Childbirth Education is a Fraud

Here is a post from Life & Times that started some talk about hospital based childbirth education. I teach hospital based childbirth ed, and therefore feel the authority to criticize it. This is one of the reasons why I started my blog childbirth ed series and be able to do it my way. For those who plan to take a childbirth education class, I highly encourage you to keep this post in mind.

Childbirth Education is a Fraud

If you attend hospital based programs, that is. This is why:
Most hospital based Childbirth Education programs have curriculum that is reviewed and approved by the medical staff. The obstetricians want to make sure that what their patients are being told is congruent with their medical management of labor and delivery. What most people don't understand is that "medical management" of labor is usually unnecessary for healthy, normal pregnancies. They want their patients to know that it is "normal" to be continuously hooked up to the fetal monitor, that an "adequate" labor pattern means contractions every two to three minutes apart even if less frequent contractions have been causing cervical change, and that epidurals are the way to go. And, oh yeah, a few minutes of breathing techniques is helpful for when you are waiting for that epidural.
I am a labor and delivery nurse in a hospital, and I teach in a hospital based childbirth education program. I am continuously frustrated by the incongruent messages that pregnant women are given in regards to "normal" birth. For most, and particularly those who attend my classes, a normal birth consists of going to a hospital, being monitored by machines, getting an epidural, and pushing on your back while your support person and the nurse hold your legs. And this may be the positive experience that most want. Which is fine if that is what makes you feel safe and what you envision as a positive birth experience. I have attended many births that follow in this path and those women and their families are very happy and grateful for the experience and outcome. So, I can't say that just one way is the right way. I have also attended births where the woman wants to grab her baby as it's being born and place their baby directly onto their chests and didn't want an epidural. But none of those things happen, and she later voices to me that she wished that she was "never talked into that epidural" and that it took 20 minutes before she even got to hold her baby after the birth.
However, what I can say is that what the public is being told is not the only way. It is also not necessarily the safest way, either. What many people don't know is the the United States does not have the lowest neonatal and maternal death rates among industrialized countries. The US has the second worst newborn death rate among all industrialized nations, according to the Save the Children foundation. Which makes me wonder how good is all of the advances in fetal monitoring really? If one was to look at this statistic: in the US, there has been a 99% decline in maternal deaths, it would be encouraging. But I still wonder what is it we are missing that other countries, such as Finland and Sweden, have figured out?
Anyhow, back to childbirth education. So as I was saying, what is taught in hospital based childbirth education programs is not what a lot of people would think of as a "normal" birth. Again, the focus on childbirth education in my class is intervention and medical management. I also cover comfort measures, but with all the other information that I have to cover in regards to what these mothers are going have happen to them when they get to the hospital cuts that material to about an hour. The total class time is 12 hours. I also try to squeeze in information about "normal" birth according to Lamaze International, and inform women of the recommendations for inductions and c-sections according to the American College of Obstetrics and Gynecology. Many are surprised to learn that what their doctors are telling them ("You're baby is probably going to be too big, so we need to do a c-section" or "You've had a lot of aches and pains this pregnancy, and I am going to be on-call the day of your due date, so why don't we schedule an induction?") are not medically or even ethically indicated. I can't tell you the number of times these things come up in my classes, and I am continuously stunned. And frustrated, because in the end, the patients almost always go with what the doctors are telling them what should be done, and I (as well as my fellow Childbirth Educators) look like liars.
One other factor is that many doctors approach their practice negatively. In other words, in our litigious society, these doctors feel they must rely on technology and conservative medical approach to birth in order to cover their butts (aka CYA). They feel it's safer to have a woman hooked up to a monitor, an automatic blood pressure cuff, and an epidural (for a quicker c-section if needed) than to allow her to walk around to facilitate labor with intermittent fetal heart rate auscultation. And so these classes must cover what the "normal" birth is like for their patients, which by my standards is not normal for healthy women.
So, the bottom line: if you are looking to learn about how to experience a "normal" birth, attend a childbirth education class that is independent of your hospital. If you can afford one, hire a doula. Or talk with a trusted female family member or friend and see if they would be willing to be your labor doula. Statistics also show that women who have continuous labor support have less complications, shorter active labor phases, and fewer medical management of pain than women who do not have a doula. Also, many women are under the false impression that their labor nurse will be at their side breathing through every contraction with them, dabbing their brows with cold cloths. As much as labor nurses want to be right at the bedside with a laboring woman, we can't. It's impossible when we are trying to manage all that equipment, interpreting fetal heart rate patterns, and also managing the care for one or two other laboring women. Which is why I wholeheartedly welcome doulas.
Anyhow, I encourage pregnant women to learn about and seek a normal birth. Because pregnancy and birth is not an illness.

