What Happens at Hospital Admission with Trish From Labor Nurse Mama – Episode 146

What happens at your hospital admission is something to understand ahead of time, so you’re not caught off guard when you get to the hospital. I’m excited to have a super-experienced nurse with me to discuss it!

Today’s guest is Trish from Labor Nurse Mama.

Trish is a mama of 7 children, ranging in age from 7 years old to 30 years old, including one adopted daughter. She is a long-time labor and delivery RN. She is the creator of Labor Nurse Mama, and host of her new podcast, The Birth Experience with Labor Nurse Mama. Over the years, Trish has developed a reputation for making laboring mamas feel empowered and confident — even if she’s not in the labor room with them 🙂 

What’s important to Trish is that you have access to the education you need to make informed decisions while you’re in labor…Empowered Women will change the birth culture one birth at a time.
She has spent many years analyzing the literature and her own experiences in the labor room, and she’s come to the conclusion that just two things lead to a successful avoidance of an unwanted birth story: A prepared and educated mama who has proper support during labor! You can find her shaking up the birth world on Instagram, her blog, and inside her new private community membership for mams of all stages.

Free pregnancy/postpartum checklists: https://labor-nurse-mama.mykajabi.com/pl/2147550313

Big thanks to our sponsor The Online Prenatal Class for Couples — if you like to know what to expect as you get to the hospital, it is the class for you!

In this episode

What to expect as you go to the hospital.

What happens at the admission desk

What happens first when you get in the room

What types of questions can you plan on?

Do you have to have an IV?

When should you give your birth preferences?

Other things that might interest you

What you can refuse during labor

Producer: Drew Erickson

Check out my other pregnancy podcasts:

Transcript

[00:00:00.190] – Hilary Erickson

Hey, guys, welcome back to the Pulling Curls Podcast. Today on episode 146, we are talking about admission, not admission of guilt, admission to the hospital. Let’s untangle it.

[00:00:20.730] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls podcast, where we untangle pregnancy, parenting, home, and even travel. We know there’s no right answer for every family, but hopefully we can spark some ideas that will work for yours. Life’s tangled, just like my hair.

[00:00:43.690] – Hilary Erickson

Today’s guest I first met on Pinterest. I just thought she had great pregnancy content. She ran a blog at the time called The Beebe House. Now she’s everywhere. She’s totally hot on Instagram. She makes great content there. She also has an online childbirth class. Actually, classes, a great one for VBAC. I want to introduce my guest, Trish, the Labor Nurse Mama.

[00:01:09.110] – Hilary Erickson

Do you feel prepared for your delivery? In just three short hours, you can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor, stories from my 20 years in the delivery room to engage both of you. I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page from bump to bassinet. Join the online prenatal class for couples today. You can save 15% with coupon code UNTANGLED. You can find the link in the show notes.

[00:01:44.010] – Hilary Erickson

Hey, Trish, welcome to the Pulling Curls Podcast.

[00:01:46.380] – Trish

Thank you so much for having me. I’m so excited to be here.

[00:01:49.370] – Hilary Erickson

Oh, I love it when I have a fellow nurse on, it’s so fun. So quickly. Where have you practiced? I know you’re a travel nurse. So you’ve been all over the place.

[00:01:57.070] – Trish

All over the place. Most of my career has actually been in California and Tennessee. So my home base is Tennessee. Then my home base was Florida, but I’ve done Minneapolis. I’ve done Texas. California.

[00:02:14.820] – Hilary Erickson

Which part of California?

[00:02:16.060] – Trish

I’ve done La. Okay, so I’ve done Harbor City and Torrance, and a lot in Northern California, mostly Kaisers. Okay, then what was the one I did in Torrence? It’s something Mary or Saint Mary. No, I can’t think of what it is right now. I can’t believe I’ve just totally blanked on it anyway, in my brain right now.

[00:02:40.520] – Hilary Erickson

All right.

[00:02:41.910] – Trish

Seattle, though.

[00:02:42.970] – Hilary Erickson

Oh, Seattle. That would be lovely.

