More learning going on here...I wish I could post the whole power points for you on some of these subjects for there has been so much information to share...but I'm going to give you the very short version so that this post doesn't get way out of hand ~
The first session of the day was on postpartum cardiomyopathy. A women's heart has more work to do during pregnancy. And some hearts do not tolerate all of the changes in blood volume and extra demands on the heart. The outcomes are tragic as the symptoms of heart disease are often missed in pregnant women. All I will say is that my patients who come in with shortness of breath and a fast heartrate will certainly be checked a little more fully by me (I've already had the chance to ask a doctor for an EKG and an echocardiogram on a patient that had previously had a heart valve replacement)
The second lecture of the day was on postpartum hemorrhage. I didn't learn a whole lot of new information from this lecture for we already have a bleeding algorithm where I work and bleeding orders. Ours are very similar to the ones we saw in the lecture today. Basically you need to have a system in place to handle a hemorrhage ~ for pregnant women can bleed fast and bleed alot. We came in to the lecture to find this on our table:
Only at an obstetrical conference - RIGHT? Can you guess how much blood loss this is??
It is 150ml.
Not really alot. The most important thing is that you need to weigh the loss. 1gm = 1ml of blood loss. We can't just 'quesstimate' as has been done in the past for it is frequently underestimated and by the time we realize something is going on and it can be too late to give appropriate treatment.
After lunch we learned about delayed cord clamping. Delaying the clamping of the cord would give the baby a little extra boost of it's own blood and this may be beneficial.
Here are a few points from the lecture:
• 80 mls of blood gets transferred in the first minute,and 100 mls by 3 minutes after birth
• This blood supplies extra iron of 40-50 mg/kg
• Term infants are born with approximately 75 mg/kg so this increases the total iron to 115- 125 mg/kg
• WHO ( 2012)
• Increase of cerebral blood flow
• Better perfusion and circulation to the gut
• Increased blood pressure
• Increased hematocrit, hemoglobin levels and ferritin
• Decreased iron-deficiency anemia
• Increased duration of breastfeeding
World re-known, Penny Simkin does a good job of explaining the concept:
Know more about labor and birth now then you ever wanted to know?
I actually like attending OB conferences...I always learn so much and I like connecting with old friends and making new ones. And those that attend conferences often have common goals and interests which makes talking and networking pretty easy.
I try to make it like a mini vacation, yes, it is work related but I like getting away to a different city and staying in a hotel. I like trying the local food and doing some touristy type things.
Back to the conference though~
Our first speaker, Dolores Aguilar talked about Centering in Pregnancy. She is from northern California and does group appointments for her pregnant patients. It is a new way of giving care where women learn about their health, are taken care of, are provided with education and form a support group with the other pregnant women. It is quite a novel thought. I then had lunch with Dolores...what a sweet natured woman. And she is really making a difference for her patients. You can learn about the Centering in pregnancy model by clicking here.
Then I heard about Assessing Women's Coping in labor. Instead of always asking about a women's pain in labor (yes, they are going to have pain), we should be asking and assessing how well they are coping with that pain. Maybe we need to quit bringing up their pain and instead help them work through that pain. Here is the algorithm for the coping scale.
The next speaker talked about skin to skin in the operating room. We do lots of skin to skin where I work. The babies are born and go right up on to the mom. Any medications and assessments are done while the baby is with mom. The bath is not giving till hours later. Skin to skin is important for it increases bonding and helps with breastfeeding.
Our c/section patients get to see the baby and touch the baby but the dad does most of the holding in the operating room...once the mother is in the recovery room then the baby is placed skin to skin. Our babies do not go to the nursery for a routine exam as is done in many hospitals but stays in the recovery room with the mother (as long as both patients are stable). We try to keep the delivery family centered as much as possible, whether that be a vaginal delivery or a c/section.
But, the new info from this lecture was that babies should be able to go skin to skin in the operating room too. Impossible ~ no...but it would take some adjusting and convincing of doctors that it could be done.
