Just some thoughts on Birth, Nurses and birth interventions.

Did you know that Jacho does not review Birth Centers? I just found out. I am thrilled. Cause I hate Jacho. I think it was started to help things out but has caused a lot of problems. It seems that Jacho and/or the Hospital wants to put each patient into the same little slot of box. Each person is the same so you can check them off the same and keep track of them the same. Makes for easy accounting.

Well as you know, we are not the same. One of the most interesting things about people are their differences. That is one of the things I really like about the Birth Center Concept. I am hoping to do some of my clinical in a birth center a hour or so away. One of the CNMs that I have worked with works there now. I have yet to ask her.

My reading has also discussed how hospitals have changed midwife practice. Very interesting. It seems like a catch 22. You need large turn over to perfect skills but with large turn over you become less sensitive to differences, I think. In the small community hospital, nurses skills like Iv placement, foley insertion, baby resus become rusty.

I think it wise to train new nurses in large tertiary centers to perfect skills. But also important to have them attend weekend doula seminars where everyone stays in the same house together chatting. I have done both and think I am better off for it. Also important to be open minded to change and different ways of doing things. When I first went to the large hospital, I spent most of my time in the room with the patient. Other nurses noted this. Some laughed at my interventions that were strange to them. Such as the hip squeeze and the press at the bottom of the spine. I don't think any new labor nurses I know, know these techniques. Which is sad because there are times when epidurals 1)don't work 2) due to medical reasons a woman cannot have an epidural.

Funny how history repeats itself. In the 60s and 70s women started questioning birth practices and some opted for home birth. This concerned the Maternity Center Association. MCA is a wonderful organization that has worked to help moms and babies since 1919. Really an amazing organization. Anyhow MCA started the first modern birth center in New York city in 1975. They had success with maternal satisfaction and good perinatal outcomes but they had to document it. So The National Birth Center Study was conducted from 1985-1987. It was published in the New England Journal of Medicine in 1989. "The study reported care and outcomes for more than 17,000 women enrolled for care in 84 birth centers and almost 12,000 women admitted to centers for labor and birth" (Phillippi, Alliman and Bauer, 2009).

So what did this study come up with? "The intrapartum and neonatal mortality rate was 1.3 per 1000 births, no higher than rates from studies of low-risk births in hospitals" (Rooks, page 92, 1997). I think the intrapartum mortality rate is much much lower now. Not sure. I will look that up at some point. Another statistic I would like to see if the mortality rate of infants from complications of Nicu stay. Not what put them in the nicu in the first place but complications of the Nicu. Some of which are definitely unavoidable but I would like to investigate that.

Anyhow I should continue writing my paper.

Home birth vs. Freestanding Birth Center. Would you go to the birth center if there was one near you?

So I am writing a paper on the history of midwifery. It has been wicked interesting. Did you know that Jacho does not over see birth centers? I had to stand and applaud when I read that one.The Maternity Center Association was able to write their own standards. Why can't we do that?

The article is in the Journal of Midwifery and Women's health. Written by Julia C. Phillippi, CNM, MSN, Jill Alliman, CNM, MSN, and Kate Bauer, MBA. Title is The American association of birth centres: history, membership, and current initiatives.

So I got to thinking about birth centers. Would folks who want a homebirth because of the restrictive nature of the hospital, come to a freestanding birth center? Is there a demand for Birth Centers? Especially a Birth center across the street from the hospital that has a large staff and 24 hour Ob and anesthesia folks so they can handle anything you throw at them. And a Nicu would be good too. I was thinking, if we did start up a birth center across the street from the hospital I worked at, would it be used? If we build it, will they come?

So for any home birth folks out there, could you please leave me a comment on your thoughts. What would you need in a birth center to make it attractive to birth at?

H1N1 and the CDC

"Elizabeth Weise: Hi. Thanks so much for taking my call. In talking to parents and pediatricians, I'm hearing a lot of concern that the H1N1 vaccine is not sufficiently tested. I'm wondering, were any corners cut on clinical trials? Is there any reason that people should be worried? Or is that -- is there any basis for that is this.