[00:02:44.560] – Trish

Oh, it’s amazing.

[00:02:45.900] – Hilary Erickson

Amazing.

[00:02:46.460] – Trish

It’s so in line with how I like to practice. So they don’t even start IVs labor patients, man. No, unless they have to.

[00:02:54.340] – Hilary Erickson

That’s a big no where I work.

[00:02:56.480] – Trish

Yeah. Everywhere else I’ve been to, I got reprimanded for starting, and this girl came in active labor, and they said, can you go admit her real quick? So I went in there, admitted her, of course. Started IV. Right. I didn’t even start fluids. Just started an IV? No, I did. I started fluids, and then the doctor was like, why did you start an IV? And I was like, she’s like, did someone tell you to? And I was like, oh, God tells me.

[00:03:22.080] – Hilary Erickson

Yeah. Well, that’s interesting. I think this will be awesome because I’ve always hear like, well, in the south, that’s not how we do it, girl.

[00:03:28.860] – Trish

Yeah.

[00:03:29.660] – Hilary Erickson

Today we are talking about the admission process. So basically, it’s what to expect when you show up to the hospital, either an induction or labor. It’s really pretty much the same. And honestly, these steps, even if you came in because your baby’s not moving or you think you have strep throat, you’re still going to get all these fun things done. Okay. So when you come to the hospital, the first thing you’re going to do is hit admitting. Well, the first thing you should do is find out where to go, because a lot of hospitals are different. Some you show up to the Er and they take you to labor and delivery. Some they tell you to just show up to labor and delivery. So ask your doctor if you remember, show up where to go, but you can always just present to the Er when.

[00:04:03.800] – Trish

And the other thing is what time of day? Some facilities, if you show up during the night, only the Er is open, so you have to go through the Er. And of course they’re going to panic and freak out when they see you.

[00:04:15.430] – Hilary Erickson

Yes, Er nurses do not like pregnant ladies.

[00:04:18.030] – Trish

I don’t like victims that are cut up and bleeding. So I’m good.

[00:04:22.490] – Hilary Erickson

And if you think about it, that does make sense because we want to keep the entrances to the hospital closed because some hospitals are in sketchy areas. Definitely something that I’ve worked at. So we want to make sure that those entrances are closed off at night so everybody stays safe in the hospital. That’s why they do something like that. But ask your doctor where you should show up. I used to work at a birth suite that was separate from the hospital, so patients needed to know to come to there. Otherwise, we had to go pick them up from the Er. Just wasted some of their time that they could have recouped by just showing up to us.

[00:04:50.930] – Trish

And I think you’re right. This is something I tell my students as well. We talk to your provider when you’re around 32 to 34 weeks. What is the process? What are you expecting? Expecting me to call you? And what situations would I just go to the hospital?

[00:05:06.640] – Hilary Erickson

Yeah. And where to show up because they’ll know that kind of stuff.

[00:05:09.490] – Trish

Well, I’ve worked at some hospitals that I don’t. I’m there 13 weeks, eight weeks, and I still have a hard time finding the labor and delivery Department. Yes, some hospitals are very complicated. A lot of hospitals, though, will have a dedicated entrance. Even if it goes to labor and delivery, and it’ll be very visible. I’ve worked at some that have like a dedicated door, dedicated elevator that says dedicated valet, which is always nice.

[00:05:35.070] – Hilary Erickson

Yeah. That brings the moms in to make the money to the hospital. So that’s smart.

[00:05:39.510] – Trish

Yeah.

[00:05:39.840] – Hilary Erickson

And I will say, like some hospitals I’ve worked at, if you’re 13 weeks enough, you come to labor and delivery no matter what. Well, I mean, if you’re in a heart attack, we would hope they keep you in the Er, but pretty much anything else. They’re going to want you to go to labor and delivery, even if you think you broke your leg. A lot of times we’re going to take an Xray and then send you labor and delivery.