Watch this cool video to see how it is done. It is a bit long but worth the watch. Remember to turn off my playlist so the two sounds don't compete for your attention. Warning it is a bit graphic (cool to me, but if you aren't used to the blood it may be hard for you).
The blurb from the you tube site:
"Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a 'natural' approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide."
Our last speaker of the day, Tiffany Montgomery, was so funny. She has quite a sense of humor and was so easy to listen to. She was speaking on "Protecting Mom's and Babies, How to take Legislative Action". Now I have never been one to get involved in political things...but she actually made it sound pretty fun. She taught us how to write letters to our legislative leaders and encouraged us to get involved to make a difference. Did you know there are nurses in congress? Well, people that were nurses before they became congress women. Tiffany even travels to Washington, D.C to support certain bills and speak to the House. She lives an exciting life!
A couple of the bills that are on the floor right now are related to women's health and newborns.
There is one for supporting preterm infants - The PREEMIE Act:
Preterm birth is the leading cause of neonatal death. In an effort to better understand preterm birth and improve the health of millions of newborns, Congress passed the PREEMIE Act in 2006. The law expands research and other federal activities related to prematurity. The PREEMIE Act of 2006 must be reauthorized. Email your Representative and Senators and ask them to support the health of newborns by co-sponsoring the PREEMIE Reauthorization Act of 2011 (S. 1440/ H.R. 2679).
One to combat Maternal Mortality:
Women in the United States face a greater risk of dying from pregnancy-related causes than women in 49 other countries. The Maternal Health Accountability Act of 2011 (H.R. 894) would provide grant funding to better understand and combat maternal mortality and morbidity
And one for breastfeeding promotion.
Breastfeeding is the optimal form of infant nutrition. Help ensure that more moms can continue to breastfeed their babies after they return to work. Email your Representative and Senators and them to co-sponsor the Breastfeeding Promotion Act of 2011 (H.R. 2758/S. 1463).
The AWHONN site actually has a page where you can click on a form letter to send to your lawmakers. It is super easy. If these are things that are important to you then click on the AWHONN site and send those letters. You do not have to be an AWHONN member to send the letters (but they do say you are a nurse, so you may have to change the wording a bit if you aren't one). I told you that she made getting involved fun. It is all about awareness.
This was just a quick snapshot of the conference. So much to learn about!
I am a big reader.
I always have a book with me - rather it be a simple pleasure reading book or a more serious bibliography type book or lifestyle change book. In fact ~ in the days before I went back to school, I belonged to a book club and that was a great way to discover new authors or read books that maybe I wouldn't have chosen. When I travel, I always take more than one book with me and love to go to bookstores in different cities. Now that I am busy with school I have less time for pleasure reading. Most of my spare time is spent reading textbooks, yet I make sure to carve out time to pleasure read almost every day. I'd much rather read a good book than watch TV. But I don't often talk about the books that I am reading. Today, I am going to break that trend...
A friend of mine from work recommended this book to me:
If you are a dog owner, or simply a dog lover then you have to read this book!
It flows easily and speaks to the relationship of man (woman) and their dogs. It is written from the viewpoint of the dog...and talks about how a dog can save a person and vice-versa how people can save dogs. The dog in the book tries to figure out what his real purpose is ~ and mostly finds that his purpose is to love his humans (and in turn the humans love him). This is one of the best books that I have read in awhile. I can totally see my dog narrating this and doing all he can to please me. It is one of those books that I just want to "read a few more pages" before I put it down.
Thanks Kim for suggesting this! As a fellow dog lover, I can see why you thought it was worth reading.
My room is so quiet...There is no one here but little ole me and it is kinda weird.
I'm used to semi-chaos. For years my home was filled with chidren and their friends. As they grew things changed and I found myself home alone more frequently. Well, that is except for the dogs and the whiny cat. So, it is never completely quiet and I always have 'things' to do.
Today, I drove down to San Diego. By myself. It was a lovely, sunny drive. Then I checked in to a hotel and spent some time alone.
I am attending the California chapter AWHONN meeting. I saw a couple of old friends earlier. They invited me to go along on a trolley ride with them but I declined.
