Tuesday, June 29, 2010


I just want to fold this guy up and carry him around in my pocket. 

Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the black and white about mortality rates in the United States.


Monday, June 14, 2010

Quote from another nurse...

"The difference between midwives and doctors is that doctors will blow up your vagina and midwives keep it together."

Isn't that the freaking truth.

Friday, June 11, 2010

I just don't trust em.

My hospital is a teaching hospital which means that we take baby docs and turn them into real docs. Of course, we have a 4 year OB/Gyn program, but my hospital also has a Family Practice program that rotates through OB. You see, if the FP is in a rural area they need to be able to deliver babies if there isn't an OB around- or so they say. My issue is that I have over and over seen the FP docs make dumb errors. Not all of them, some are actually pretty good, but enough errors that I get concerned. For example:

1) A little G1P0 that I pushed to beautifully crowning. Her perineum was generously lubed with mineral oil and I kept my fingers out of her vagina while she was pushing to prevent swelling and tissue injury. The FP doc comes in for delivery (baby is at +3 station when I call for a doc) and she delivers in 2 pushes. I am telling her to breathe, to push just a little, while they are yelling at her to push HARDER and counting to 10. I can SEE her perineum split because there is not a hand there supporting it. 3rd degree repair that this inexperienced doctor sewed up with staff looking over her shoulder. It's just not right.
2) How about the FP that missed the vagina all together and stuck his fingers up her rectum for a vaginal exam. It gets worse, but trust me you really don't want to know.
3) How about the FPs coming into my room while I am pushing my patient. Repeatedly. Seriously, stay the heck out of my room until I call for you. It makes the pt nervous to have people trooping in and out. I will call you when I need you and not a minute before.
4) Baby deceling and an FP not being able to put a scalp electrode on. Move out of the freaking way and let a nurse do it.
5) An FP nicking a bladder during a c/s or a freaking artery. OB is a SURGICAL specialty. Just because you have MD or DO after your name doesn't mean that you should be operating on people.
6) I swear the FP's want to have surgical vaginal deliveries- just so that they can practice. It feels like nearly every FP delivery they are asking for a freaking vacuum.
7) First year FP docs acting snotty towards me. Yeah, I may be a newer nurse but I know what I'm talking about when it comes to birth. Shut the heck up and learn something.
8) First year FP that breaks my baby's clavicle because she pulled up before the anterior shoulder delivered.
9) Grinding their thumb on a pt's clitoris during a vaginal exam. She doesn't have an epidural, watch your freaking thumb.
10) Taking pt after pt that is a high risk patient. Really, you don't need the PIH'er, chronic hypertensive, A2diabetic. Seriously, send that lady to an OB.

There is more, but really I think that you all get the idea. I hate it. I am pro midwives and would never go to an OB/Gyn unless I was high risk for some reason, but at least I know that they won't make some of these really irritating and harmful mistakes.

Now, one good thing.
1) There is one FP doc that ALWAYS writes for a liquid diet (instead of strict NPO) and for the pt to ambulate PRN. I appreciate that. He says that the research supports it, and it does. But this really is the only good thing that I can say about them.

I am NOT anti-FP docs. Heck, the primary doctor for my family is a FP DO, but I don't think that they should be delivering babies. OR, if they are going to deliver babies, they should have the same kind of constraints as CNM's and limit their practice to normal pregnancy and birth. Surgical deliveries, vaginal or otherwise should be moved to an OB, high risk pregnancies should be moved to an OB. And thats all I have to say about that.

Wednesday, June 2, 2010


A friend just told me that her fiancee makes 100k a year (actually she is my bff). He is an AC repairman....
Holy shite! I went to school for how many years? Expose myself to how many pathogens? Have literally saved how many lives?

I probably won't even make that with a freaking DNP.