[00:05:55.740] – Trish

I had a terrible experience at my last hospital in Florida. A girl came in and she was like 27, 28 weeks, and she had a wound on her back that they had been doing different things. She had a wound back. She had all these different things. And of course, because she was pregnant, she was there for the wound. They sent her to me. And the doctor ended up having me culture the wound. And I was not a happy labor nurse.

[00:06:23.850] – Hilary Erickson

I was like, I don’t do this. No, that’s not my thing. No.

[00:06:27.550] – Trish

And it’s been years and years and years since I had done anything like that. So I was breaking out the Internet looking like, okay, I got to do this. What do I grab? It was interesting, but yes, typically you would call your provider. Usually depending on the situation is what I think most providers. And then they walk you through. Whether or not you go to the.

[00:06:47.420] – Hilary Erickson

Hospital or not really depends on your provider. I have some that you couldn’t get hold of them at all. Fewer than patients.

[00:06:53.610] – Trish

I’ve worked a lot with Kaiser, and.

[00:06:55.980] – Hilary Erickson

Kaiser has so many policies.

[00:06:58.540] – Trish

Yeah. And also they call the triage nurse, and the triage nurse goes through a list of whether you come or not.

[00:07:05.050] – Hilary Erickson

Yeah. And they already have you in the system because your Kaiser is pretty snappy.

[00:07:09.360] – Trish

Yeah.

[00:07:09.660] – Hilary Erickson

Okay. So you show up to the admitting desk. If you are in reproducing labor, you do need to tell them your name. I mean, let’s be fair to the admitting clerk, but I’ve definitely had a meeting clerk that even when patients were visibly in pain, we’re like, let me stop and have you fill out this form. And I’d be like, Let me get.

[00:07:24.680] – Trish

Your ID and your insurance.

[00:07:26.480] – Hilary Erickson

I will send dad back when we are done. Let me see her. So that is actually a law. You don’t have to come to the room if you are in pain. You can say, Let me go to the room, and then they can come to you or dad can go out and give them your insurance card. Obviously, we need to get paid for our services, but yeah. We want to make sure that the baby’s head doesn’t come out while you’re at admitting.

[00:07:47.230] – Trish

Yeah. And I remember when I had my older kids, we went and registered weeks before we had our babies. And I don’t feel like a lot of places do that anymore.

[00:07:56.870] – Hilary Erickson

Ours still did. But you did it online. Well, during Covet especially, they didn’t want to see anybody so they started an online process. Before that they asked people to Fax it in which I was like, yeah, everybody has a Fax machine. I mean, this wasn’t like 1948, it was like three years ago. I was like so people will usually just stop in and hand it to them online.

[00:08:15.260] – Trish

Makes life so easy. I get so in a Ripper when someone doesn’t have an online process or something. And nowadays I’m finding that if someone doesn’t have a virtual option, I’m like, wait, what, what’s wrong with them?

[00:08:29.790] – Hilary Erickson

And it totally makes things easier if you do that preregistration process because they’ve already got your address. Like they can just pull you up in the system and boom, you’re ready. If you haven’t done that or let’s say you’re on vacation and you show up while you’re in Hawaii, then they are going to need like all your information. You’re going to want to have your insurance card with you, your ID. They’re going to want all those different kinds of things just to make sure you’re who you are and that you have insurance, then you’re going to get paid. Obviously, if you don’t have insurance and you’re unstable, we have to take care of you either way.

[00:08:55.620] – Trish

But yeah, well, and Coba has made some things different. But what you don’t show up with is a four piece luggage set. You don’t need all your stuff. I always tell my parents to leave all the things in the car except for what they need during labor because it really makes it hard on your partner or your family or whoever or your nurses to move stuff to your postpartum room when you can just leave it in the car and someone can go grab it.

[00:09:22.340] – Hilary Erickson

Yeah. It’s just more stuff in the room. And nurses tend to get a little bit nervous when the room starts to get packed because if there was an emergency, we want lots of room to be able to move the bed, grab the baby, all these different kinds of things. We have all these scenarios going on in our head.

