Help the March of Dimes fight Prematurity!!!!!

Everyone who is concerned about the health of babies needs to be involved in the March of Dimes, they are such a wonderful organization whose only concern is healthy babies.

They have started a campaign called the Petition for Preemies. Join the rest of us fighting for these little ones and sign it!!

Mothers are casting their votes for healthy babies and asking all Americans to join them in signing the March of Dimes 2008 Petition for Preemies. They’re putting public officials – and all Americans – on notice that it’s time to focus on the growing problem of premature birth, the leading cause of newborn death.

Go here to sign the Petition for Preemies
1. We urge the federal government to increase support for prematurity-related research and data collection as recommended by the Institute of Medicine and the Surgeon General’s Conference on the Prevention of Preterm Birth, to:
(a) identify the causes of premature birth;
(b) test strategies for prevention;
(c) improve the care, treatment and outcomes of preterm infants;
(d) and better define and track the problem of premature birth.
2. We urge federal and state policymakers to expand access to health coverage for women of childbearing age and to support smoking cessation programs as part of maternity care.
3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.
4. We call on businesses to create workplaces that support maternal and infant health. View our 14 recommendations. (workplacecriteria.pdf, 90kb)

A Midwife on a Mission

Ruth Lubic is one amazing woman! I hope I still have this kind of energy and passion at 81 years young.

http://www.cbsnews.com/stories/2008/09/08/eveningnews/main4428250.shtml

Towards the end of the interview the reporter says that Ruth keeps babies out of prenatal care when he means intensive care (NICU).

Abbreviations

Okay, at one time I said I would post a list of abbreviations used in labor and delivery......so here it is and I have included some gyn stuff too.

I'm sure if I have missed anything all my OB friends out there in bloggerland will chime in and add to the list (or make any corrections :)

AB abortion
AP antepartum
MAB - missed abortion
SAB - spontaneous abortion
TAB - therapeutic abortion
EAB - elective abortion
AFP Alpha Fetoprotein
MSAFP - maternal serum alpha-fetoprotein
AMA advanced maternal age
AFI amniotic fluid index
AROM artificial rupture of membranes
BBOW bulging bag of water
BPP biophysical profile
CPD cephalopelvic disproportion
CST contraction stress test
CT chlamydia trachomatous
CVS chorionic villi sampling
D & C dilatation & curettage
D & E dilatation & evacuation
DIC disseminating intravascular coagulopathy
DI/DI dichorionic/diamniotic twins
EDC/EDD estimated date of confinement/estimated date of delivery
EFM electronic fetal monitoring.......cEFM continuous electronic fetal monitoring
EFW estimated fetal weight
EGA estimated gestational age
FAVD forceps assisted vaginal delivery
FHR/FHT fetal heart rate/fetal heart tracing or tone
FLM fetal lung maturity
FSE fetal scalp electrode
FTP failure to progress
GBS group B beta streptococcus
GC gonorrhea
GDM gestational diabetes mellitus
GH gestational hypertension (the most currently correct name for PIH)
GIFT gamete intra-fallopian tube transfer
G_P_ gravida, para (TPAL - term, preterm, abortions, living children)
GTD gestational trophoblastic disease
HCG human chorionic gonadotropin
BHCG - beta human chorionic gonadotropin (usually serum)
UHCG - urinary human chorionic gonadotropin
HELLP hemolysis, elevated liver enzymes, low platelets
HSV herpes simplex virus
IP intrapartum
IUD intrauterine device
IUFD intrauterine fetal death
IUGR intrauterine growth retardation
IUI intrauterine insemination
IUP intrauterine pregnancy
IUPC intrauterine pressure catheter
IVF in vitro fertilization
LDR labor, delivery, recovery (all in one room)
LDRP labor, delivery, recovery, postpartum
LEEP loop electrical excision procedure
LGA large for gestational age
LMP last menstrual period
LOA/LOT/LOP left occiput anterior/left occiput transverse/left occiput posterior
LOF leaking of fluid
LTCS/LVCS low transverse C- section/low vertical C-section
MBU mother/baby unit
MVU Montevideo units
NB newborn
NBN newborn nursery
NICU neonatal intensive care unit
NST non-stress test
NSVD normal spontaneous vaginal delivery
NT nuchal translucency
NTD neural tube defect
OCP oral contraceptive pills
OT occiput transverse
PCOS polycystic ovarian syndrome
PID pelvic inflammatory disease
PIH pregnancy induced hypertension
POC products of conception
POD/PPD post-operative day/postpartum day
PP postpartum
PPH postpartum hemorrhage
PPROM preterm premature rupture of membranes
PROM premature rupture of membranes
PTL preterm labor
PUBS percutaneous umbilical blood sampling
PUPPPS pruritic urticarial papules and plaques of pregnancy
ROA/ROT/ROP right occiput anterior/right occiput transverse/right occiput posterior
ROM rupture of membranes
SGA small for gestational age
SRMC single room maternity care
SROM spontaneous rupture of membranes
STI sexually transmitted transmitted infection
SVE sterile vaginal exam
TOL trial of labor
UC uterine contraction
US ultrasound
VAVD vacuum-assisted vaginal delivery
VBAC vaginal birth after C-section