Don't get me wrong. The last thing that I would want to do with my life is climb through attics in the middle of summer. My exhusband has a job that keeps him in attics and on ladders. Lord knows that is not for me. I just feel that what I do is as specialized and valuable to society as the work of an AC repairman (bless him).

Is it because nursing is still mostly women? The dichotomy between physician salaries and APN's salaries would support that. Of course, full time for me is only 36 hours a week- just three 12 hour shifts....

The feminazi in me is all bristling now. Am I overreacting?

A nice birth...

I walked in yesterday morning to my patient pushing. I always hate to have shift change in the middle of a delivery. Really, this is the thing that I hate the most out of my job in comparison with my life as a doula. As a doula, I was with my client from the time that she thought that she was in labor until many hours postpartum. But, I will admit that if it is the end of a 12 hour shift for me and I know that I have to come in the next morning, I leave if birth is not imminent.

This patient was a 19yo G1 who was being induced for PIH. After a very long induction (cervadil, followed by another cervadil, followed by a balloon, now on 34{!}mu of pitocin). She was also on magnesium sulfate for her B/P. We use Mag for two things in LAD 1) to lower high B/P in someone with PIH and 2) to stop preterm labor. Mag is a smooth muscle relaxer, the vascular system is made of smooth muscle (thus the lowering of B/P) as is the uterus (thus the stopping of contractions in a pretermer). Induction of someone on Mag for PIH is very difficult. It is a dance between having the Mag at a therapeutic level, watching the fluid ins and outs, and having the pitocin at a high enough level that the contractions are adequate to dilate a cervix which may not be ready. I was relieved though to see this little G1 push the baby to +2 with each push! Baby was sucked right back up in between ctx though. She had come a long way by this point, truly against all odds.

Her night nurse was one of my favorite nurses and her care throughout the night was perfect. I did notice a little laceration just with her pushing effort (without my hand in her vagina at all) and proceeded to lube her up with mineral oil. I kept my hands out of her vagina for pushing as she was pushing in just the right spot. I suggested that she reach down and touch the head, she did! She ASKED me for a mirror to watch the birth! She kept pushing and 46 minutes after shift change delivered a beautiful little boy! `He did great btw. After the NI nurses were done with him, I put him immediately skin to skin with mom. She was still in repair. She ended up with a 3rd degree lac which honestly, I was kind of expecting.

She really impressed me. She was adamant about breastfeeding right away, did not want baby to have a bottle at all in the hospital, initially wanted circumcision, but started to question that decision after I told them that circumcision was not recommended by the AAP. She and the FOB were just so open to suggestions. It isn't very often that I have a patient who is so informed at 19 and so open to the process.

One great thing about a patient with PIH is that I get to keep them after they deliver. They stay on L&D on Mag for 24 hours after delivery, which meant that I had her and her family all day. Even in her "Mag'ed out" state (Mag makes women loopey and out of it, like they have the flu) she was still watching the clock to make sure that she nursed her baby every one and half to two hours. Her family was really helpful with the care of the baby.

I had another delivery in my other room later that afternoon. A lovely multip easy birth, but the one that will stick with me was my little G1.

Skin to Skin after a C-Section

Truthfully, one of the things that I hate most about c/sections at my hospital is that skin to skin doesn't happen until women are many hours postpartum. Sure, we chart "skin to skin with mother" and "skin to skin with significant other", but that is basically only saying that they were able to touch the only exposed part of the baby- the face. Should that even be charted? Heck no. I was trained to chart it, but as I am learning about what kind of nurse that I want to be, I am only charting it if they are truly put skin to skin- which never happens in the OR. I saw this link at Woman to Woman Childbirth Education that showed a baby put skin to skin IN THE OR and BREASTFEEDING! Check it out...

A lot of great breastfeeding information as well. But, really HOW can I make this happen at my hospital? I would love it if the babies could go to recovery with the moms instead of being wheeled off to the nursery. I would love it if babies could be skin to skin in the OR. Of course, all of this only if baby is doing well.