Some questions for you:

As you've noticed, my side bar has a poll (now closed) asking if I should repost some of my Life and Times blog entries. 89% said YES. So majority wins. My questions to you all are this:

• What Life and Times posts would you like to see?
• For those who said NO to reposting, how come? I'd like to have your feedback.
  

Egomaniac Bloggers

It’s been asked of me why I blog. I am sure other bloggers, especially health care bloggers, are asked this at least once. I’ve said before that I think bloggers are egomaniacs with inferiority complexes (me included). We love what we have to say and want everyone else to love it, too. Putting our thoughts out there helps to soothe that inferiority some of us don’t like to be associated with.

But health care bloggers are a special group. I think on a whole we want to get our message out there. We want the public to know the inside workings of health care. We want people to understand where we are coming from, our experiences, our education, our opinions. I specifically started The Life and Times to help women think about and question their choices in maternity care while giving myself a platform to vent. Being a cog in the wheel of a system you disagree with in so many ways takes its toll.

Rebirth is no different. But why start it in a new blog? I felt it necessary to continue what I was doing with some new skin.

The Non-Diabetic Diabetic

I admitted a woman for a labor induction at 39 and a half weeks. This was her first baby, and I had the opportunity to review her prenatal record before her arrival. It was one of those lucky days on the unit where things could occur at a leisurely pace. I found a curious piece of information that was quite vague. Her “problem list” reported “glucose intolerance”. Her one hour glucose loading test was 142. Anything 140 or greater requires a follow up glucose challenge test. This was done as well, and 2 of the 4 values were elevated. Not borderline…. Clearly above the normal limits.

But no where on her record was Gestational Diabetes.

Her visit notes reported that she was checking her blood sugars at home with fair results. Diet and exercise were not cutting it, and so in the last two weeks she was started on an insulin sliding scale.

Now, call me what you will, but isn’t this diabetes? Unfortunately her doctor was not available to question when I was initially reviewing this information. Perhaps the words GESTATIONAL DIABETES just didn’t make it on paper.

Getting back to the patient…I escort her to her labor room and begin to discuss what to expect. I tell her that I have lots of questions for her, some that will seem repetitive, but I needed to make sure we had all the correct information.

She’s as pleasant as can be and answers everything I ask. I then said, “Well, it looks like you have gestational diabetes, correct?”

“No, I don’t.”

“I read in your prenatal records that you were checking your sugars at home and recently started insulin.”

“Yes, that’s true.”

“My understanding is that this is gestational diabetes,” I begin cautiously. I’m treading into some choppy waters here. Clearly something isn’t connecting, and I’m confident enough to believe it’s not me. Did her doctor never tell her she had diabetes? How was the blood sugar checking and insulin explained? Was this woman’s head in the sand?

“No, Dr. X said I have glucose intolerance, not diabetes.”

“Ok.” I look at her for a moment to gather whether I am missing something here. “So how come you are being induced today?”

“Because my doctor is afraid my baby is too big.”

Uck! My next favorite reason. But that’s a different story.

Once Dr. X is on the unit and has seen her patient, I ask about the blood sugars. “Did I miss a new criteria for gestational diabetes diagnosis?”

Dr. X looks at me funny. “What?”

“Well your induction patient down there seems to have it, but nothing in her record actually states it and she claims that it’s ‘glucose intolerance’”.

Dr X didn’t answer for a minute. “Well, technically it is glucose intolerance.”

Technically, I wasn’t buying this, as my understanding of the diagnosis of glucose intolerance is not used in pregnant women. I pointed out her glucose tests were clear cut for gestational diabetes. And then flippantly I asked, “What? You didn’t want to offend her?”

“That’s right.”

Well, now. It left me speechless.

Interview for Shits and Giggles

Most people don’t go on job interviews for shits and giggles. But I highly recommend it. It’s amazing how much you pick up when you really don’t care much about getting the job.