GYN related abbreviations
AGUS atypical glandular cells of unknown significance
ASCUS atypical squamous cells of unknown significance
BSO bilateral salpingo-oophorectomy
BTL bilateral tubal ligation
CIN cervical intraepithelial neoplasia
EMB endometrial biopsy
ERT estrogen replacement therapy
HGSIL high-grade squamous intraepithelial lesion
HPL human placental lactogen
HPV human papilloma virus
HRT hormone replacement therapy
HSG hysterosalpingogram
LGSIL low grade squamous intraepithelial lesion
TAH total abdominal hysterectomy
TOA tubo-ovarian abscess
TVH total vaginal hysterectomy VAIN vaginal intraepithelial neoplasia
VIN vulvar intraepithelial neoplasia

Tired and unmotivated............

I want to be done with midwifery school......NOW! Sorry for the shouting, just feeling unmotivated and just plain over it right now.
I am stuck. I have been working on a theory paper for a week now and haven't made squat for progress. I am over this paper and over this class! Because I have been so hung up on this stupid paper I haven't done my reading for my other two classes in a week. I think if I can just get this paper out of the way the rest of this class will roll pretty well and I can get the other two classes back in gear.
I am on week 7 of this term, so just five more left before the next term starts. I am in a good place with the reproductive A&P class, just two more tests left to take. The health assessment class is interesting so I can really get caught up on it this weekend pretty easily. Just finding the motivation to pound out the theory paper is my real issue right now.

I am also feeling a bit weepy today....worked last night and didn't make it home in time to see my oldest before he left for his first day of middle school :(
He is attending a local private school that is very big on personal responsibility and independence. I am used to dropping him off at school at 0845 and picking him up at 1530, at a school that is 3 minutes from my house. I used to eat lunch with him at least one day a week.
Now, he gets dropped of by his dad at 0730 and remains at school until his dad picks him up at 1720. He has cross country practice after school, so he is not just "hanging out" until his dad get there, he actually only has 20 minutes from the time cross country ends until his dad gets there. This school is also 30 minutes from my house and the campus is HUGE (like >600 acres huge), so I don't foresee the weekly lunches anymore (esp. not with gas prices the way they are). The school he attends is also a boarding school so there are always students, faculty and many other adults around.....it is a very busy campus.
I can't wait until he gets home today......I want to hear all about his day. I know he's totally loving it! He has been excited for school to start ever since he got his acceptance letter, way back in March!

I am going to go take a quick nap, throw some tacos together for supper and then take the middle child to football practice.

Tonight I am going to work really hard on that paper.......maybe if I type it here I can hold myself to it :)

Not 1, not 2, always 3!

I worked at the big house again last night. Since I've been back I've only worked L&D one shift, all the others I have been down on the HRPU (pronounced harpu) the High-Risk Ante-Partum Unit. I do like the HRPU, usually have about 3-4 patients depending on acuity and once you get everyone their meds and tucked into bed the nights tend to be quiet. Just an FYI, never say the Q word (quiet) on a L&D unit, it is sure to get you many dirty looks.....nurses are a superstitious bunch!
Monday night they put me on L&D, and initially I had two patients. One patient had just delivered so all I needed to do was get her recovered and moved over to mother/baby unit. The other patient was a 27+ weeker who had limited prenatal care and had arrived an hour earlier with her water broke. Well, I ended up having to pass off the fresh delivery because the pre-termer didn't even have an IV going yet.
I got her IV going and gave her; fluids, stadol, antibiotics, steroids (for fetal lung development) and magnesium sulfate (tocolytic, help calm the uterus down so it will quit contracting). Unfortunately, despite our best efforts she delivered shortly after midnight by repeat c/s (baby was breech).....under general anesthesia, because she could/would not sit still for regional block.

