Archive for January, 2010
Posted by realityrounds on January 29, 2010
The most “popular” day in the United States to give birth is (drum roll please)…………Wednesday! Wonder why that is? Hmmmm. What sucks is I work every Wednesday, and it is always crazy busy on Wednesdays. Now I know why. The least “popular” day in the United States to give birth is (drum roll please)……….Sunday! Wonder why that is? Hmmmm.
On a side note, I thought is was kinda cool that super model Giselle Bundchen gave birth to her first-born at home, in her bathtub. I wonder if there is a higher rate of homebirths for celebrities. It must be very intimidating for them to give birth in a hospital, with paparazzi and stalkers waiting in the wings. I would also be worried about an unscrupulous health care worker leaking my info to the press, or posting a sneaky picture of me crowning on Facebook. Anyway, just thought it was a cool story.
Have a great weekend!
RR
Posted in Friday Fun Facts, Uncategorized | Tagged: Friday Fun Facts, childbirth, homebirth, giselle bundchen | 13 Comments »
Posted by realityrounds on January 26, 2010
The The New York Times picked up on the recent Cochrane review that concluded eating and drinking during labor is not harmful (or helpful, although satiating hunger seems helpful to me). Historically hospitals restricted food and fluids to laboring moms, due to the possible risk of being put under general anesthesia, and vomiting and aspirating during the surgery. This is such a rare risk that making all labor patients NPO (Nothing By Mouth) does not make sense. I won’t go over the debate (I personally believe it is A-OK to eat during labor. Heck, I snuck food into my own delivery, and ended up with a C-Section, and survived to blog about it!) because I do not want to beat a dead horse. What I found interesting in the NYT’s article were some of the quotes embedded in the article. They actually made me laugh, and I do not think this was a comedy piece. Here is what I thought was funny, in a not-so-funny kind of way:
- Dr. Tranmer, (a nursing professor…yeah!) who said she had seen all too many women in labor complaining of thirst and dry mouth resort to sucking wet washcloths. This just makes me sad. The thing is, I believe her! The image of laboring moms sucking on washcloths seems so pathetic and demeaning. Thankfully I have not witnessed this. I have furiously spooned ice chips into laboring women’s dry mouths, but never had them suck on a wet washcloth. Jeez!
- “My own view of this has always been that you could say one shouldn’t eat or drink anything before getting into a car on the same basis, because you could be in an automobile accident and you might require general anesthesia,” said Dr. Marcie Richardson, an obstetrician and gynecologist at Harvard Vanguard Medical Associates in Boston, who was not connected to the new study. I have never heard of this analogy, and I like it. I may use it at work! It’s funny because I have heard of (she who will not be named) some anti-home birth advocates saying things like delivering at home is like driving without a seat-belt, or some weird sh*t like that, so I like when the car analogies are U-turned (tee hee) around.
- “From an anesthesiologist’s perspective, they missed the boat on this one,” said Dr. Craig M. Palmer, chairman of the committee on obstetrical anesthesia for the American Society of Anesthesiologists. They looked at the impact on the progression of labor, but to be honest, that’s not an issue for anesthesiologists. Our primary concern is patient safety.” Oh Craig, you are my hero. I completely agree with you. The researchers did ignore you, and that was mean! We can never predict who may need an emergency C-Section. I have seen women walk in off the street who have eaten, gasp, and have needed a crash C-Section right on the spot. So I propose that ALL pregnant women with a viable gestation, become NPO until they deliver. This is the safest way. We can insert central or PICC lines at around 23 weeks gestation, and have home health nurses hang total parental nutrition once a day. At around 36 weeks, all pregnant women should have Foley catheters inserted, so we are not futzing around in the OR and wasting time, in case she needs that emergency C. Let’s see, is there anything else I’m forgetting? How about weekly abdominal shaves? Sounds about right.
The NYT article was an enjoyable read. Not so enjoyable was reading the comments. I should know better!
RR
Posted in child birth, health | Tagged: childbirth, cochrane review, labor, new york times, NPO | 25 Comments »
Posted by realityrounds on January 25, 2010
This story sums up how important nurses are to healthcare, not just in the United States, but globally.
Haiti Awash in Doctors; Nurses in Short Supply
When all the surgeries and suturing is done, who is there to do the rest? No one. For all the nurses out there reading this who think they do not make a difference and hate what they do, some perspective. You do make a HUGE difference. You do. The people of Haiti are aware of this, and they desperately need you.
