Things you won't hear your L and D nurse say (but she's thinking them)

What I'm thinking versus what I really say

I have never seen something like that before!
Well, that's interesting.

What IS that?!?
I'm not quite sure. Let me get your doctor or midwife.

All 20 of your visitors are your labor support? Sure.
That's wonderful that you have so many supportive people to help you through labor.

Grandma is drunk. I can smell it from 10 feet away.
Grandma, you look a little tired. Can I show you to our waiting room so you can rest your feet for a bit.

Oh crap! A cord prolapse!
Apparently, the cord is coming out first. This is urgent, and we need to go for a c-section right now. A lot of people are going to be coming in to get you ready, so don't panic. I'll be right here with you.

Oh crap! SHOULDER DYSTOCIA!
We need to get your legs far back and you need to push really hard now, alright?

Oh crap! This is a LOT of bleeding! Why won't it stop???
It appears that you're having some extra bleeding.

Where is the doc when I really need him/her??
The doctor is on his way.

Of course your doctor will be with you all throughout your labor - NOT.
Your nurse is with you for the majority of your labor. The doctor comes in when you're close to the birth.

I have no clue what I'm feeling (during a cervical check).
I can't quite reach your cervix. Do you mind if I have another nurse check?

I hope I never see that again.
Well, that was interesting.

This is the first time I'm doing this.
I've done this lots of times.

What a funny looking kid!
Oh look, he has your eyes!

The call bell needs to be taken away from you. You're on it every 2 minutes!
Is there anything I can get for you?

Your pain is 10/10? Seriously? I don't believe you when you're on the phone and laughing with your "guests".
.....blink blink....... What have you done to help ease your pain?

History of rapid births. Better have everything set up 20 minutes ago!
Tell me when you feel like the baby is coming, I trust you 110%!

She has five kids already, working on #6. And she's not old enough to drink. Hip hip hurray for welfare!
What method of birth control do you plan on using after the baby is born? (Not a normal question when admitting a laboring woman. But very pertinent.) Oh, you haven't thought about that? Let's review your options.........

Aw crap! Another laboring patient. We are packed to the gills with no spare labor rooms. WTF are we doing to do??
Hi there! How can I help you?

Ahhhh, the wheelchair sign. She's either 10 cm or has a closed cervix. I'm betting on the closed cervix.
Hi there! How can I help you?

Ahhhh, the positive towel test. She's definitely ruptured her membranes!
Let's get you into a room right away.

Your doctor is an ass. I wouldn't let him touch me, even if I was dying.
All of his patients seem to really like him.

A multip who is breech, and in active labor at 6 cm, and is sectioned. WTF didn't he deliver her vaginally?!
You should be able to have a VBAC next time, if you choose.

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?

Just how secure are we? Not very.

We have had increasing levels and incidents of violence and robbery in the city that I work in. It's starting to get a little too close to the hospital. Just yesterday, a nurse was robbed at gunpoint by two young men. Luckily, she only lost her purse, and not her life. She was not injured or physically harmed.

Where did it happen? On the short walk to her car. A trip she makes every day.

Working at the hospital, day shift employees (those who start before 1pm) must park in one of the four distant parking lots. They are all a short 5-10 minute walk to the hospital. There are shuttle buses that pick up and drop off employees from the distant parking lots. The parking lots themselves have surveillance cameras and security guards who make their rounds.

However, security is not perfect nor always present. If employees choose to walk to and from the lots (as very, very many do, because there are just not enough shuttles to drive everyone), there is no security because you walk along public streets or through an apartment complex.

And thus, people get mugged and robbed.

It's not the first time, nor will it be the last time that a hospital employee is mugged or robbed.

What does the hospital say about it?

Use the shuttle buses.

Walk in groups to and from your cars.

Call security to escort you to your car.

Who seriously has time for that? I have personally had to wait 30 minutes for a security guard to drive/walk me to my car after the shuttles are done (after midnight). Who in the heck really wants to wait that long after working overtime at the hospital? I can tell you just how dead tired I am after working many of my shifts. The only thing on my mind is to get home and go to sleep.

However, I do value my personal safety, and I waited 30+ minutes for a security escort to my car when I am getting out of work after shuttle hours, and I'm parked in one of the parking lots.

Luckily, if you start work after 1pm, you can park in the parking garage - which is still a 5 minute walk through dark areas of the garage and a tunnel to get to the hospital. Still scary. Still a risk of being mugged or robbed. But at least you're on camera the whole time.

Cars are routinely broken into in the parking garage. The garage is right off of the city street, where people get mugged/robbed/shot/stabbed. It's open to the street, so anyone can be lurking anywhere in the garage (if they know how to avoid the cameras).

Time to buy some pepper spray, and time to stop carrying any credit cards/cash/valuables.