[00:09:36.290] – Trish

Well and the other thing is if for some reason you end up needing a cesarean, then all that stuff is going to be moved out because you’re not typically in most hospitals you’re going to go to a Packy recovery room and not back to your labor room. So that sometimes is difficult as well. So keeping in mind that you may not be able to have your eyes on your stuff all the time, really I think just bring in one labor bag.

[00:10:00.340] – Hilary Erickson

Yeah, I’m a big fan of that. And it should be pretty small.

[00:10:02.770] – Trish

Yeah. And stuff for the dad that he can have in case your labor is long. So now they’ve come to the admitting desk.

[00:10:09.430] – Hilary Erickson

Yes. So they get your information. Now, if you come in for a scheduled induction or scheduled NST, then admitting can 100% stop you and get all your information before you go to your room, because that’s a scheduled procedure. But I always like to let Moms know you don’t have to stop there if you’re in Rip Roar and labor.

[00:10:24.160] – Trish

Yeah, but some hospitals that I’ve worked at, if they come in for a later late night, like if they’re getting side attack or something, some admitting deaths are closed, so they’ll do that in the room. So let’s talk about if they’re in labor. I think they’re in labor.

[00:10:40.170] – Hilary Erickson

Well, honestly, anything, you go to the room and we put monitors on you. That is our first thing. So we monitor the baby, make sure we can get baby’s heart rate, and then we put on one that monitors for any contractions, and we do that as long as you’re like. Over twelve weeks. I’m trying to find it with my crappy little ultrasound, seeing if I can find baby or grabbing my Doppler. That’s a huge requirement of us is that we make sure baby is okay when you come to the hospital. Yeah.

[00:11:04.340] – Trish

So most places I’ve worked, depending on the weeks we’ll do the Doppler, and a lot of places that I’ve worked at, unless it’s 100% pregnancy related, if they’re under 24 weeks, they don’t come to us right away.

[00:11:16.340] – Hilary Erickson

I’ve been at one that was 13 weeks. The last one I worked out was 20 weeks. Every hospital has it. I think it’s based off of their malpractice insurance. Ours is based off our malpractice insurance.

[00:11:26.870] – Trish

Okay.

[00:11:27.660] – Hilary Erickson

Er wasn’t covered to do anything pregnancy related after 20 weeks.

[00:11:32.350] – Trish

Yeah. A lot of them that I’ve worked at, they’ll send me down there if they’re under.

[00:11:35.830] – Hilary Erickson

Yeah. We will come to you sometime. Or if you go to the Er and you have like shortness of breath, you actually have a medical problem that I shouldn’t solve for you. Then a lot of times you’ll get a labor nurse that comes there and doesn’t innocence.

[00:11:46.890] – Trish

Right. And I put on my hazmat suit because again, I don’t like going to the Er anyhow. Yes. Unless I always tell my Mama that if you are side riding a wheelchair, like you can’t sit all the way on your butt and you’re leaned over on the side of the wheelchair, then you get a fast track pass you do, because we know what that means.

[00:12:12.030] – Hilary Erickson

Something’s keeping you from sitting on your bottom fully.

[00:12:15.240] – Trish

And I tell my students, too, that a good seasoned labor nurse can usually most of the time because some people can throw you for a loop but can look at you and decide about where you’re dilated if you’re really in labor.

[00:12:29.030] – Hilary Erickson

Yeah, that’s definitely how I was trained. She was like, I want you to guess what everyone centimeters is before you go in there. And then we’ll find out if you’re right and you’re not always right.

[00:12:37.260] – Trish

But in a ballpark, typically you can.

[00:12:39.400] – Hilary Erickson

Yeah. Or you just realize that this lady literally shows no pain on her face and it’s impressive. Or this lady shows every single ounce of pain on her face and she’s still close second high.

[00:12:49.210] – Trish

Yeah, true.

[00:12:51.690] – Hilary Erickson

Okay, so we put all the monitors on you and then comes all the questions, which is why I say probably don’t invite with COVID. We haven’t been able to invite as many people anyway. But I would really try not to invite anybody more than your direct partner for the first part of your admission, if at all possible. If you’re planning on bringing other people, possibly not even your doula. She probably doesn’t need to show up those 1st 20 minutes, depending if you’re.