RR
Posted in nursing | Tagged: haiti, nursing | Comments Off
Posted by realityrounds on January 24, 2010
I was alerted to this story from a comment left by a reader. There is a very emotional case causing controversy in Canada. It revolves around a three-month old infant who suffered catastrophic and irreversible brain damage during delivery. The infant’s physicians want to remove the infant from the ventilator stating that removing the child from the ventilator is medically reasonable, ethically responsible and appropriate. The parent’s do not want their son Isaiah removed from life support, and sought a court order to stop the physicians from doing so. According to the CBC-Canada news article, the case currently stands as follows : “An Alberta Court of Queen’s Bench justice has ordered an Edmonton hospital not to remove a ventilator that is keeping a three-month-old infant alive until a court hearing can be held on his medical condition.”
This story illustrates the real life difficulties of “deciding” on futile care for any human being. When the case involves an infant, it is even more emotionally and ethically challenging, since the infant can not speak for themselves. So who should decide futile care? Should it be the patient’s physicians who are keeping the patient alive with their treatments? Should it be the patient’s family (in the above case the parents), who will bear the ultimate burden of either grief from the loss of the child, or burden from caring for a severely disabled child. Or, should it be the courts supported by expert opinion and detached involvement?
In ethical cases like these, there is never a black or white, right or wrong answer. What ever answer you feel is right, will be wrought with other ethical questions to follow.
RR
Posted in Sunday Ethics, Uncategorized | Tagged: end of life, futile care, health, NICU, parental rights, Sunday Ethics | 2 Comments »
Posted by realityrounds on January 22, 2010
Why didn’t someone warn me? I have never watched this show, but for some reason I watched it last night. Why do I hate it? Here are some reasons:
- Storyline of a mother “forcing” her daughter to get an abortion.
- Making fun of a woman wanting natural childbirth.
- Doctor stating she could only help a pregnant woman if she wanted surgery.
- Nurses saying asinine things like “dead infants are God’s Angels” to a grieving mom.
- Lit candles in the delivery room next to an oxygen tank.
- A resident helping the natural child birth mom labor. Nurses nowhere in sight.
- Resident repeatedly asking natural child birth mom if she needs pain meds.
- Teenagers roaming the halls un-escorted in L&D while viewing stranger’s labor in pain.
- Doctor mom who drags her pregnant teenage daughter into a NCB delivery so she can see how it would ruin her life. (HIPAA hello!).
- Resident delivering NCB mom with no nurse in sight.
- OB’s living in a house on a private beach in California.
I could go on, but I won’t. Why didn’t anyone warn me about this show?
RR
Posted in Uncategorized | Tagged: Friday Fun Facts, natural child birth, nursing, Private Practice | 18 Comments »
Posted by realityrounds on January 17, 2010
There has been much press regarding the case of a Florida mom who was forced to undergo court-ordered bedrest at 25 weeks into her pregnancy. For those who are not familiar with the case, Samantha Burton showed signs of preterm labor at 25 weeks, and her hospital physician ordered her to be on bedrest. Ms. Burton refused due to issues of childcare and work responsibilities. The hospital received a court order to confine Ms. Burton to the hospital on bedrest and any other medical treatments deemed appropriate by the hospital. She subsequently underwent a C-Section for a 25 week fetal demise. For a thorough round-up of this story, go here.
The conventional debate on this story is one of maternal rights vs. fetal rights. Does the state have control over the body of a pregnant sentient adult female, over the rights of a “viable” fetus? I do not believe those in power can dictate the decision making capacity of any pregnant female. Ms.Burton refused treatment due to childcare and work issues. Conventional wisdom makes her reasons for refusing bedrest, logical, understandable and acceptable. From where I stand as NICU nurse, I did not view this debate in a conventional way.
For those whose lives have been touched by the NICU, conventional wisdom goes out the window. This story made me think of the many anecdotal stories I have heard from pregnant Neonatologists and NICU nurses saying that they would run away to a remote location in order to avoid their “periviable” infants from being resuscitated against their will. They said these things tongue in cheek, out of fear and desperation. In the United States, viability is defined at about 23-25 weeks of gestation. Infants born between 23-24 weeks should have a consultation with the parents and doctors to decide what is the best action for the infant. Infants born at 25 weeks or above, there really are no options. A full blown, full court press of resuscitation will occur, regardless of outcome statistics or parental wishes.
