to print underneath. It transmits the footprint without actually applying ink to the foot. No fuss, no muss!
Well, you need a hard surface to use it. We implemented small clipboards in each room to use the ink pad system when making footprints. At first, it was awkward: trying to hold the printer on the clipboard, with the paper you are printing underneath, while trying to grasp the infant's foot to make the prints. First prints, I found when using this new system, were very messy and not pretty at all.
Now, if you know me, you know I like to make the prettiest prints! This WOULD NOT DO.
So, I practiced. And practiced. And finally found the art of working it all out to create beautiful footprints for the families.
And, like I said, I stepped out of my safety zone recently, and actually tried doing a full set of footprints while baby was on mom. BEAUTIFUL!!!! They turned out gorgeous!!!
Mom and baby were only ever separated for all of 60 seconds when I brought the scale to her bedside to weigh and measure her infant.
Every single other newborn procedure was done with baby on mom's chest. Every. Single. One.
Now that folks, is the way it should be!!
What, you might ask, is my safety zone? And just what do I mean by stepping out of it?
I am *one of those nurses* who feels like I can do a better job of doing some portions of normal newborn baby care under the radiant warmer. (Shock of all shocks! Yes, ME!) Not all of the newborn care, mind you, just some of it. Mostly the footprints. That's because we used to have this messy ink pad and paper system.
We know have this inkless system, which I am growing to actually LOVE. The more I use it, the more I love it. I didn't love it so much when we first transitioned to it. It was awkward. I can't find a picture of it, but let me describe it to you.
There is a cardboard sheet, about 5x7 inches. There are 3 rectangles on it: the far left is small, for the mother's index fingerprint, and the other two will fit for each newborn footprint. On the top side it's inkless. On the back side, there is black ink. You press the foot against the top side, with the paper you want to print underneath. It transmits the footprint without actually applying ink to the foot. No fuss, no muss!
Well, you need a hard surface to use it. We implemented small clipboards in each room to use the ink pad system when making footprints. At first, it was awkward: trying to hold the printer on the clipboard, with the paper you are printing underneath, while trying to grasp the infant's foot to make the prints. First prints, I found when using this new system, were very messy and not pretty at all.
Now, if you know me, you know I like to make the prettiest prints! This WOULD NOT DO.
So, I practiced. And practiced. And finally found the art of working it all out to create beautiful footprints for the families.
And, like I said, I stepped out of my safety zone recently, and actually tried doing a full set of footprints while baby was on mom. BEAUTIFUL!!!! They turned out gorgeous!!!
Mom and baby were only ever separated for all of 60 seconds when I brought the scale to her bedside to weigh and measure her infant.
Every single other newborn procedure was done with baby on mom's chest. Every. Single. One.
Now that folks, is the way it should be!!
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