I chose to come down early and just relax for a day...I went to the mall, grabbed dinner, finished reading a book, came back to my room and called it a night by 7 pm. After a nice warm bath and hot cup of tea I have been watching what ever I want to on T.V. It is fun...just different...I guess I am not used to being totally alone.
Tomorrow I will be surrounded by L&D and NICU nurses. We will be learning all about new trends in the OB world. And I will be more social tomorrow, I will network and learn all I can in the hopes of taking something back to my workplace.
For tonight, I will just relish in this quiet weirdness and watch a good movie!
Debbie
We tried out a new church. Actually, my daughter, Erika came home for the weekend and asked if we wanted to go to church with her. So we did. She has been attending Rock Harbor Orange. It is a 'younger' church than ours with more contempory music and a different feel than our church. They meet at Orange high school in the multipurpose room and they are already outgrowing that space. The church is a plant from the main Rock Harbor in Costa Mesa. Erika has been going there for awhile. She started going while she was a student at Biola. Her boyfriend's brother is one of the main pastors. We went to hear Matt preach...but he didn't preach that day... guess we will have to go back again.
The pastor that did speak, spoke on MOTIVATION...
and that was something I guess I needed...
What is your motivation??
What drives you to get up each day?
What helps you to get through the mundane stuff you do every day?
Is it Jesus?
I've had to stop a look at my life and ask myself why I do the things I do. Why do I desire to make a difference? Why do I work so hard? What is it that drives me?
I need to be more intentional. I need to have more purpose. I don't want to be complaincent and just get up and go to work because I have to. I want others to look at me and see a difference. See a real purpose. Haggai 1:5-7 5. Now therefore, thus says the LORD of hosts, "Consider your ways! 6. "You have sown much, but harvest little; you eat, but there is not enough to be satisfied; you drink, but there is not enough to become drunk; you put on clothing, but no one is warm enough; and he who earns, earns wages to put into a purse with holes." 7. Thus says the LORD of hosts, "Consider your ways!
I know that I can't be that kind of intentional type person on my own. I will need to be in relationship with Jesus. In order to be purposeful, I need Him... Zechariah 4:6Then he answered and said to me, "This is the word of the LORD to Zerubbabel saying, 'Not by might nor by power, but by My Spirit,' says the LORD of hosts.
I want to be different, set apart, distinct. I peter 1:13-1513. Therefore, gird your minds for action, keep sober in spirit, fix your hope completely on the grace to be brought to you at the revelation of Jesus Christ. 14. As obedient children, do not be conformed to the former lusts which were yours in your ignorance, 15. but like the Holy One who called you, be holy yourselves also in all your behavior.
I want to have real motivation, real purpose.
I need to be able to use my platform - what ever that platform is. I need to be open to being used by God where ever he has me planted. Whether it be here on this blog, at work, at school or with my family and friends. To purpose to be different. To have real motivation. To purpose to be set apart so that I can really make a difference...
Debbie
I like it when moms are brave enough to say no to elective inductions and wait for natural labor.
To me, it is the way birth should be - when the baby is ready. It is a joy to be with a mom as she works through her labor, getting up and about, monitoring as needed, showering for comfort or pain medication if that is what the patient wants.
The bag of water breaks on its own.
Labor progresses smoothly - up to the point that the patient is completely dilated and starts pushing as her body is telling her to do.
The fetal head moves down.
Pushing is short lived (I hate those 2-3 hour pushing marathons)...and with each push the head is closer and closer to being delivered.
I call for the doctor and he comes in as the baby is crowning.
The head comes out with the next push...I think to myself, "What a nice delivery".
Then the doctor says, "Put her legs back!"
Oh great...my nice normal delivery is not happening! The babies shoulders are STUCK!
So as the nurse, I do my job...I call for help, ask for a STAT pediatrician page, put the head of the bed down and flex the mom's legs way back.
That doesn't work.
The doctor tries rotating the baby, I give suprapubic pressure, the family freaks out, we call out for a second OB.