So the questions arise for those families who do not want a full court press for their 25 or 26 weeker. They may not want the extreme (real or imagined) pain and suffering of a NICU admission. They may not want or can not handle the financial and emotional toll bringing home a medically fragile infant can extole on their family.
Should these parents have a choice? Is it permissable by law to allow parents to make those kind of decisions for their families? Can parents say no to a forced hospital delivery or resuscitation of a viable infant?
Tough questions
RR
Posted in Sunday Ethics, child abuse, ethics | Tagged: birth, ethics, health, law, NICU, prematurity, reproductive rights | 10 Comments »
Posted by realityrounds on January 13, 2010
I can not stop thinking about Haiti. It always makes my soul sad to see devastation of this kind, especially in one of the poorest countries in the world. It makes me made at God, at karma, at fate, at whatever controls or does not control the destiny of this earth. There seems, at times, to be no justice in the universe.
Public health experts are predicting a death toll of 100,000 people, with at least 3 million, yes 3 million humans, being in danger of death from disease, malnutrition and injury.
I want to help in more ways than just writing a check. I want to use my nursing skills to better the lives of Haitians who are living in a Hell right now. I feel guilty that I can not just get on a plane or boat and be in Haiti in a day. It would be easier if I did not have two small children to care for at home. Always an excuse.
Medical professionals are needed in Haiti, and they are needed badly. According to the aid organization Doctors Without Borders, there is an urgent need for OB/Gyne’s, Midwives, OR nurses and anesthesiologist and nurse anesthetists. There most be many pregnant women and their infants in danger in Haiti, and this is breaking my heart.
*For more on the medical complexities the Haitian crisis will incur on it’s citizens, read this from Kevin MD.
RR
Posted in health | Tagged: haiti | 1 Comment »
Posted by realityrounds on January 10, 2010
One of my favorite blogs is The Preemie Experiment, written by Stacey, a mom of two preemies. As noted in her blog title, her site brings together :” A community of people dedicated to the open discussion of the long term effects of prematurity.” Her blog is extremely enlightening to me as a NICU nurse. Stacey has two premature children of her own, so she knows firsthand what the challenges of raising preemies can be.
In her latest post she brings up the very controversial topic, which is very relevant in the current health care reform debate, of whether costs should determine the age of when a preemie should be resuscitated. Read the post here: Should the Cost of Saving a Preemie…., and see what you think.
I personally do not think cost should determine the gestational age at which a premature infant is resucitated or not. I believe it should be determined by outcomes , full-informed consent, and communications between the parents and the physicians. What I find even more educating than Stacey’s post itself, is the comments left by her readers. They are often written by other parents of preemies. Everyone else, including NICU doctors and nurses, can speculate about the physical and financial tolls prematurity takes on society, but they live it, everyday. One theme left by Stacey’s readers was the fact that the financial cost of the NICU to save their infants, pales in comparison to the follow-up care costs once they leave the NICU. No one, especially the media, seems interested in these “miracle” babies and families once they leave the glamour of the NICU, and head out to the unglamorous world of physical therapy, repeated surgeries, developmental follow-up, psychiatry visits, insurance denials, etc. The road to discharge from the NICU seems very short indeed.
RR
Posted in health | Tagged: costs, ethics, health care rationing, health care reform, NICU, prematurity, the preemie experiment | 4 Comments »
Posted by realityrounds on January 4, 2010
In recent memory I can not remember any American politicians, male or female, using childbirth choices as a campaign issue. Not even in the cluster f*ck (excuse my French, er English, uhm really Irish) that is the current American health care debate/reform, we don’t hear much about the state of maternity care.
Our brethren across the pond however, have bravely taken the matter of maternity care on as a political issue. Politician David Cameron of the conservative Torie (cute) party, has promised “real choices” for English women in regards to childbirth. As reported on BBC News, Mr. Cameron had the following to say:
“childbirth was one of life’s “most daunting experiences” and that it was best to conduct this in a “non-emergency setting” where possible.”
“By putting the best local maternity provider in charge of co-ordinating local maternity care we will ensure the highest standards of safety are applied while also giving mothers access to a variety of community-led services.”
