Use the call light

Hello! Welcome back. So, this is quick but, it is something that I would like to tell you. When you need your nurse, push the call light button. Don't send your husband to the nurses station. It is a pet peeve of us labor nurses. First of all, there are rules and laws in regards to patient privacy. Talking about patients where others can hear is not allowed. The law I am referring to is called HIPAA You can read about it here. http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

 You are not allowed to know what other patients have going on either. There is a lot going on at the RN station that really is about protecting your privacy. Also, when your mother-in-law comes up to the nurses station to ask how your progressing, we can't tell her that either.  Keep in mind it is quicker for us to respond to your questions if you ring the call light and we come to you than if daddy-to-be runs down the hall. Odds are, when you husband comes to get us, we still have to come to you to answer the question in front of you.

We have what is called central monitoring. We can see your fetal monitor from the nurses station. We are watching it constantly. You don't need to call us to tell us what your baby's heart beat is doing on the monitor. We can see the difference between something to be concerned about or something as simple as signal loss. We will not teach your husband fetal monitoring while you are in labor. We are experts at fetal monitoring and we know what concerns us and what doesn't.

Last week on my unit while I was charting at the nurses station, a dad with a laboring wife ran frantically to our nurses station yelling, "Nurse, please, hurry, come here, OH MY GOD, something is wrong with the baby's heart beat, it is at 200 beats then to 160. It is jumping all over the place!" This guy looked like he was going to have a stroke! No joke! Not only did the poor fellow make a little bit of a fool out of himself, he was stressing over nothing! I went to the room and looked at what he saw. (The nurse managing that patient was well aware that the fetal monitoring was FINE!) He was out of control, freaking out! I understand that they worry. But, please trust us. We do know what we are doing. He was freaking out about a baby that was PERFECT! It was beautiful! Accelerations from the baby's baseline heart beat are GOOD!!!! So, please don't expect to understand fetal monitoring. It is complicated and there is  a lot to learn. If there is something to be concerned about it, you will know! I promise, we won't keep you in the dark. The nurses will be at your bedside, and they will be doing something about it. There probably will be several nurses and even a doctor that runs into the room if we are concerned. Think of it like you would a flight attendant on an airplane. Have you ever been on a flight and you think a sound was strange or turbulence is scary? When you think something is wrong on the fight and you look at the flight attendant and she is smiling and going about normal business, then all is well, right?! RIGHT! Same thing in Labor! If we aren't concerned your shouldn't be concerned.

Thanks for reading!!

Kathy L&D RN

Admitted

Welcome to the real deal! OK, you are officially admitted in labor. So what happens once you are admitted? The RN will call your OB and get admit orders. We have what we call "standing orders." Most of the time the doctor will say, "Usual orders, AROM (Artificial rupture of membranes- Breaking your water.), they will say you can have an early epidural, or they will say, IV pain medications prior to epidural, or even epidural when she is 3-4 centimeters. They will also give orders for Oxytocin. Odds are if you aren't three or four centimeters in active labor, your labor will be augmented with oxytocin (Pitocin). If you are trying to avoid Pitocin, then you probably should have been a little more active before you arrived. But, either way, you will wind up with a baby in your arms!

At this point the nurse will call the doctor and got admission orders. Oh, and a huge favor for your nurse and yourself,  please put your cell phone away or turn off the ringer for the time being. It makes it so much easier for everyone if you are getting through the initial questions and admission without taking phone calls or text messages. It is really quicker and easier for everyone if you can alleviate those interruptions. Also, unless you came in and your are 8-10 cm, your family, and friends will still have plenty of time to get to the hospital for your delivery. Odds are you will be there from 6 to 24 hours before your baby is born, especially your first baby.

Most of the time you will now get your IV started. The nurse has to draw some labs with your IV start. There is important information in the lab results. If you are planning (or not planning, you might change your mind later when the pain gets worse) to get an epidural, your labs give the anesthesiologist information that he/she needs to feel comfortable placing your epidural. Most of the time you can't really refuse an IV. Almost 100% of the time, the MD will insist on the IV or at least a saline lock. I personally see no reason to avoid an IV. Most pregnant woman come in a little dehydrated already.  In an emergency situation the time that it takes to start that IV could make a difference.

OK, now your labor RN will put in your IV. Here's where EVERYONE, 90% at least, tell me that they "hate needles." I really don't know anyone that "loves needles." We use a pretty good size needle to start your IV. It is usually an 18 gauge needle. It looks big, it is big. I try to use lidocaine to numb the IV area prior to inserting the IV. But, that is a needle too, and it does sting. Although, having experienced an IV start in my own arm both with and without lidocaine, I do prefer the lidocaine. It takes a minute to set everything up for your IV. Your husband can hold your hand. Please try to just go to your happy place in your mind while we are starting your IV. There is no real reason to get lightheaded, or pass out. I think most of the people feel faint at this point, get themselves so worked up and anxious that they wind up making it a horrible experience for themselves and their nurse. If you are collecting cord blood from your babies cord we will draw the maternal labs that the kit requires at this time, along with the hospital labs from the IV site.

