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Some tips from a labor & delivery unit *added a few more*


Forum: May 2012 Playroom

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  #1  
February 29th, 2012, 04:14 PM
LindseyB's Avatar Mega Super Mommy
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I thought it would be fun to post a thread where I can post some things that I personally did not know while I was pregnant with DD, but learned in L&D.


-Many women have a "forebag" of water that for some reason forms near your cervix but is not attached to the baby whatsoever. Alot of times, this will break and it will be only a small amount of fluid with no other fluid afterwards. This will show up on the nitrazine/amnisure/ferning (whatever your hospital uses) tests that we use to test for amniotic fluid. We still consider this the time of rupture for our records, and we keep them, but technically we still have to "break" your water later on or wait until the real bag of water ruptures. We can usually tell with a vag exam whether it was a forebag that broke, or the real deal because it feels very different with a bag intact.


-Group B strep is NOT something that you can "catch" as many of my patients ask me. Its just a normal bacteria that "lives" in your vagina/rectal region that is not harmful to you whatsoever, but can be pretty rough on babies passing through it. The first dose of antibiotics is the only one you need, as long as it has been in for 4 hours before delivery. At our hospital at least, if you had it with a previous pregnancy you get treated with subsequent ones regardless.

-Heart rate decels happen during labor, period. There are what we call "early" decels which just tells us the head is being compressed and only occurs during a contraction. We like to see these.

There are "variable" decels, which means the cord is compressed somewhere and they live up to their name. They can happen with or without a contraction. These aren't necessarily bad unless baby starts having a hard time recovering from them. If they're severe, we will replace the amniotic fluid with a tube and this is called an amnioinfusion. Lactated Ringers (same as in your IV to hydrate) is what is used..works pretty well. Whether you knew it or not, your baby probably had lots of these decels during pushing and delivery, but at that point its not too much to worry about.

Then there are "late" decels. These are decelerations of the heart rate that start after the peak of the contraction, and they're a placental issue. For some reason, baby is not getting enough blood flow during a contraction and these are the decels that can warrant a c-section if they can't be resolved. So, if youre in labor and a nurse (or group of nurses) comes in and puts oxygen on you, flips your bed up to where your feet are above your head, and flips you on your side, this is probably what you are having. Again, these don't bother us much either unless we can't get them to go away and they are consistent with each contraction.

-I tell my patients babies are like boxers. They can take so many hits (i.e decels/long contractions/etc) and do fine, but eventually they get worn down and their oxygen supply gets used up. Sometimes supplemental oxygen will help, but not always. There ARE cases where a c-section is needed, but alot of times its the doctor thats getting nervous. This annoys labor nurses and patients alike,especially if the patient is close to delivery.

-Sometimes babies have a hard time transitioning to the outside world. That doesn't mean your baby is "sick" or there is anything wrong, but its a natural process and the baby has to figure it out. Its our job as nurses to help them a little, but let them do it on their own if they can.

-Meconium. Most of you I'm sure know what this is, but I didn't when I had DD and I had meconium fluid so I'll talk about it anyway. Meconium fluid is when your baby has their first bowel movement before birth, usually due to a stressor of some sort where they had a lack of oxygen. This could be continuous contracting, cord compression, etc.
If your water breaks at home, pay attention to the color and odor. Most assume that their amniotic fluid will be clear, but it usually has some color to it. It can be very light yellow, which is fine. It can be varying shades of green (meconium) and the shade of green tells us how long ago the baby passed it into the fluid. It can be brownish, pink, red, bloody, etc. Its important to note the color, even though we will see more of it later when you get to the hospital.
Meconium is something no nurse likes to see, but its fine the majority of the time. If the baby comes out vigorous and crying, we don't do anything about it. If the baby comes out quiet and hasn't cried, we tried to prevent any stimulation that will cause crying before they suck it down into their lungs.

-The only time I ever see an epidural causing problems for the baby is the blood pressure drop that can happen right after the epidural is in place and running. Thats why we give you extra fluid (at least 1 liter) before anesthesia starts. Most of the time, even if it drops, its not enough to affect your baby. The IV medication we give (Nubain) makes your baby sleepy as well as you, so I'd rather have an epidural than that in case labor is rapid. If given close to delivery, which we try not to do, the baby may be pretty sleepy.

-Sometimes it's a tight rope to walk especially during day shift trying to be both a good nurse and labor support person. There is tons of paperwork to do (every 15-30 minutes) and if the unit is busy with only 3 nurses, don't hate us if we can't be in your room as much as we would like to. On a typical day at my job, we have more than 2 laboring, a c-section happening (which requires at least 1 nurse) and 10+ outpatients coming in for NSTs, ultrasounds, labor checks, SROM checks (think their water broke), etc. It can be hard to balance with 3-4 nurses, but we try to do it. We only allow RNs to work, so we don't get the help from LPNs and CNAs that other units get. Oh, and the phone rings every 2 minutes it seems like.

-If you have a history of drugs, we have to drug test you. It's nothing personal, but anesthesia requires it if you want an epidural, and the nursery usually wants to know as well. We get lots of surprises, unfortunately.

