Emergencies

I've been taking care of a lot of seriously sick pregnant and freshly delivered women lately.

Uterine rupture - caught before it happened (just barely)
Placenta previa - hemorrhaging, stat c/s, baby is stable
Preeclampsia - severe, BP out of control, labs going really wonky
Placental abruption - hemorrhaging, stat c/s, baby is stable
Mysterious illness with severe pain, vomiting, some wacky labs - still don't know what's going on with her

Just lots of sick people, keeping me on my toes. Needless to say, I have also been in the operating room for the last solid week of shifts. I don't like it.

I need some healthy moms and babies for my birth fix! (yeah, I'm a junkie.....)

Overuse of personal electronic gadgets in labor and birth?

Maybe it's just me, but what's up with all of the personal electronic gadgetry that people are so focused on while in Labor and Delivery? Everyone has a cell phone: mom, dad, every one of her labor partners, sometimes even the kids.

EVERY. SINGLE. ONE!

And they're all using them. Constantly!

Can we have one aspect of our lives that doesn't need to be documented/twittered/facebooked/texted minute by minute? I understand the idea of keeping loved ones updated from time to time, but this is really getting ridiculous. Is there no sanctity and intimacy in labor and birth anymore?

(And.........ironically........cue the power going out in the house, cutting off my precious INTERNET!!!)

(Power restored, internet back!)

Yes, I guess that does tell me what kind of technology-filled and driven world we live in.

Technology is here to stay. Even during labor and birth. Like it or not.



Photo from: http://www.hardwareinsight.com/wp-content/uploads/2009/05/cell_phones.jpg

Is hands on nursing care a dying art?

I was just reading at Birth Sense about how we're becoming more and more high tech and less hands on with caring for pregnant women. Is hands on care becoming a dying art?

With increasing alarm, it feels like the technology and gadgets are slowly taking over. Fetal monitoring has advanced from intermittent auscultation with a fetoscope, to doppler, to external fetal monitoring, to internal fetal monitoring. Or a combination of the last two.

Cervical exams might be replaced by the new gadgets that are clipped to the cervix to gauge dilation, effacement, and station. (I could not imagine using these in labor, but no doubt: it will be coming to a hospital near you before you know it!)

Leopold's is a lost art on newer nurses. Why palpate a belly when you can get a quick ultrasound? We are just not palpating bellies for fetal parts and position anymore. (Well, not all of us! Some of us still use Leopold's on almost every pregnant belly.)

A new nurse recently was aghast at the idea of not starting an IV on a woman who comes in completely dilated and pushing. Why? She's having a baby, not having a medical emergency. If she hemorrhages, we're good at putting in IVs lickity split. Or if we can't get a line in, there is always metherine or pitocin IM. Or cytotec given rectally. I mean, really, people! Think outside of the box!

Woman comes in, 10 cm dilated, pushing, delivering her baby within the next few minutes. ---> What are your priorities?

-Allergies to medication? Good to know this info.
-GBS status is moot. She's delivering.
-Is she term or preterm? (Do we need to have NICU ready?)
-Membranes ruptured? Clear fluid? (Mec??)
-Who is her provider? Is he/she readily available to come catch the baby, or will it be an RN catch?
-Auscultate fetal heart tones, if possible.

Slap on some gloves and prepare to catch the baby. Simple, really.



That is it folks.