[00:13:14.670] – Trish

Really in active labor. Maybe your Duala would come with you.

[00:13:17.980] – Hilary Erickson

Yeah, because it is so many questions, including if you’ve had any miscarriages herpes chlamydia gonorrhea, all these different kinds of things and a lot of it you.

[00:13:27.400] – Trish

Might not want everyone to know.

[00:13:28.940] – Hilary Erickson

Yeah. A lot of it’s super boring. Like the health history of your family, any cardiac history, cancer.

[00:13:34.970] – Trish

Well. And the abuse screening. I see that shops a patient a lot and they look at their partner and I think that it’s so important for us that that is another reason why if you’re listening and that’s a time where you can get help.

[00:13:52.160] – Hilary Erickson

Yes.

[00:13:52.640] – Trish

If you’re alone doing your admission process.

[00:13:55.090] – Hilary Erickson

Yeah. And that’s a requirement for every hospital admission. So even if you go to the Er, we’re required to just say, are you safe in your home environment? Do they ask the men? Do you know?

[00:14:04.480] – Trish

I don’t know. I don’t talk to men in the hospital unless they’re a partner. I don’t ask them questions. And just a side note, for any partners we cannot give you Tylenol or Ibuprofen.

[00:14:16.800] – Hilary Erickson

We can’t. No, I don’t treat men.

[00:14:20.540] – Trish

I don’t know about that.

[00:14:22.500] – Hilary Erickson

You have the Y chromosome. I literally have no idea. Unless you’re super tiny. If you can fit in my hand, I’ll help. I’ll treat you.

[00:14:29.610] – Trish

But that being said, for the abuse questions, don’t be offended. Like it is state law or it’s everywhere. We have to ask. We have to ask that. And it’s really important because a lot of people like being admitted or being a patient or being seen by a health care provider are sometimes the only people that these people see on the outside. So it can be a really important lifeline.

[00:14:52.260] – Hilary Erickson

Yeah. And sometimes I ask the question during admission and then I’ll ask them again, like when we’re alone in the restroom, like everything cool with you guys. It’s weird when we ask that question in front of them.

[00:15:02.090] – Trish

It is it’s awkward.

[00:15:03.360] – Hilary Erickson

Yeah. At the same time, I also don’t know that it helps their relationship when I’m like, can you step out, please?

[00:15:08.530] – Trish

Yeah. Well, and that’s what I was saying. If you’re listening and it is like you do need some sort of help, your labor nurse is your best advocate. Tell her, yes.

[00:15:21.120] – Hilary Erickson

Even more than your doctor, because your labor nurse has all the resources at the hospital, like, at her disposal, where the doctor literally just asks the nurse to do things. Yeah.

[00:15:30.330] – Trish

We really run this show.

[00:15:32.320] – Hilary Erickson

Well, as far as getting you help or anything like that, we really just hand it off to social work. And the only way you’re going to see social work is if you ask us. So really? Yeah. But there’s lots of important questions, and I think a lot of people are surprised because they probably haven’t had a whole lot of admissions to the hospital previously.

[00:15:49.410] – Trish

This is their first time.

[00:15:50.830] – Hilary Erickson

Yeah. So you’re just unaware that we go through all of those very quickly so that we can move on to other things. Whereas when you’re at the doctor’s office, a lot of times you’re filling out the form or I don’t know, it doesn’t seem as bad as when we’re admitting you to the hospital. It’s just so many questions. So just be prepared.

[00:16:06.220] – Trish

In labor, you’re like, shut up.

[00:16:09.100] – Hilary Erickson

Yeah. And if you’re in rip roaring labor, usually we have one nurse, hopefully, if we have enough staff who’s asking the questions and then one nurse who’s doing the same. So hopefully that can happen. And if you’re just, like, about to blow, just move on. We can definitely ask the cancer and the cardiovascular questions after you have your baby.