-You can refuse anything that you want. I would love it if my patients would refuse to stay in bed hooked up more often. Honestly, thats less charting for me if nothing else, except I worry the whole time about what your baby is doing. Policy states we don't let anyone in the jacuzzi if they're on pitocin, but if you're comfortable stopping the pitocin to get in the tub, by all means. Doctors hate it when patients don't "follow the rules" but nurses love it. Mostly we like telling the doctors how its going to be, instead of the other way around. HAHA. Nurses don't like pitocin much either, but it can come in handy.

-We hear it all and we see it all, so don't worry about any tattoos or birthmarks or cysts or whatnot you might have down there.

-We do prefer that our patients shave but mostly because it gets reallllyyyy mucousy down there during active labor/transitioning and nothing grosses me out more than trying to get that stuff out of pubic hair. Especially pregnant, makes me want to gag because its soooo stringgyyyyyy and sticky. Yuck. Alot of people lose their mucus plug at delivery, even if they lost part of it weeks ago.


-Vag exams hurt, we know. We try to limit them just for pain and infection risk reasons but if you are curious and want to be checked again 10 minutes after you are checked, that doesn't bother us. You know your body best, and alot can happen in 10 minutes where a cervix is involved.





Thats all i can think of but ill keep adding to the thread. I'm sure I'll think of a funny story or tip later
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Last edited by LindseyB; March 2nd, 2012 at 07:36 AM.
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  #2  
February 29th, 2012, 04:24 PM
Bella_Luna's Avatar Platinum Supermommy
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This is a great thread. A lot of this stuff I didn't know! I have a huge appreciation for L&D nurses after giving birth. The nurse who was on at the time that I was in transition/delivering was a saint. She stayed with me and held my hand, telling me how to breathe and keep calm when things were really intense and they couldn't get the epidural in. Oh, and DF had frozen in panic so he was good for nothing. She took over like it was nothing and I swear I must have fractured her hand I squeezed it so hard. Looking forward to more tips!
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  #3  
February 29th, 2012, 05:12 PM
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Lindsey, thanks so much!
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  #4  
February 29th, 2012, 05:20 PM
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Great info, Lindsey!
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  #5  
February 29th, 2012, 05:24 PM
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I love inside information!!! I always felt like my nurses were my cheering squad and the doctor did so little really. I'm glad to hear all the info from someone that deals with birth everyday! Thanks!
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  #6  
February 29th, 2012, 06:01 PM
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Amazing! Thank you so much for sharing all of this
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  #7  
February 29th, 2012, 06:07 PM
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Awesome info~!!! I think it sounds so fascinating! I would love to do that for a living
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  #8  
February 29th, 2012, 06:13 PM
rmarie9509's Avatar Liam's Mommy
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this is awesome Im going to ask my mom if she has any inside tips she was an LD nurse for 20 years!
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  #9  
February 29th, 2012, 07:23 PM
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Great, now I feel pressure to try and figure out how to shave my junk

I made Mike help me last time
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  #10  
February 29th, 2012, 07:45 PM
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It doesn't need to be bald ir anything just tidy is better. Short hair dsnt bother us at all its the ones that are long. I always say theyre letting it "grow wild and free" lol
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  #11  
February 29th, 2012, 07:50 PM
.:fearless:.'s Avatar Platinum Supermommy
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hahaha, I was kidding. I can't stand when it's "not taken care of". I used to be an every other day kinda girl...thennnn it went to once a week...now I am at like twice a month. Sigh. Drives me nuts. LOL
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  #12  
February 29th, 2012, 08:11 PM
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Love this! Thanks for sharing! Nurses work SO hard and seem to have to fill so many shoes at the same time.
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  #13  
February 29th, 2012, 09:38 PM
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Great info! Thanks.
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  #14  
March 1st, 2012, 04:43 AM
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Great info. Thanks for sharing...

Any tips for Twin deliveries? Not sure if I'll have a vaginal or section. I'll like to try vaginal if there is no problems with the twins.
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  #15  
March 1st, 2012, 05:40 AM
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Quote:
Originally Posted by LindseyB View Post
It doesn't need to be bald ir anything just tidy is better. Short hair dsnt bother us at all its the ones that are long. I always say theyre letting it "grow wild and free" lol
Freaked me out to..lol
I use to be bald when I was younger down there and DH said he did not like that and he wanted some hair. So now I just keep it super short. But I do remember it was longer than I liked with DD but I could not see what I was doing and had a hard time reaching under the belly.
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  #16  
March 1st, 2012, 05:41 AM
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Great info! Thanks!!! Even with having had 2 babies; you covered some things I didn't know/had forgotten. And it is SO exciting that we will be experiencing this in a very short little while!
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  #17  
March 1st, 2012, 06:02 AM
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Great info. Thanks for sharing. I just love having a labor and delivery nurse in our group!!
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  #18  
March 1st, 2012, 06:11 AM
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Thank you so much for sharing!!! Being a first timer it really helps!!
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  #19  
March 1st, 2012, 06:20 AM
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Quote:
Originally Posted by .:fearless:. View Post
Great, now I feel pressure to try and figure out how to shave my junk

I made Mike help me last time
Teehee, I made Aaron do it too but it backfired! He found like three GREYS!! Gaaahhh!!!
Thanks so much for the info, it's so nice to have someone on the 'inside', lol!!
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  #20  
March 1st, 2012, 07:45 AM
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Thank you so much for sharing! I know the L&D nurses are what made my first birth experience a wonderful time (it definatly wasn't the doctor ).
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