Congratulations your IV is started! Some people tell me that the IV was worse than the epidural. Now at this point you will have to answer a large amount of questions. Some of these questions are quite personal in nature. You really shouldn't have visitors in the room while the nurse asks you these questions. For example, if you have a history of genital herpes, will you state "yes" to that question in front of your mother-in-law? If you had a therapeutic abortion, will you want your parents or grandparents to know? Most likely you don't want them to know these things. Make sense? So if your family, and friends are rushing to the hospital to be there for the baby's birth, they really shouldn't show up until you have been admitted for about an hour or so.

Now your IV is in, you are oriented to the room, the call light, and you are officially going to have your baby. What happens from here on will be a pretty tiring process. Having visitors in your room from admission to delivery adds to the exhaustion. I feel so badly for the husbands that can't lay down on the dad's bed, because the mother, friends, sister, uncle, and cousins have taken over the room. The best advice I can give  you, is to have your visitors stay  home until you are close to pushing. Rule of thumb, once you are 4 cm dilated, you will go about a centimeter an hour, then you will "labor down" for an hour or two, and then you will push. For a first baby it isn't unusual to push for 1 to 3 hours.

Just a final note while I am thinking of it, there are many doctors that care if you are going to increase your chance of a cesarean section, and to be brutally honest, there are many doctors that would rather do a cesarean section. That is the truth of the matter. It is important to ask your doctor what their c-section rate is. In my opinion, that does tell you something.

Until next time!!

Kathy RN, L&D.

Am I in Labor?

What will happen when you get to the hospital to give birth to your baby? What will they do? What will you do? I’ll give you the inside view from a nurse's perspective.  You might be a little surprised about what will happen. It usually isn’t as dramatic as what you see on tv. As a matter of fact, you might think you're in real labor when, in fact, you are not.  This blog is not intended to give you medical advice whatsoever. It is intended to help you understand what you will experience and how things work in the world of Labor and Delivery. These are just my opinions and if you have any questions regarding your own situation or have medical questions, please consult with your doctor.

I know how it goes.....you had a doctor's appointment today and your OB checked your cervix. You are so tired of being pregnant but you are only 38 weeks along. Don't beg for an induction! Please.... don't beg for an induction! You have a much greater chance of winding up with a cesarean section if you have an induction before  your body is ready.  It is also important to STAY pregnant for your baby's sake at this point. Babies should be fully 39 weeks before they are born. There are medical reasons to be induced but "tired of being pregnant" is not a one of them.

Here is a link to the March of Dimes website that explains the above information in depth. http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html

So....being 9 months pregnant is miserable! I know! I remember! I did it too! I had 4 children that were all 41 plus weeks before I went into labor. I know how much it stinks to sleep, breath, and climb the stairs. It's miserable! But it's almost over! It will be over! And when it IS over you will not feel your baby moving inside of you and you will miss that part!

So......say you wake up one morning and you feel some uterine tightening. You think, "is it Braxton Hicks?" Seriously, forget about Braxton Hicks, contractions are contractions. The question is, are these contractions labor? The definition of labor is a change in your cervix. You have no way of knowing this. So forget about the contractions. Don't time them if they don't hurt. HURT matters! You don't do yourself any favors by timing them for an hour and heading to the hospital when they are five minutes apart for an hour. It probably hasn't been long enough or they aren't even strong enough to change your cervix. Instead, eat lightly (NO BIG MEALS! You will vomit in labor if you have a heavy meal in your stomach. You may vomit anyway but ice chips make for better puke than lasagna.), and take a bath (unless you think your water has broken, then no bath. If your water has broken just go to the hospital. Don't time your contractions, don't worry about the lack of pain, If your water is broken you must go to the hospital. End of story! Just go!).

OK....so, you're having contractions and they are starting to hurt. When you get to the hospital your nurse will ask you what your pain level is. On a scale of 0 to 10, 0 meaning no pain and 10 meaning the worst pain you could ever imagine (like someone chopping off your arm). I always say 3-4 means you feel like you need something for the pain. For example, when you have a headache and it's bad enough to take Tylenol, that would be 3-4. If you can talk and smile and walk during a contraction it is not pain yet! It is discomfort! There is a difference! So when you have contractions and you know you are having them but you can talk to your husband through the contraction, rate that a 1 or 2. Comprendo?

So, they are consistent and rated as 1-2? Is it ime to go to the hospital? No! You can go but you might get sent home. Once you go you're stuck on a monitor and you're most likely stuck in a labor bed. Your home environment is a much better environment for early labor, trust me! Seriously, the labor bed and the IV in your arm are not comfortable! You can't eat, you are hooked up to monitors that have only about 4 feet of cord and your baby is being scrutinized by labor nurses in the station.

If you DO go to the hospital during early labor, leave your belongings. Your suitcase, husband's snacks, music, and focal point should remain in the car! Don't drag all that stuff with you. First of all, even if you are in rip roaring labor, you don't need your boppy pillow, suitcase or baby clothes. Leave it! You are going to have to drag those things around. If you wind up with a c-section or when you transfer to postpartum your husband will look like a pack mule. Bring only what you need for labor. The kitchen sink is  not necessary for labor! Leave it home! Thanks.

Thanks for reading! I hope you keep following....I will try to put out a couple of blogs per week.
Enjoy this time with your baby moving inside of you, it is the BEST! :-)

Kathy, Labor and Delivery RN