[00:16:28.290] – Trish

What is your thought about when someone is admitted and they’re in active labor and they don’t want to lay down.

[00:16:36.060] – Hilary Erickson

During the admission questions, then we sway together.

[00:16:39.930] – Trish

Okay, good.

[00:16:41.080] – Hilary Erickson

But I do need to find the baby first. Like, if they were just coming in, like, I want to sway, and I don’t care if you can find the baby. That would make me extremely nervous for liability issues, which I don’t think any.

[00:16:50.110] – Trish

Mom would say that, but I definitely have put the monitors on the ball next to the bed. If I can get them. If I can get them, I’m willing to do whatever we need to do.

[00:16:59.400] – Hilary Erickson

I mean, I’ll literally do anything as long as I can see the baby’s heart.

[00:17:02.740] – Trish

Exactly.

[00:17:03.340] – Hilary Erickson

Well, not anything.

[00:17:04.480] – Trish

I know some labor nurses are very like, they want to get you in bed, get the monitor, and do it a very specific way. And I think as you’ve been a labor nurse a long time, I can do a vaginal exam, but she’s pretty much on her head at this point.

[00:17:18.820] – Hilary Erickson

The only way I can’t do it is they’re literally sitting on the hole.

[00:17:22.590] – Trish

Yeah, exactly.

[00:17:23.780] – Hilary Erickson

But even then, I could probably give it a try.

[00:17:25.630] – Trish

Yeah. But I remember when I first started, I had to be on one side of the bed. They had to be in a certain way with their legs in a particular way. I was like, it was just all this mental set up for me to be able to do it.

[00:17:38.320] – Hilary Erickson

And I think you guys have to realize that, too. I know I’ve seen a lot of people like, there was a new nurse who did an exam, and it was wrong. And I’m like, it happens. And people don’t have any idea how hard it is to learn how to do a cervical exam as a new nurse. So we do have to give some shout outs to new nurses out there who definitely have a routine. I remember I had somebody come in to blow out a baby, and I was like, fumbling with the IV. And my preceptor was like, the baby will still come out if we don’t have an IV, but we have to get the delivery pack in the room so that we can cut the cord.

[00:18:08.830] – Trish

Hilary. Yeah. Well, I’ve told my students before because we’ve had discussions about that as well, that it took me a long time to really be confident in my cervical exams. And even as a seasoned labor nurse for 16 years, there were times where I was like, what am I feeling? And I would get someone to come check behind me because that’s just being humble.

[00:18:33.390] – Hilary Erickson

Well, I didn’t have doctors that are like, what did you think that was? Because sometimes there will be a scar on the cervix or they’ll say they haven’t had a procedure, but it really seems like they’ve had a procedure done. And also sometimes the head is just real wonky.

[00:18:47.090] – Trish

We’re a lot of vaginal folds. Yes, there’s a lot of wonky was.

[00:18:51.800] – Hilary Erickson

One of our biggest terms. I don’t know that’s wonky in there.

[00:18:54.560] – Trish

Yeah, I say that, too. Yes, it’s a lot. That’s a whole other podcast.

[00:19:00.840] – Hilary Erickson

Yeah. So they may check your celebrity. They may not. Sometimes if we had a direct admission for an induction and they’ve just been checked in the office, they were just going to start pit. Sometimes I would just be like, I trust that doctor. It’s documented in their chart. We’re just going to start pit. But most often we’re probably going to want to check your cervix just to see what’s going on. And you can check out that podcast I had recently about refusing cervical exams, if that’s in your big plan.

[00:19:23.410] – Trish

Yeah. Well, and I’m very much an advocate of cervical exams when necessary. And I tell my girls, it’s good to know a baseline. I know.

[00:19:34.210] – Hilary Erickson

I think it’s really hard to get out of that admission one.

[00:19:36.530] – Trish

Well, yeah. And especially if we’re not sure you’re actually in labor.