Because of my never-ending per diem issues, I decided to apply for another per diem position. My thinking is if I have two per diem jobs, I will likely get hours somewhere. So I applied to several other hospitals that had per diem L&D positions open, and promptly received requests for interviews. Today I had my first one.

I was highly impressed with the L&D unit itself. It was up to date with pleasing décor and large birth rooms. None of this actually matters, of course, unless you don’t have it. I am sure there is some study out there that says employees are happier working in aesthetically pleasing surroundings. I’ve worked in very nice units and some ugly units, and will frequently tell you that one of my best obstetrics nursing jobs was in a very pretty unit.

But I digress….

My interview starts with the nurse recruiter in HR, who is a complete weirdo. I actually ended up finding her amusing in a friendly sort of way, and she asked some good questions. While I was answering, she would frequently say, “Ah! I see where you are headed!” And I’m thinking, “Well, that’s good because I don’t.” After we were done, she brought me to the L&D nurse manager.

The nurse manager seemed pleasant enough, but never asked me any questions. She seemed genuinely disinterested, not necessarily in me but in the whole process. It appeared that she didn’t really read my resume, as she missed the fact I currently work as a per diem nurse at a competing hospital and that I am in school.

She gave me a brief tour of the unit, never stopping by the nurse’s station where a friendly appearing group of nurses were sitting eating chips and salsa (at 10AM, true L&D nurses in my books) to introduce me. The nurses walking in the halls sized me up and down while simultaneously shooting daggers from their eyes.

The required hours are flexible, as is the orientation process. They pay isn’t so great and it’s a longer commute. But do I want to work there? Hmmm…. I have to think about it.

Now, had I really needed this job, I may have missed some of these things. I may have got too caught up in the pretty delivery rooms and computer charting. I might have overlooked the fact that no one even smiled at the nurse manager walking onto the unit. So I guess the moral of the story is go to every job interview like you don’t need it. Perhaps you will get a better idea of the place and the job.

More on Per Diem

Ok, I know I bitch about being called off frequently at work. So you won't have much sympathy for this. But I have good reason.

This week I am very busy. I have two job interviews for another per diem position. I also have a shit load of school responsibilities that are piled up to my neck. So of all days I was hoping to be canceled, I'm not. I go to work today thinking it must be busy if they are keeping me.

Until, of course, I see our census board. I was assigned to work postpartum (my favorite....not) with just 2 patients. T-W-O. I went to the charge nurse after I assessed my patients and said, "I'll be happy to go home at 11am. You really don't need me and you have another nurse coming on at that time."

So Charge Nurse is noncommittal, but says it's very possible. There are no laboring patients, and one labor nurse is not assigned to any patient. Charge Nurse does not have any patients either. Ok. Good. I'll get to catch up on some things at home.

Thirty minutes later a call comes in that a patient is coming over in labor. No big deal, right? Nurse With Nothing To Do can take her, and 11AM Nurse can take my assignment.

But no. Charge Nurse says, "With this labor patient coming, I can't let you leave."

"Fine," I say because what else can I do? She gets the final decision. And I am not going to argue.

But instead I bitched to all of my friend nurses (fortunately there were a few of them on today). They totally agreed and couldn't see why I had to stay. Well, yes, we could...it was to ensure that Charge Nurse never had to take a patient, even if another labor patient came in. 11AM Nurse had no assignment and sat out in the break room reading magazines. No other patients came in the rest of the shift.

Damn lazy people.

ChildBirth Ed Terminology Part 2

The following is the second post in the Childbirth Education Series that was originally posted on Life & Times.

Childbirth Education, Terminology Part 2

GRAPHIC PHOTOS. CONSIDER YOURSELF WARNED.
So has everyone studied their terms from part one? Good, because you'll need to know it as we move along here.
Station: This refers to the location of the top of the baby's head in relation to the ischial spines within the pelvic cavity. Ok... what? Take a look at this:

This is a pelvis with the front portion cut off (like the pubic bone) to reveal those ischial spines. So the top of the baby's head is assessed in relation to that in either a positive or negative number with zero being in line with the spines. So your nurse, midwife, or doctor says to you: "You're 5/100/0". This means you are 5 centimeters dilated, 100% effaced, and at zero station. A positive number, like +2 means that the top of baby's head is about 2 centimeters below the spines.
Vertex: Most people say vertex when they are talking about the baby's position, which in that case would mean head down. But it literally means the top of the baby's head. You might hear someone say, "The vertex is well engaged" or "The vertex is +1".
Placenta: Again, I am not trying to insult anyone here by putting placenta in the terminology, but would like to share some interesting facts. The placenta is the only organ a body will grow "from scratch" and get rid of without detrimental effects. The placenta is the important exchange organ between mother and fetus. It provides oxygen and nutrients to the fetus, and takes away waste products (like carbon dioxide) so that mom's body can get rid of it. There are two sides to a placenta: maternal and fetal. The vessels on mom's side and baby's side, in perfect circumstances, never come in to contact with each other. Instead they come very close to each other and diffuse their substances across to each other. Pretty cool, huh?