Anne Schuchat: You know, safety is a top priority to us. And what i want people to know is that no corners have been cut at all. The H1N1 vaccine is being produced exactly the same way that the seasonal flu vaccines are produced, with exactly the same careful oversight. We've gone a further step to that, and the clinical trials have not found any red flags in terms of safety. Safety is just extremely important to all of us. And it's something we take very seriously. Next question from the room? "

I got this quote from the CDC site. This was my concern about the vaccine. Seems I was given incorrect information about the vaccine being rushed to production. So this changes my mind on vaccinating small children. I think it is now a no brainer to get them vaccinated.

Take a look at the CDC site. I got it from Confutata which is Squillo's blog. The site is very informative.

http://www.cdc.gov/media/transcripts/2009/t091001.htm

Nurse specialty. Which one would you pick?

If I had it to do over, if I could be transported back 10 or so years, I think I would choose to become a cardiac ICU nurse. Maybe a cardiac surgery ICU nurse? Why? Well I kind of fell into L&D. I never meant to be an L&D nurse. Not overly excited when I did my clinical at school. It has been a wonderful experience but I do have a spine problem from the experience.

My plan 10 years ago was to become an ICU nurse. I thought hearts and lungs were fascinating. I still do. And when you turn ICU patients you have time to decide what posture to assume.

On the other hand, I would have missed out on 10 years of helping folks into this world. It is mind blowing, even today, to imagine the baby was inside the Mom and now the baby is outside breathing air, crying, moving. It is still mind blowing. It is still amazing when the small baby looks at me and gives me a confused look. As if to say, "Did you get the number of that bus that hit me?"

I would have never learned how to scrub into surgery. Which is also extremely interesting. I would never have met so many wonderful couples and been able to really get to know them. To get to know their story. Amazing what comes up in a 12 hour shift where you are sitting in the room with the couple the whole time?

I would never have caught a baby. Which is also an amazing experience. That is one of the many reasons I am going to Midwifery school and not NP school. The other reason is that I don't like how the Maternity system is changing. Many young L&D nurses don't learn how to support women who do not want an epidural or cannot have an epidural for medical reasons. Too much time is spent charting and not being with the patient. Too much time is spent at the desk instead of in the room with the patient.

So I think I should rephrase my question to, "What kind of specialty would I pick if I could not have been and L&D nurse." I think many of the expediences I have had, I would not trade. Even though my spine is in bad shape for it. Who knows, maybe it is not from being and L&D nurse. Maybe it is from skiing during my 20s and 30s. Really hard to pin point it. But I think it is the job. Also many of my L&D friends are broken in various places too. Backs, knees, shoulders, those are the injuries most of us have.

So, if you are a nurse and you had to pick a specialty other than what you are doing now, what would it be? If you are not a nurse, what kind of specialty would you pick if you became a nurse tomorrow?

Yes, I should be writing my paper. Yes, I am procrastinating. Yes, I have given myself a due date of Wednesday. I got a lot of work done last night. So perhaps this is not procrastinating as much as taking a break. At least that is what I am going to call it, for now.

The question is not are you procrastinating, but what are you procrastinating over? And some more about H1N1 since I was procrastinating.

Today's procrastination is a paper on the history of Midwifery. I did some of it. I read a bunch of it prior to getting all OCD about my Patho class. I have a bunch of articles and a textbook that basically say the same damn thing. So how hard could it be? Well really hard it you keep procrastinating!

I have given myself a due date of Wednesday. I think that is doable. Also I have to drive my a$$ one hour North to attend a faculty meeting for the college I teach for. Last time I told my boss I was not able to go she didn't take it well. She gave me a guilting over it and I just can't take another one. We are both Irish Catholic so she can hand over a really authentic guilting. You end up feeling bad for 3-4 days at least. So I am going.

Oh and about H1N1, Orac says it does not cause dystonia which Gloria Lemay had suggested on her blog. The dystonia cheerleader actually got the seasonal flu shot. Not the H1N1 so....I would not fear the dystonia. And Jon Gossling, LIndsay Lohan and Tom And Kate are still on the shelves of the grocery store. Just in case you didn't know...ANd wanted to. Also You tube has extensive video on how to lance an abcess..Just in case you wanted to know. Not that I have been spending my time watching it.....I cannot confirm or deny wasting my time doing that.

