Saturday, January 19, 2013

How does induction work at 38 weeks?

Q. I'm currently 34w3d and yesterday at my appointment I was told that they may want to have me induced at 38 weeks due to me being diabetic.
We will be talking about it in more depth at my 36 week appointment but I was just wondering about the procedure if the baby hasn't engaged by that point. Is it something that would happen naturally as the labour went on?
Anyone else been in the same situation?

A. I was induced at 38 weeks with my first child due to PIH. The baby was still very high, I was not dilated or effaced when we started the induction. I was to report to the L & D unit at 7 AM so they could monitor the baby for an hour prior to starting the induction. After that was done my OB arrived and placed Cytoek, a small pill, on my cervix to help dilation. I had to lay flat for 3 hours. At 11 AM she came back and since I was dilated to 2 CM broke my water which started contractions about an hour after my water broke. Since the contractions were not as strong as they would have liked them at 3 PM they hooked me up to a Pitocin drip and it worked great. The contractions got very strong and very close together. By 6 PM I need an epidural, I finally received it at 8 PM. I was able to relax at that point. However, I feel it slowed my dilation process as I was stuck at 7-8 CM for hours. At 11 PM my OB tol dme that in 1 hour if I had not dilated fully to 10 CM I was going to have to have a c-section for lack of progression. When she came back at midnight I was fully dilated and stared to push. My epidural ran out around 1 AM and I pushed without any pain medication, which seemed to be more helpful and she was born at 2:38 AM, 6 lbs 13.5 oz. Recovery was almost instant, I had absolutely no problems. Best of luck to you!


How old was your child when you stopped using the monitor? If you had 2 young kids, did you...?
Q. ...use 2 monitors?
We'll be having baby #2 soon. and #1 will be 2 years old. Do we buy another monitor?

A. Once the older kids were in a bed and not a crib, we stopped using a monitor for them. At that time, if they needed our attention, they could climb out of bed and come get us. And although we had to train them with the sometimes-conflicting message "OK, now you have to stay in bed, but you can get out of bed if you need us", it has worked well for three of our children so far (#4 is still in the crib).

So if you are putting your 2-year-old in a big boy/girl bed, I think you can ditch the monitor. But if the two year old is staying in a crib, I say you buy another one. Otherwise, you have no way of knowing when they are in distress. Sometimes though it is hard to operate two monitors in the same house. Despite specifically purchasing one with different frequencies, we have had trouble getting two separate monitors to work.

They do sell a monitor that we now own made by First Years that we have now that has three different base units and three different channels on the receiver. The receiver can be set to either one channel exclusively or it can cycle through all three channels. We have owned probably three different monitors over the years and this one is definitely the best.

Good luck with the new baby and your new "big brother/sister"!!


Does a Rn have to specialize in piedatrics before specializing in neonatal?
Q. when i get out of college i would like to be a neonatal nurse. but i was told i would have to go thru and first become a piedatric rn then wait a year to specialize. but i was doing some research and i learned that if i was an ob nurse i would be somewhat working with the neonatal unit. can i just be an ob nurse then work my way up,skipping piedatrics????

A. I'm feeling kind of lazy today, so I'm going to cut and paste my answer from one I gave earlier today....but as far as needing to work in peds......No, I don't know why you would. A neonate (especially a micropreemie) is nothing like a toddler or a school-age child or adolescent. Here's my general take on NICU:
A Neonatal Nurse in an RN who generally works in the NICU (Neonatal/Newborn Intensive Care Unit) of a larger hospital. Neonatal nurses care for premature and ill newborns; that can entail starting an IV or other method of access, administering meds, watching and evaluating monitors, and resuscitation. They work with Neonatalogists, Pediatricians, Respiratory Therapists, Neonatal Nurse Practitioners, and different kinds of developmental therapists.

You need to become an RN first. I would strongly encourage you to go straight into a BSN program and forget an Associate Degree program. For one thing, everyone and their cousin is vying for admission into an Associate Degree program.....so much so that the once "2.5 year program" is now more of a "3.5- 4 year program" due to waiting lists for the clinical phase. You can get a BSN from a state university in 4 years.

Next. DO NOT wait until you have graduated from college to start looking for a nursing job. Most hospitals have Student Nurse Externs (once you've completed a semester or two of clinicals) and they are nearly always offered new grad positions. If you start at a hospital that isn't a Children's Specialty hospital, you will likely need to work Mother/Baby or Postpartum for about a year. You will be taking care of healthy newborns (and their moms) during this period and it will help you to be familiar with caring for the childbearing family. After about a year, most places will let you transfer to the NICU since you already have experience with newborns (and you will have worked with a lot of the NICU staff during your year of Postpartum.

Now, if you are lucky enough to live near a Children's Hospital, most of them have new grad programs that will start you right into the NICU. Be forewarned, these new grad programs are often for BSN grads only. There is a BIG trend towards making the BSN the minimum for new grads at a lot of larger hospital networks. That means that should you earn an ASN instead, you'd need experience before being hired at one of those hospitals.


Need some consoling about the birthing process?
Q. I am 35 weeks and in a high risk pregnancy. I am starting to get really scared about the birthing process. Can anyone console me a little and tell me what it is like so I can know what to expect? Thanks!
Yes the father of the baby/my fiancee will be with me during labor and delivery!

A. I was on bed rest with a high risk pregnancy. My ob gyn told me "anything can happen to you, prepare yourself or any procedure".

I watched 3 video's provided to me by neo-natal home care nurses that really got me up to speed about every procedure that I could happen during delivery. I felt better after that as I was educated about the topic.

I was told "the only thing that is guaranteed NOT to happen is a C-Section" and I ended up having one.

Honestly, when you're high risk and everyone is buzzing and concerned and you're there, you start to not care what it is they are doing. You trust that the doctor knows more than you and would not recommend something unnecessary and you say "if that will allow myself and my child to come out OK, let's do that".

I had blood pressure cuff, finger blood oxygen monitor, oxygen mask, internal monitor on the baby's head (NOT COMFORTABLE), epi-dural, belly baby monitor, VI, medicated VI, catheter (gotta have one with epi-dural) and a catheter flushing baby with saline solution (to keep his stress down).

I was going into early labour on my own, they broke my water AND put me on the drip.

The worst part was having to lay in a soaking wet bed.

I ended up in emergency C-Section, my blood pressure was 188/119 and my son's heart was stopping during contractions. He was only 4 lbs 7 oz.

The worst part of the section was that once he was out he was whisked off to a table where I couldn't really see him. They showed him to me while he was on his way to that table and put him on my chest for a few seconds before he was taken to the neo-natal unit. I had to go to recovery. It was a very detacted feeling, I wasn't pregnant but I didn't really have a baby, that's how I felt.

My dream delivery would have been at home, in water and starting nursing him as soon as he was born.

Just know that if its not what you want to be happening it truly IS worth it in the end. Talk to your fiancee AND doctor about your worries and concerns before you go into labour. Apologize to your guy before you get there in case you get angry or emotional (it will help him get through it, if he does well, so will you.) Also, give yourself mini goals and smile when they come...

In one hour, I will not have any more contractions

In 2 hours I will NOT be pregnant anymore

Tomorrow I will be holding a beautiful, precious little baby.

15 minutes from now I'll be looking at brand new eyes

5 minutes from now I'll be touching tiny cute hands

1 year from now I'll look HOT in a bikini!

It is a LOT scarier before you get into it, good luck!





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