This is the fetal side in the picture. You can see the umbilical cord on the right upper corner.

And this is the maternal side which was attached to the uterus. Makes you want some steak, huh?


Placentas also produce hormones that support the pregnancy. For all those infertility mom's out there taking progesterone until you are between 7-12 weeks stop when the placenta is putting out the full amount of progesterone needed. The beginning stages of the placenta are what produces HCG, the hormone used to detect pregnancy.
Placentas act as a filter as well. This is why some medications are ok to take and some are not. Some medications do not cross the placenta, some do and it is not considered harmful to the fetus, some do and are harmful, and some drugs we just don't know for certain about anything. It is unethical to do random clinical trials/research on pregnant women when testing drugs. So this is why the answer to, "Is it ok to take such and such?" gets you the answer: "It is thought to be safe, but we don't know for certain."
Umbilical Cord: This is the line between mother and fetus. It contains two arteries and one vein and is protected by a jelly like substance called Wharton's Jelly. You'll notice when the baby is born that the umbilical stump right after birth is a moist off white-ish substance. The baby below is just born and shows the Wharton's jelly really well. And don't worry, we trim that way back so that no one can jump rope with it.


Amniotic Sac and Fluid: Hang on to your seat because everyone falls off it when I tell them that the baby produces the amniotic fluid with its kidneys, pees it out, swallows it, and keeps making more. Ya, that's right. They are constantly recycling amniotic fluid. By full term healthy babies make and recycle about 1 liter of fluid. Keep in mind, however, that the baby is in a sterile environment and so it's not the same as if an adult was drinking their own piss.

Here you can see the placenta with the amniotic sac pulled out to demonstrate the baby's ex-home:

The amniotic sac is a very thin yet strong membrane that keeps the fluid and baby well protected. The sac and fluid act as cushions and muffle any movement from you. It is said that those whose water breaks in a big gush have a tear very low in the amniotic sac whereas the slow trickle is from a tear high up in the sac.

Born in the USA

Born in the USA: How a Broken Maternity System Must be Fixed to Put Women and Children First by Marsden Wagner is a must read for anyone who has been born, given birth, or plans to give birth. But I warn you that it may upset those who have beliefs rooted in our contemporary maternity care system. You are in for a rude awakening. For others, you may end up with neck strain from nodding your head in agreeance so frequently on issues you may already be aware of. And you'll find reaffirmations in how pissed off you are. Like me.

Marsden Wagner is a perinatalogist whose background is quite extensive. He began his medical career in pediatrics and continued to train in the specialty of perinatalogy and perinatal epidemiology. He taught in the UCLA medical school and was also the Director of Maternal and Child Health for the California State Health Department. He later went on to become the Director of the World Health Organization’s (WHO) Women’s and Children’s Health division. He’s written multiple scientific papers and has been a consultant within many countries through out the world. He is an advocate for midwifery care for normal low risk women.

This book covers what is wrong with our current system, the history of obstetrics and midwifery in our country, and the politics behind maternity care. It includes compelling real life cases. He cites a multitude of scientific literature to further his points. However, he points out how many obstetricians in our country either ignore the scientific research, or make up their own to back up their unsafe and unnecessary interventions. For instance, the use of the drug Cytotec is extensively discussed. Cytotec is frequently used to induce labor. However, it is not approved for this use and furthermore both the drug manufacturer and the FDA have released statements against this use. And there are families that can attest to why these statements have been published.