ADHD, yes again! Too bad the drugs didn't help with procrastination!And a few words about H1N! vaccine

http://www.ncpamd.com/Treatment_of_women_and_girls_with_ADHD.htm So this is a site I found very helpful for women. Especially young women and girls. Definitely worth reading.

I wish the ADHD drugs helped with procrastination. Once I start a project, I do stick to it. Unfortunately I get hyper focused on it. And often I do not want to stop until it is done. That has helped in Patho class. I am 1/2 way through. However I have not done a thing in the other classes. They are papers. Once I start a paper I am OK. I just need to start. And boy do I need to start these 2 papers. I think I will start with the easy paper. Less intimidating!

I did take the weekend off to do some homework and get caught up. I also need to buy a chair that is ergonomically better than the one I am sitting in right now. Also my Daughter suggested we have dinner with her boyfriend. So I am making lasagna. Boy I hope she is not pregnant! Terrible that is what I think when she suggest we get together with her boyfriend. I discussed this with some of the girls at my clinical. One of the girls said, "That is what I did when I told my Mom I was pregnant!" Sh!t.

The good news would be that she is almost 25 so she is not a youngster so it would not be earth shattering and she is gainfully employed and going to nursing school too. It is a 2 year school. She has a 4 year Biology degree and gets good grades. And she is the light of my life. Her and her brother. Funny you love both kids the same but different. One could not replace the other. I have a special relationship with my Daughter because she talks to me more than the boy ever will. She opens up to me. Always has. And she loves me, loves me, loves me. I never went through the "I hate you phase during her adolescence." Anyhow, I will see tonight if she has an agenda.

One of my students asked me my opinion on the H1N1 virus. And I left a comment on Gloria Lemay's blog about my opinion. The thing is, we don't really know enough about this vaccine. It was rushed to production. However, the virus is somewhat deadly. Has killed young healthy people, kids and pregnant women.

I don't have the time to do a full investigation but have looked into a few things. The March of Dimes is suggesting pregnant women get the vaccine. The March of Dimes is an organization that does not seem to have another agenda other than keeping babies healthy. So I would call them a good source.

I have decided, if I can get vaccinated, that I will. I will also ask my Daughter to get vaccinated and my 11 year old son. He is also going to get a booster shot for whooping cough since that has been going around and it is F-ing miserable! However, my student has a 1 year old and she is worried that the vaccine is alive, that is what she said, "it is a live virus!" Well it is a severely weakened virus. They call it attenuated. And they have been using attenuated viruses for years. I certainly can see her concern. Her baby is small. Much more susceptible to compromise. I sympathize with her plight.

I told her that I sympathize and that it is not an easy decision to make. My suggestion was to write down the pros and cons for taking the vaccine and the pros and cons of not taking the vaccine. Or the list of possible outcomes. Then decide what she can live with. And do some reading at the March of dimes, the CDC and the NIH. Also talk to her Pediatrician. This is a decision she must make. She is going to get vaccinated. Ester on Mainstream parenting blog is a pedi she might have more good information about the vaccine.

Galatosemia in the fetus with a mother who has active TB.

So instead of doing my home work, I have been googling this concept. Why? Because last night at clinical one of my students said that galactosemia is an effect of active TB in the Mother. I have recently read the word galactosemia in my large Path textbook and it got me wondering how that process works. I really got nothing from Google.

I also have to review hyperbilirubia for my clinical kids. They are going to be tested on it and the student who gave the report on it missed a bunch of stuff that they might be tested on. So I will review that with them next Friday. I think I will also call the class lecture teacher and find out what she is testing them on. That way I can emphasis those points.

Good news is that I am half way through my patho class. And I ordered one of those book holders to hold my book up so that I won't kill my neck as I have been doing. I am sick of neck pain. It makes it harder to concentrate when you feel like a knife is being stuck in your neck.

My students have gotten a lot done this semester. I am so happy they have all been able to see births. And they all seem to feel comfortable doing assessments and taking vital signs. So we are in good shape. I really like teaching clinical rotation. However, I don't think I can fit it in next semester. I need to stay with employment that is flexible and teaching a clinical group is just not flexible.

I have also been procrastinating starting my concept paper. Yes, me, procrastinate! Shocking!

Well that is all for now folks...