“He said many mothers with low-risk pregnancies were taking highly medicalised care in hospitals against their wishes.”
Ensuring childbirth choice by expanding services would, of course, cost some serious pounds, dollars, gold bullions, or whatever the hell the English use as currency (crowns?). The opposing Liberal Democrat party in England is sounding off on how the country will pay for expanded childbirth services in an economic downturn (seriously, is Britain upside down? Conservatives wanting to spend money? Liberals wanting to save? Whatsup ?).
Anyway, it is refreshing to see maternity care as a campaign issue. I wonder why it is not brought up much here in the colonies?
RR
Posted in child birth, health, healthcare reform | Tagged: england, health, health care reform, maternity care, money | 4 Comments »
Posted by realityrounds on January 3, 2010
Someone tell me what the Big eFfin’ Deal is with the New Years Baby? Since I’ve been a nurse, hospitals trip all over themselves to brag that they delivered the first baby of the New Year. So what? It drives me crazy. Why is this baby so special, or more special, than that baby born on Arbor Day or Flag Day? If a mom is pushing at 11:55 pm on New Years Eve, we may be “coaching” a little louder to PUSH, to get that baby out at 12:00 am. (and, do you go by the clock time or the time on the fetal monitor? I think it’s the monitor.)
I have never been involved with covert inductions or sections by a provider to win the coveted prize of the first baby born on the New Year. But I bet other nurses have, fess up! Yet, working in the big, bad, inner city hospital, some patients will take matters into their own hands to deliver that coveted New Years Baby.
The craziest New Years Eve was of course…..1999! It was a very big deal to be that hospital to deliver that first baby of 2000. There were rumors galore that some hospitals were offering free college educations, and cars, and tens of thousands of dollars to New Years Baby 2000. I was on call New Years Eve 1999. The hospital had pretty much everyone on call due to the Y2K computer crash, and Armageddon, and Godzilla destroying Manhattan, or some shit like that. More horrifying than Godzilla was the fact that I had to carry a pager, and could not drink alcohol on New Years Eve 1999. Nursing is awesome! You should see the pictures of me dressed to the nines, carrying a pager as big as a toaster on my very big eighties belt. Dayum I looked hot. I was lucky enough not to be called in, and the hospital I worked at was lucky enough to deliver the celebrated New Years Baby. What an honor. New Years Baby Momma 2000 decided to take matters into her own hands to be the first woman to deliver in 2000. New Years Baby Momma 2000 took matters into her own hands, partied like it was 1999, and snorted as much cocaine as humanly possible to contract her vessels and contract her uterus. Who needs pitocin anyway?
That morning there was much pomp and circumstance as we presented New Years Baby Momma 2000, with her big ole gift basket stuffed with toys, free formula (thank you Enfamil), diapers, and grocery gift certificates. Now, smile pretty for your publicity shot! But New Years Baby Momma 2000 would not smile. She…would…not...smile. New Years Baby Momma 2000 took one look at that over sized and over stuffed gift basket, and went off like the fireworks the night before. Oh No. She was not having it. She went through a lot to be the first to deliver on 2000. She took a taxi, yes a taxi to this inner city hospital to deliver. She could have taken her taxi to any other big city hospital, and she chose ours. A gift basket? Oh Hell No! New Years Baby Momma 2000 wanted a free college education for Baby 2000. She demanded a new car. She needed tens of thousands of dollars in cash. She did not need some dumb cheap ass gift basket. Smile pretty now!
So we all stood there slack- jawed and stunned at New Years Baby Momma 2000′s speech. We would not smile pretty. We…would…not…smile pretty. New Years Baby Momma 2000 did not get all that she wanted. She did not even get the gift basket. New Years Baby 2000 got a urine bag and positive tox screen and a mandated DCFS report. Happy New Year! The staff got a life lesson, time and a half that was not worth it, and a Holiday cafeteria lunch (not free) of prime rib (?!) and mashed potatoes from a box.
Screw Baby New Year! That’s right, I said it. Flame on! Let’s celebrate Flag Day Baby, or Arbor Day Baby, or Armistice Day Baby, or Boxing Day Baby (Canadians count ya know). The New Years Day Hype Baby is done to me. Done I say!
RR
Posted in Uncategorized | 12 Comments »