Dr. Wagner’s chapter on the “witch hunt” against midwives in our country is appalling. His discussion as to why this still occurs certainly hits home. I found myself further inspired to fight for women’s rights over their body from conception to birth. There is a pervasive yet underlying belief in our country that birth is a medical event and it must be treated as pathological. And for a small percentage pregnancy complications do lead to necessary medical intervention and treatment. But for the rest of us, birth is a normal and natural process that remains a social event for the woman and her family. Midwifery care understands this difference, and supports it. Other industrialized countries that value this model have lower maternal and neonatal mortality rates. There are about 28 other countries that have better maternal mortality rates than the US and about 41 countries with lower infant mortality rates.

Dr. Wagner also includes suggestions to change our current system and remains realistic in the progress. He advocates for midwifery care and a system that allows access of care for all women. He points out that nothing can change overnight, but is hopeful that change will occur. So am I, but only if we are willing to put in the work to do so.

Don't Do This

I have learned to never make assumptions. For instance, never assume that the man with the gray hair in the labor room is the 18 year old patient’s father. Because it’s her husband. Or that the man rubbing a patient’s back is the father of the baby, because he’s actually her brother. Or that the patient’s boyfriend is the father of the baby.

As you can imagine, I learned the hard way.

Congrats to May

Giving props to May over at about a nurse for being mentioned as a nurse blogger in Nursing Spectrum.

Turned Away

Imagine you are at your first prenatal appointment of a very wanted pregnancy. It seems like you waited forever for this appointment at 11 weeks gestation. Things have gone along quite swimmingly, experiencing minimal morning sickness and very little fatigue. During your exam, your midwife tells you that your uterus feels a little small for 11 weeks along. Perhaps your dates were off, she suggests, and decides to do an ultrasound. The office is a large practice and so they have an ultrasound machine in house.

Almost as soon as the probe visualizes inside your uterus, a small sac with a fetal pole emerges on the screen. Without a heartbeat.

You are crushed. All your dreams of being a mother are ripped away. The midwife is empathetic and after some talk about your loss, she asks you to get dressed and leaves the room.

When she comes back she gives you several options:

1. Let nature takes its course and wait for your body to expel the sac and embryo.

2. Take an oral medication to medically induce the products of the miscarriage.

3. Have a D&C, a surgical procedure to take out the sac and embryo.

After some discussion, you decide that option 2 is the best. You don’t think you can “sit around and wait” for nature because it would be emotionally taxing. You would like to avoid surgery if possible, especially since it would have to be with a provider (gynecologist) that you don’t know.

The midwife writes you the prescription for misoprostil and for a pain medication. The midwife says she will call you tomorrow and you make a follow up before leaving. Despite feeling emotionally drained and beat up, you head over to your pharmacy.

As usual, the pharmacy is busy. You wait in line to drop the prescriptions off. Once it’s your turn, the pharmacy tech enters the prescriptions into their computer and asks you if you are waiting for them. You answer that you are, and the tech points you to their waiting area. The waiting area is essentially two chairs at the end of an aisle.

You sit and watch customers pick up their prescriptions. The stream of people seems endless. All of them seem content and oblivious while you sit trying to hold back tears. A life you had hoped for has ended, and these people are just picking up their medications like it was any other day.

You’re startled to hear your name called so quickly. As you head over to the counter, you notice that the pharmacist has empty hands. You wonder where your prescriptions are.

“I’m not filling your prescription, Ms. S,” he says curtly.

Before you can reply, he continues, “The medication that was prescribed is used for abortion and it would be unethical and against my principles to fill it.”

“But that’s not the case,” you answer. You look around and realize the others at the counter are watching this exchange. You can feel tears building, almost spilling down your cheeks.

The pharmacist slams your prescriptions on the counter. “It is against my beliefs to partake in abortion. You can take these elsewhere.”

You gather the prescriptions and shove them into your purse quickly. With your head down and tears dripping off your face you leave the store ashamed. You feel too traumatized to head to the other pharmacy across town. Instead you go home and decide you’ll wait until the midwife’s phone call tomorrow.

When you tell your midwife what occurred, she is outraged. She tells you that she is going to call the pharmacist and straighten this out. She also has plans to contact the pharmacist’s supervisor.

Think this story is unbelievable? Well, it’s not. This happens to women across the country. Misoprostil is a drug that is prescribed for medical abortion in the first trimester, and many are unaware that it is also used for expelling the products of miscarriages. Pharmacists have the right to refuse fulfilling prescriptions against their religious beliefs but some fail to recognize this situation

There have been cases on of this on the news so I would imagine that it has opened some eyes. But what do these pharmacists do then, when a woman presents a prescription for misoprostil? Do they ask if it is for miscarriage or abortion? And do women feel obligated to answer this question?

