Driving to the hospital
last night I wondered what my assignment would be . Would
I be assigned to the nursery where I would be responsible for the
assessment and care of all the babies on the unit, including any
sick ones (not TOO sick, those we send out to a nearby NICU).
Would I have an assignment of postpartum women who I would assess,
assist with breast feeding and newborn care, answer questions, assist
with comfort needs etc. Maybe I would be assigned a labor
patient who could be anywhere in the process of labor and/or delivery
when I pick her up at the start of my shift. Or maybe I will
be in charge and responsible for the triaging of any patients who
are sent in by their doctor/midwife or come in on their own.
These patients could present with any number of issues. That
is the nice thing about working on our unit, the variety!
Arriving on the unit I find that tonight I am to
be in charge. The charge nurse from the previous shift gives
me report on the situation throughout the unit and the patients
presently in triage. Tonight we have 6 postpartum mothers,
two of whom had cesareans today. The 6 infants born to those
mothers are either in the nursery or with their mothers and are
well babies. There is a 7th infant, a boarder baby, who has stayed
with us to receive treatment for an elevated bilirubin level.
There is one woman in active labor, a primip who had an uncomplicated
pregnancy who is presently at 6 cm and can be expected to deliver
on our shift. There is also a 33 week teen primip in the triage
room who says she has had pains all day long but has just now presented
to us for evaluation.
In addition, the charge nurse from the previous shift
tells me that she sent home a multip with ruptured membranes who
was not contracting and who, along with her midwife, made the decision
to go home, rest and come in in the morning if labor hadn't begun
on it's own.
After I got report and checked the assignment to
make sure that all the patients had nurses assigned to them I began
my night. I checked in with the teen mom in triage. The fetal
monitor was showing that she was indeed having contractions.
After consulting with her doctor I started an IV to give her a bolus
of fluids and gave her the first in a series of injections of terbutaline
to, hopefully, stop her contractions. While doing this I need
to explain to her disbelieving boyfriend why it was not safe for
this baby to be born at 33 weeks in addition to explaining the reasons
for the IV and the terbutaline and the expected side effects.
Once that was done I had 30 minutes before the next
injection of terbutaline to check in with the nursery nurse.
All was under control there, I helped her to weigh one of the babies
so he could get out to his mother quickly to be nursed. He
was rooting and sucking on his fist in desperation!
Once that was done I ran down to the section room
to be sure all was set up for a potential CS in case there were
complications with our labor patient. Also, I made sure we
had a birthing room set up for immediate delivery in case that multip
waiting out in the wings decided to come in fully and pushing!
Then I returned to the teen pretermer who was still
having contractions, one more shot of terb, some reassurance that
her racing heart and jittery sensation was normal and off I go again.
This time to check in with the nurse assigned to the labor patient.
Her patient was ready for an epidural, so a call to anesthesia,
paperwork prepared, and meds retrieved from the med cart.
In the meantime the postpartum nurse was having
a problem giving a bolus of morphine through the PCA to one of her
CS patients. Off to help her out and while in the room helped
her to turn the patient for a lung assessment, change the linens,
rub the moms back and tell her how her baby was doing in the nursery.
Back to my patient in triage, still contracting,
yet another shot. Ran to get her some ice water to drink and
assisted her off the monitor so she could make a trip to the bathroom.
Answered a call from the labor nurse&ldots;.her patient
had received her epidural and was now experiencing hypotension and
fetal bradycardia. Ran in there to help anesthesia to give
the required IV meds and to reposition the patient to alleviate
the bradycardia.
When all was stable there, back out to the nurses
station to answer a call from a mom who was having trouble getting
her baby to latch on. A quick check with the pretermer in
triage showed that she was no longer contracting so off I went to
help with breastfeeding.
The baby truly wasn't rooting or latching and the
mom had been trying without much success to nurse this infant all
day long. Off I go to obtain a breastpump for her so she can
pump and feed the infant the pumped colostrum. Education is
a big part of my job so I spend quite a bit of time teaching this
mom about pumping, breast massage, treatment for sore nipples and
finger feeding the infant.
Answering the phone I find out that the multip with
the ruptured membranes started contracting almost as soon as she
got home and was now having contractions only 2 minutes apart.
I tell her to come on in and I call her midwife to alert her that
the patient is on her way. The midwife tells me that she is
not at home and has a 20 minute drive to the hospital, she says
she will hurry.
Almost as soon as I get off the phone with the midwife,
the phone rings again&ldots;..it is admitting telling me that the
multip is here. I send the postpartum nurse down to get her
while I check again on my pretermer. She is still not contracting.
She and her boyfriend have settled in and are dozing comfortably.
The multip arrives on the unit looking extremely
uncomfortable. We get her into a birthing bed and while putting
her on the monitor she says that she feels a lot of pressure.