When finally the stuck shoulder releases and the baby comes out....that 60-90 seconds sure seems like a life time.
The baby needs some resusciation but in the end is just fine, with no signs of trauma and goes skin to skin with his mother.
I have decided that shoulder dystocia deliveries are my least favorite deliveries!!! I want to cry right along with the family. Thank God, I don't have to do these very often.
Simulation delivery (how we practice for emergencies) and it isn't as crazy as watching the real thing:
Be sure to silence my music playlist below.
I better get a "normal" delivery the next time I work!
Debbie
February tends to be a slow month for our unit. It is the perfect time to throw in our yearly skills day and to catch up on things. Traditionally there seem to be fewer babies made in May ~ hence fewer deliveries in February (other slower months for labor and delivery are late October and November).
Yet, this year that trend is not holding true for us. We seem to be busier than ever! I haven't decided if it is because we are truly doing more deliveries or that we have less staff. Some area hospitals have closed their L&D departments and that may be impacting us too. We are one of the few units in the hospital that is still hiring. We just added 3 new 'experienced' nurses who just need to be trained to the L&D piece and we are looking at adding 4 or 5 new grads for an upcoming internship. (Any one want a job???) Hopefully this will help!
I do know is that we are running 12-15 patients at any given time right now. (not counting our longer term antepartum patients). Yesterday was the first time in a long time that I saw a measly 7 patients on the board at a given time. We still did 11 deliveries though on my shift alone. It is hard to get up and go to work when you know that you are going to be running around and never getting a moment to just socialize with your patients. Ok - maybe work isn't about socializing, but I like sitting with my patients, just chatting with my them :) I like learning about my patients. Things like ~ one of my patients is a lawyer that works with underprivileged women and does international work fighting women trafficking. If I didn't have time to just "be" with her I'd never have found that out. And who knows when I may need to refer someone to her services??
To add to the over all busyness of the unit....we added on a new computer charting system this week. We already use one for our laboring mom's and now we are adding a hospital wide charting system for the baby and the mom post delivery. What a learning curve!! The system is not very user friendly. I Say that as someone who is actually some what computer savvy....the system is just cumbersome...takes about 10 clicks just to get in to it to chart. UGH!! It is easy once you are in but getting there is a bit overwhelming. I know that we will adjust and we need to tweak some of it but it really came at a bad time. Add in the ongoing construction on the unit and we are about to throw in the towel....I've even had recent conversation with my husband about trying to cut back to part time. But for now I don't think that is happening. Management would never approve that at the moment :(
Yet, I do love my job. As much as we complain, the majority of us wouldn't do anything else. It is sort of an addiction. I love being there when a new little one arrives. I love meeting up with former patients and snuggling with their babies. It just feels good to help someone have the delivery that they want. It may be a challenge at times to get that 'perfect' delivery but every one is special. The labor is worth the effort. How many people can say they work all day and have results like this?? A baby that comes out with a lusty cry and a smile on his face...ever see a newborn smile?
That is why I keep going back. So that I can be one of the first to meet a precious new baby. Like Sweet little Austin. He arrived earlier this week. His mother asked me to take care of her. She lived by me a few years back and we have stayed friends. I've been able to play a part in all four of her deliveries. It is a special time when you can be there for someone that you know and I think it helps to put everyone at ease. We had a good time catching up and it reconfirmed for me that even in these crazy busy days I want to stay working as a labor and delivery nurse.
Debbie
I've a big school project to work on. I need to sit down and just get it done! It is a teaching tool on Potter's Syndrome (a condition where the baby lacks kidney function or has no kidney's). I really need to focus and just conquer it. But I am having a hard time getting it going. I'm having a hard time focusing. I can't sit still for long for I threw my back out at work this week. I think it is just muscular strain and I am trying to take it easy. It hurst every time I move. It is hard sitting in a chair for long yet I really need to get this project done.
Oh My...