Women filling the misoprostil prescription regardless of the reason do so under emotional distress. Neither woman wants to be scrutinized at this time in her life. Perhaps women’s health care providers could have a list of pharmacies in the community that will fill such prescriptions. This could avoid the terrible blow these women feel when they are turned away and scorned.

If I Were a Movie:

Obviously, I haven't been swearing enough.

Childbirth Ed Series Redux

The following is a Life and Times original. I am reposting the original posts of the Childbirth Education Series. Enjoy!

Childbirth Education, Labor Nurse Style: The Introduction

I have several different types of readers: mom's, moms-to-be, nurses, lurkers of undetermined classification, and my family (I think my biggest fans). Oh, and let's not forget the enema crowd. My plan is to gear this childbirth education series to everyone. My purpose is to help the moms-to-be make educated choices regarding their pregnancy, childbirth, and postpartum periods as well as help everyone else understand the process. There is a lot to cover but I will break it down into small chunks of info so that it is not quite as overwhelming. I hope to post weekly on this series, but don't hold me to it. I have shitloads of school work that requires a lot of my time.
So why should you bother being one of my childbirth ed students? Because I am going to tell you how it is straight up. No bull shit. No hospital agenda, not what your doctor wants you to know (ie, how to be a good patient, essentially). Because the majority of women give birth in hospitals I am focusing on that type of birth but much of what I discuss can be applied to out of hospital births. And besides, I have been in this type of nursing for a while now.
And so to begin, I am going to give you the terminology you will be reading throughout this series. I realize that many already know or have a general idea of these words, but I can't assume that every one does. So here we go....

Terminology, Part One

Uterus: this is a large muscle that houses the fetus and the placenta. Before pregnancy the uterus is approximately 2 inches big and weighs about 2 ounces. It sits just behind and below the pubic bone. The uterus typically tilts towards the front of the abdomen, so in other words the top portion leans a bit forward. Some women have normal variations in how the uterus sits within the pelvic cavity, none of which I have seen as being a problem for getting pregnant or with fetal growth. Common variations are retroverted (tipped towards the butt) and retroflexed (tipped towards the butt and slightly folded over). I have read in obstetrical textbooks that a non-anteverted uterus may become stuck in the pelvic cavity, but I have not personally encountered this in practice.

The uterus has several parts. The part you will hear discussed the most is the fundus. The fundus is the top of the uterus. It is the strongest part of the uterus and contractions originate in this section. During labor the nurse, nurse midwife, and/or physician will place their hand on your abdomen where the fundus lies beneath. It helps them assess the strength of the labor contractions, and after birth it helps to assess the tone of the uterus. The muscle tone of the uterus after birth is important because a contracted uterus keeps the mom from bleeding too heavily. You'll hear your fundus being called either "firm" (this is good) or "boggy" (not good). When a uterus is boggy, the nurse or other provider at your delivery will give constant uterus massage... and no, it isn't like getting a back massage.
The body of the uterus is the area that houses the fetus and placenta. Just below the body of a pregnant uterus is the lower uterine segment where c-section incisions are made. Then follows the cervix.
Oh, and by the end of your pregnancy the uterus will weigh several pounds and be almost 16 inches long (40 centimeters) which reaches just below the rib cage.

Cervix: this is the doorway from the uterus into the vagina. The cervix must do two things in order for a baby to leave the uterus for the big bad world on the other side. But more on that in a second.
Almost as soon as conception occurs, the mucous plug is formed. The mucous plug in the cervix provides protection against any bacteria, virus, other other forgein substance from getting into the uterus. We'll talk more about the infamous mucous plug later...of which provides no indication for when labor occurs when it "falls out". And no, it doesn't come out looking like a cork.
So the two things will happen to your cervix during labor: dilation (sometimes called/written as dilatation) and effacement. Dilation is the opening of the cervix that is measured in centimeters. Pushing begins at 10 centimeters. Effacement is the thinning of the cervix. This is measured in percentage. Effacement is probably one of the more difficult concepts for one to understand, but I will try my best to explain.
Prior to labor, the cervix measures approximately 3-4 centimeters in length. So during labor that length is shortened. So if you are told that you are 50% effaced that means the cervix is about 1.5 - 2 centimeters long. 100% effaced means the cervix has no length left to it at all... it's like looking at the edge of a piece of paper.