On examination I find her to be fully dilated and during a contraction
I find that the baby is coming quickly. The postpartum nurse
and I race to set things up so we are prepared for the arrival of
this baby all the while trying to look calm ourselves and reassure
the parents that all is well and, "sure, it's okay to push"!!
Three pushes later the baby's head is out, then the
body. We clamp the cord, the father cuts it and we hand the
baby to the mother just as the midwife is rushing in the door.
She drove 80 miles an hour the whole way and still didn't make it!!
The mother is thrilled, the baby is crying lustily and all is well.
PHEW!
The labor nurse tells me that her patient is sleeping
comfortably with her epidural and at last exam was 8 cm dilated.
She expects her to be pushing soon.
Back to the pumping mom to see how she is doing.
She has managed to pump a half an ounce of colostrum and is happily
finger feeding it to her newborn. All is well there.
Back to the pretermer, still napping and not contracting,
hooray!
Looks like I might have a moment to take a breather,
so I go in to the nursery to offer to feed one of the bottlefed
babies. I get to spend a pleasant 20 minutes rocking a beautiful
baby girl as she happily drinks her bottle. Once she is burped,
changed, swaddled and settled into her crib I decide to check on
my pretermer again.
Still no contractions, a quick call to her doctor
and the order is given to discharge her to home. I give her
extensive instructions on what to look for and what to contact us
for and I make her very happy by removing her IV and letting her
go home.
Now, however, the midwife tells me that there is
another patient coming in who may be in labor. In the meantime
I get a call from the labor nurse that her patient is pushing.
I hope that I won't be too tied up with the new patient coming in
to be available to assist at the delivery. I consult with
the postpartum nurse who says she thinks that she will be available
to help if I am not.
The new patient arrives. She doesn't look too
uncomfortable but she is very anxious and has lots of questions.
The midwife and I spend a lot of time providing comfort and reassurance
and answering the concerns of both parents while we assess her to
determine whether or not she is in labor. She says she was
2 cm at her last doctor visit, she is full term and has no pregnancy
complications. After assessing her we find that she is now
3 cm dilated, contracting about every 5 minutes and her membranes
are intact. I begin the process of admitting her as a labor
patient. We get her settled into a birthing room and the midwife
plans to assist her as she heads for the whirlpool tub for comfort.
This is great timing, because the labor nurse calls
for a second nurse to assist her. This means that she expects
her patient to deliver momentarily. In the birthing room I
check to be sure that the warming bed is on as is the suction and
O2, and I check the resuscitation equipment. The infant
is born, lifted onto the mothers abdomen but is not crying.
The doctor is bulb suctioning the baby's mouth and nose but still
no response. The labor nurse and I briskly rub the newborns back
and feet in an attempt to stimulate respiratory effort. There
is still no response. We explain to mom that we are taking the baby
for a moment to help him breathe and bring him over to the warming
bed. I begin using an ambubag on the infant while the labor
nurse listens for the heart tones and continues to stimulate the
infant. After a few anxious moments the baby begins to cry.
We discontinue bagging the baby and place O2 tubing by the baby's
nose to help him to pink up. The infant begins to cry lustily,
pees all over us and the parents begin to cry with relief and amusement
at their son's aim!! Shortly after the infant is back in the
mothers arms rooting for her breast and I am back at the nurse's
station.
All seems quiet. The postpartum nurse has started
doing her morning blood draws and finishing her paperwork.
The nursery nurse is drawing a morning bilirubin level on the boarder
baby and the labor nurse is out at the desk doing paperwork to allow
the parents some private bonding time with their baby.
I glance toward the window and see that the sun is
coming up. The day shift will be arriving shortly; we can all go
home and sleep. And tonight I will be back in for a whole
new, but equally exciting experience.
Doesn't it sound like something you want to do?
If you are interested in OB nursing make an appointment with the
manager of the OB unit on which you would like to work and find
out what their requirements are for hiring. You may find that
they require a specified amount of med-surg experience before they
will consider you for hiring. Or you may find that there are ways
to get your foot in the door even if there are currently no positions
available.
I would encourage anyone interested to look into this
exciting and rewarding field.
About
the Author
Karen
Ianacone, RN, MA, CCE
Karen
is a staff RN on a LDRP unit at a community hospital doing 900+
births per year. She is also certified childbirth educator
teaching classes in Prepared Childbirth, Newborn Care, Review/VBAC,
Early Pregnancy and more. The author's education includes
a Bachelor's degree in Developmental Psychology and a Master's in
Community Psychology. Visit Karen's website designed to supplement
traditional prepared childbirth classes: BirthandBeyond
or
e-mail at: djianacone@snet.net
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