I've never been one to celebrate too much on Valentines day. I'm sensitive to all of my single friends ~ having walked that path for so long myself. It just seems like a day that hurts those that don't have a "valentine". I used to choose to work so that those who wanted off could be home with their loved ones. I had no one special, so work was just easier.
I did enjoy the day as a child. It was fun doing all of those cheap little cards with a candy attached to it for all of the other boys and girls in my class. And I loved coming home and opening all of mine. I just loved the cards, loved the paper and seeing the types of cards others chose to send. I'd open them and reopen for days on end. In fact, I still love the old fashioned paper card over an email any day...
As my children were growing I tried to make the day fun for them (even if I didn't feel like celebrating). I'd help them make their cards. I'd wear red, have them wear red and we'd talk about love and family. I'd plan an all red dinner - spaghetti, red jello, cranberry juice, whatever...as long as it was red. It helped to have them to fuss over. Our family might have been broken by some people's definition, but we had each other and that is all that matters. I was devoted to my children. I was devoted to raising them by myself and tried to give them traditions and memories. It wasn't always easy, but I tried none the less. The children became my valentines and that is OK. My heart might have been a little bruised and broken, but I had my children, we had each other, we had a home, and friends and extended family. So there was still love to be found ~
I faced today with mixed emotions. I am remarried now. You'd think I'd want to make a fuss over Valentine's day. Sort of make up for all of the years when there was no one to celebrate with. But, I just don't like the idea of trying to go to dinner in the crowds. I don't like the fact that many restaurants have "special valentines meals" instead of a regular full service menu. I hate the fact that flowers are 3x more expensive then on any other day. My poor husband knows not to send me flowers on February 14th...any other day is ok...just not today because they cost too much!! I'd rather be spoiled 'just because' then caving to marketing pressures.
I was having a hard time getting in to the spirit of the day. Everyone kept asking, "what are you doing for Valentine's Day?" I struggled to answer. Then finally just decided that it was ok not to go all out.
It is ok to celebrate on the weekend when we can order what we want and the flowers cost less. HA!
I was talking with my husband about it the other night. Trying to explain how we don't need to celebrate. Then it dawned on me that he likes to spoil me. He likes to buy a mushy card and wants to be able to tell his friends what we did. He wants to be able to make the day fun. He also went many years without a 'special' someone so to him it is a day to show his love. Not that we don't try to show it every day. But to him it is a fun excuse to celebrate each other. So...I went out and bought him a new Apple nano touch...
I think he was surprised for he wasn't expecting anything. And I will admit that it was kinda fun being able to surprise him.
I got to sleep in this morning which is what I wanted more than anything in the world right now. Buzz got up and moved the cars for street sweeping day and then left the house so it would be quiet. Now to me that was a great gift in and of itself! I got up to find baby pink roses and almond roca (one of my favorite candies) waiting on the table for me. Buzz had also given me a heart shaped box of chocolates from See's candy last week...but we ate that pretty quick. He couldn't save it for today and I wanted to eat it while it was fresh. HA! So, I refilled the box for Michelle since she said that she has never received a heart shaped box of candy. And I bought Erika a pair of pants (I know, random Valentines gift!)
We did not go out to dinner. I did not get an expensive vase of roses. We did not spend the day together. In fact I didn't do much of anything today. And I am perfectly content with that. Buzz worked and I had school. I did enjoy the day though and will say that I am not quite as anti-Valentines day as I once was. I even made little cards with a chocolate heart on it for all my classmates tonight. And, we got out of class early!!!
Learn all you can to live a heart healthy life style.
Now on to those babies...
Since I work in a high risk labor and delivery unit, I see my share of babies born with heart defects. What a stressful way to start parenthood...with a baby that is sick from the get go. These parents need a ton of support and their babies need specialized care.
Did you know that:
Congenital heart defects affect about 35,000 (1 out of every 125) babies each year in the United States.
Heart defects are the most common birth defects
Congenital heart defects originated in early pregnancy
Heart defects are the leading cause of birth defect related deaths.
Advances in technology and surgical treatment have led to dramatic increases in survival
Two good sites to learn more about congenital heart disease are