In a women having her first child, effacement is completed before complete dilation (10 cm). In a woman having subsequent children the dilation and effacement occur almost simultaneously.

Perineum: this is an area that is steeped in controversy. How so, you ask? Because this is the area an episiotomy is performed, and the area some like to massage during labor. I will get into that stuff later.


Literally, it is the space between the vaginal and anal openings.
If you have any questions, ask me in the comments section. That way I can provide an answer for all to see.

You Are Now Entering....

Your Girl Parts Are Named:

The Abyss

Girl Parts Name Generator

I just couldn't resist. Never has it been called The Abyss.

Don't Look at Me!

I hate to be out in public in my scrubs. First off, I’ve gained enough weight to now qualify my uniform as official sausage casing. I refuse to buy bigger scrubs because the next size up requires the extra fees associated with all that fabric. I think I pay enough as it is as a fat person, and I certainly am not paying more money for scrubs, thank you very much. But more importantly, I don’t like to be identified in public as a health care worker. Notice I am not saying nurse because everyone in a hospital wears scrubs. The nursing assistants, housekeeping, phlebotomists, unit secretaries all wear scrubs (more on this later). Either way, however, if disaster strikes in Target then I’d like the option of not responding. Someone notices a person in scrubs and you know the crowd will be calling you over.

I can hear your thoughts. Why wouldn’t you help? your brain is saying. Because I don’t feel comfortable with the thought of responding to say… an abdominal evisceration, or a really bloody mess without protective equipment. Besides, you probably wouldn’t want me around if bones and limbs were in funny angles. That skeeves me out. Not to mention being held liable if you do something wrong. I know there are Good Samaritan Laws out there but that doesn’t mean you can’t be sued. If someone was unconscious then I’d respond and start CPR if needed (“You! Call 911 and get the AED!”). But if you plan on dropping your baby in the aisle I’ll most surely catch.

I know I am not alone. We had a new graduate nurse who had a vanity plate on her car that said “NewRN”. A nurse of 30 years said to her, “Honey, you best be changing that plate. You don’t want anyone to know you are a nurse. What if you happened to drive by an accident, you didn’t stop but someone noticed your plates?”

She went to the Registry of Motor Vehicles and had it changed within days.

My best friend, however, volunteered her services on a plane. Someone got very ill. I don’t remember the details, but I believe that an older person was having either symptoms of a heart attack or stroke. Or perhaps maybe not that serious because I don’t think they landed any earlier than scheduled. Maybe I should get my story straight, eh? Either way, she raised her hand when a flight attendant asked if there were any nurses or doctors on the flight. She assessed the person in need and stayed with him for the rest of the flight. There was some other person who also stepped in to help but was some ancillary type health care person who really didn’t know his ass from his elbow and had some crazy ideas of having the man keep his knees flexed and his arms above his head, or some other such intervention.

What a good doobie she is, huh? I’ll hope to be out shopping with her if any emergency occurs so she can respond. I’ll tell her when she’s done to meet me over in the Dyson aisle at Target.

Like Heaven into My Hands

I thought I would share this little clip with you all. It was made by a Certified Professional Midwife in Ohio, where practicing non-nurse midwifery is illegal.

Continuing the Bitching on Per Diem

I've mentioned before that working per diem can suck. It is my hospital's policy that per diem employees get canceled first. My last few shifts have been canceled, and I'm not liking it. One time I was already up, showered, and dressed so that time really made me mad. But, what can I do? Labor and delivery unit census fluctuates considerably. It's very hard to predict the amount of patients that may be on the floor at any given time. This is typically easier to do on a surgical floor as the OR schedule is made in advance.

My last canceled shift was over the weekend, which coincidentally was a full moon. How bizarre that they are canceling nurses on a full moon weekend! Don't these babies want to be dropped by the pull of the moon?

Anyhow, seeing that it's the summer and don't have any clinicals taking up my time I really want to work as much as possible. I anticipate money being very tight during my last year of school so I want to beef up the savings. But how can I do this while being canceled left and right?

I've thought that I could temp, or be an agency nurse. But I am afraid to call agencies in case they end up being vultures. I'm also afraid that I'd be sent to the worst hospital possible and given unsafe patient loads. What do you think? Any temp or agency nurses out there?