April 27, 2010

Whew, what a week!

Sorry, this is probably a long one.
I am back and let me tell you, I am exhausted. New Orleans was fabulous. The conference was very educational. The first day was on advanced fetal monitoring. I had taken a course shortly after I started working in L&D but it wasn't quite as in depth as this one was. It was very educational. The second day was about legal issues and litigation in Obstetrics. They had a trial lawyer who specializes in birth injury and a legal nurse consultant there to speak. After that day, I considered turning in my nursing license and going to work at the mall. It's scary stuff. But I do think that every nurse that works L&D should go to a conference like this. Like I said, it was very informative. In June, we're going to give an inservice to our department with a few other people who are attending this workshop in Chicago. I think we may actually change our pitocin protocol!!!!!! YEAH!!!! That was the biggest issue they talked about: the abuse of pitocin in the country. Our standing orders for induction/augmentation say to start at 1 munit and increase by 1 every 15 minutes until in adequate labor. The docs want the contractions every 2 minutes - that doesn't give the baby much time to recover after a contraction before the next begins. And sometimes in the second stage of labor when contractions should space a bit while mom is pushing, they will ask us to start pit because they want the contractions closer so they can get the baby delivered and be done. Big no no. It was recommended that pitocin only be used as a stimulant: stop the pit after mom is 4-5 cm. And there should be at least 60 if not 90 seconds of rest between contractions. It takes the baby 90 seconds to recover from the contraction. And we should not be starting pit if mom is contracting and making maybe slow change. There's no need, her body is working. And this whole attitude of increasing pit even if the baby isn't reactive because why pit them if we aren't' going to be aggressive attitude has to stop. I've never been one to increase my pit aggressively and I have never increased it (or started it for that matter) if the baby wasn't reactive. So many things that we do day to day are dangerous. I am very happy that we are working toward a better solution. We will probably start working with the other hospital in town so we both have the same policy. One nurse at this conference said they have a pitocin checklist. Every 30 minutes, they have to run down this list and if every single criteria isn't met, then they don't start/increase pitocin. She said once she was home, she'd email me a copy so we could get an idea of what other places are doing. I could go on and on and on about all the information they gave us. The other big thing they stressed was being a patient advocate. Our number one priority is to our patient: the one we can see and the one we can't. Even if it makes us unpopular, we need to not follow orders blindly. We need question orders that are dangerous. We have to be stand up for our patients.

After the conference, we spent time sight-seeing in New Orleans. It is a different world down there compared to my Midwest way of living. Especially the food. I don't like any seafood - they are known for seafood and it was crawfish season. The French Quarter was very cool, and I bought some fun things in the French Market. We took a tour of the city: saw the above ground cemeteries, a few celebrity homes, and the Ninth Ward. That was very sobering. You see the devastation on tv but you don't get how big it is. They have rebuilt some but there are still schools and hospitals that are closed, still houses in shambles, empty foundations. And seeing the wall that gave and picturing how much water came and how fast: very sobering. True to form, I came very close to tearing up just thinking about it. We walked down to Bourbon street, but I, of course, didn't have a drink. I was amazed that you can walk up to a vendor, buy a margarita and continue walking. And we also took a Riverboat cruise. The food sucked but the ride up and down the river was fun. Then we got up early with God to fly back so we could work Sat-Sun-Mon night. So I'm pooped. My house survived: Husband actually kept it clean! The kids were clean, laundry and dishes done. So it proves that he can do it.

Pregnancy-wise, I see doc tomorrow. I had my platelets redrawn at work Saturday and they were up to 166!!! And I looked at my records and with my other pregnancies, they were in the 100's, but non-pregnant they are in the 200's. So maybe it's a gestational thing. I'll talk to Doc about it tomorrow. I am starting to pop more, so I'll probably have to break down and buy some maternity pants within the week. Right now I'm getting by with my fav jeans with a rubberband holding the top together. Really, it's very stylish!


claire said...

hallelujah!! It's about time doctors and nurses combined take notice of the pitocin/agumenting labor abuse in our country just because it's "convenient" Which is really disappointing.

glad you had fun over all!

The Future Missy Prissy RN said...

Wow!! Sounds exhausting but fun all the while.. Glad you are back!!!

pyjammy pam said...

i've read your blog for a long time, and i live in new orleans. glad you liked it here, you got some pretty good weather (unless you were here friday night, sorry 'bout that!) yeah, the riverboat food sucks, but most places it's good. :) anyway, love reading your blog!

Caro said...

Sounds like a good meeting.

Nurse Lochia said...

I was there Friday, but it wasn't too bad. The rain quit by the time we were out and about. Besides the riverboat food, the rest was fantastic! I think I ate more calories in each day than I usually eat in a week! And those binets were sinfully good! Well worth the calories!

Becky said...

Interesting stuff about the pitocin. I've never been a fan. I refused it even after the baby was born because I didn't feel it was good to have a synthetic in my body. Did they say anything about that? It was "routine" at my hospital and I had to fight to decline it.

Laura said...

Hey, if you get that pitocin checklist, could you email me a copy? Lobug2@msn.com... Glad you're back...and that your platelets are up!

Anonymous said...

Hi, just a random aussie reader here :)
I've spent the last few weeks away from my computer (and therefore your blog saved in favorites) so I hopped on today and read that you are pregnant!
I just want to say congrats! My husband thought I was strange for being so happy when we haven't even met, but I couldn't help it.

I hope all goes well and will continue reading!

Good luck!

Tab in Oz

apvegmama said...

Glad you had a nice trip. I had to read it twice when you said, be an advocate for the patients and not blindly follow orders. I guess it does apply, but I just think it sad that the doctors may be making the wrong decisions: some just for their convenience. It's almost like the conference acknowledged this fact, which I thought was sorta taboo.
With the Pitocin, I was also given a shot in my thigh after baby came out. I stopped to ask her what it was and she acted like I was out of line, then gave it to me anyway. Putting baby to breast immediately can help the uterus stay contracted, and I've heard that Shepherd's Purse tincture can help with hemorrhaging.