We had two other 27 weekers come in and deliver on us that night as well, despite us doing all we could to keep those kiddos in!

Just another example of something every labor nurse knows......bad karma always comes in three's!

It was.......a good night

So last night I worked at the big house.
I came in and picked up a patient who had arrived the evening before for decreased fetal movement. She is being cared for by a CNM I work with frequently at the LDRP hospital.
The baby is reactive but measuring small so the midwife decides to go ahead and induce the next morning. Through the night the mom was having sporadic contractions and occasionally the baby would have a spontaneous deceleration in the heart rate but would recover and look fine. So, they attempted pitocin augmentation. They got the pit started and within fifteen minutes the baby had a seven minute deceleration, so off the pit goes. The mom continued to contract and by about 1:30 yesterday afternoon had made it to three centimeters so the CNM breaks her water and they place internal monitors on baby and the uterus. The continued all day with the spontaneous decelerations lasting anywhere from 3-8 minutes, but in between the baby was beautifully reactive. At 6:15pm the CNM checks mom and she had not changed her cervix so they decide to call in the doc and proceed with c/section since the baby won't tolerate pitocin. The doc is hung up at the LDRP hospital doing a c/section and this one wasn't emergent so we were just going to hang out until he could arrive.
Here's where I come in. Got report and headed in to assess the patient and make sure we were all on the same page and things were in-line to head to the OR once the doc arrives. I am in the room assessing the patient and chatting with the family and having a good time when the baby decides to have another deceleration, down into the 60's......so flip the mommy to her far left side, place O2 by facemask, increase IV fluids.....baby still down but coming up slowly.....vaginal check......9.5cm, just an anterior lip. The CNM comes in (she had been in the lounge on the phone with the doc), baby recovers nicely and we start pushing. Baby handles pushing wondefully and and hour and 20 minutes later we have a girl!!! Oh, I just love it when those kinds of things happen. Baby had a nuchal cord, not tight, but short! BTW, for all you L&D RN's......she had IUPC and MVU's were NEVER adequate......not once!!!!! Women's bodies are simply amazing.
So, I got her recovered and sent to postpartum and was able to sit down and have a nice relaxing dinner and then picked up a triage that had come in with her water broke.
This couple was absolutely wonderful. The mom was undecided on whether or not to go natural so I told her we would just play it by ear...We spent the night walking the halls, sitting on the birth ball and by 0330 she was 3cm and baby had moved down to 0 station (when she came in @MN she was 1cm and baby was high at -3). She spent some time in the shower, which she LOVED! and just did amazingly well. I really spent 95% of my time in that room providing labor support and just enjoying this couple, they were soooo great. At 0700 this am, I did not want to go home.....I wanted to stay with this couple and support them...I wanted to see their sweet little girl be born......I felt like she was really in a groove and I didn't want that disturbed by a new, strange face coming into the room. I feel like it is such an honor and privilege to be allowed to form such an intimate bond with someone and to witness their transformation into parenthood. I just didn't want to leave them......I feel like continuity in care is sooooo important and makes women feel secure and relaxed.
Situations like this keep me motivated to continue with my school work and become a nurse-midwife. If I had been her midwife I could have provided all that support and then stay with her and provide that continuity of care that I feel every woman deserves.

Now, I am off for a week! Woo! Hoo! Headed to camp with the church youth group. My oldest is now old enough to be part of the youth group and attend camp. Me, being the protective mother I am.....totally not ready for my kid to be so independent of me! I am going along as a camp cook. He will do his thing while we are there and I will be hanging out in the kitchen, so I am not going to be hovering or bugging him :) I just wanted to be available.....you know, in case he needed a hug from mommy or something. He hasn't ever spent more than a night or two away from home and this is for a whole week, so I wanted to be a little closer than 2.5 hrs away........just in case :)

Groan.........

Here's another one for the "what the h***" archives.
First pregnancy, twins.....both are vertex
Scheduled for primary c-section at 38 weeks.