[00:19:40.530] – Hilary Erickson

Yeah. I mean, you could have a bladder infection like you could come in feeling like you’re contracting. We’re seeing contractions, we could be like, okay, we’re ready to go into labor. But if we check your service and it’s close, thick and high and we’re seeing contractions we’re like, then we think, okay, what else is going on?

[00:19:54.860] – Trish

Yeah.

[00:19:55.260] – Hilary Erickson

So it would do a disservice if we didn’t just do that simple thing. Right. All right. So after all the questions, usually I did the exam, like in the middle of the questions just to break things up a little bit to make it.

[00:20:06.890] – Trish

A little more fun.

[00:20:08.100] – Hilary Erickson

Yeah. And then most of vital signs. Oh, vital signs. Yes. They’re going to put a blood pressure cuff on. They’re going to take your temperature, they might take your oxygen saturation. Depends on the hospital during all those questions, usually they do an initial assessment. So the nurse is going to listen to your lungs, your heart, she’s going to check swelling reflexes, check your fetal pulses, like really important things. Yeah. So it’s just like the nurse is finding out what seems normal for you because we don’t know in a half an hour if things could be very different. And I’ve had patients show up for an NST, and within 30 minutes they’re breathing hard. And I’m like, this isn’t normal for her. Always.

[00:20:43.800] – Trish

And signing consent in some hospitals, those have been simplified over the years, don’t you think?

[00:20:50.810] – Hilary Erickson

Like you remember, it depends on the hospital, don’t you think?

[00:20:54.020] – Trish

Well, I’ve done a lot.

[00:20:55.440] – Hilary Erickson

What am I, in San Jose? We had eight consent.

[00:20:57.910] – Trish

Yeah. No. Well, and I remember when I first started and I did paper charting and we had to write every darn thing out.

[00:21:06.930] – Hilary Erickson

Was it like a pre printed consent.

[00:21:10.470] – Trish

At the place that I started at? It had a lot printed, but then it had a line or a section, like a paragraph of lines, and we had to write down, like starting the AV cervical exam, like all the things.

[00:21:25.380] – Hilary Erickson

Wow. When if you missed something, you were just up a Creek.

[00:21:28.240] – Trish

Well, they had one taped on the wall.

[00:21:30.570] – Hilary Erickson

Yeah. Why didn’t you?

[00:21:32.490] – Trish

I don’t know. That was back when we had the hole punch, too.

[00:21:36.230] – Hilary Erickson

Yeah. So most hospitals are definitely going to have you sign a consent of admission, which means we can touch you and that you’re going to pay. Basically, it’s a super long way. Bless you if you’re going to read the whole thing. Most people don’t, although I’m sure anesthesia consent. Anesthesia if you’re planning on an epidural, we did a consent for vaginal delivery and a possible peveatomy.

[00:21:55.680] – Trish

Yeah, we did that. That was one thing we had to write on there, too. And vacuum.

[00:21:59.250] – Hilary Erickson

We had to write that, too. If you’re having a C section, then there would be a separate consent for a cesarean section. If you’re having your tubes tied, there would be a separate consent for that. And then the hepatitis B immunization, but either parent can sign that. If you say that that guy that’s with you is the dad of the baby, then he can sign it or you can sign the hepatitis. And some people, I think, sign one for maybe the rest of my son and the vitamin K. But I’ve never worked at a hospital that signed for those.

[00:22:22.000] – Trish

I have had some that sign for that as well.

[00:22:24.660] – Hilary Erickson

But at one of my hospitals, we had to sign that. They knew they had to take baby home in a car seat. There was a consent for that. And the Jaundice one.

[00:22:31.570] – Trish

I don’t think I’ve ever had to do that.

[00:22:33.260] – Hilary Erickson

San Jose, I don’t know.

[00:22:34.500] – Trish

Yeah. I don’t remember. I’m trying to think of any weird consent. I’ve had circumcision consent if you’re having a boy.

[00:22:42.680] – Hilary Erickson

But a lot of those don’t come. Like we don’t have them send the circumcision consent until it’s actually happening. So some of them we wait.

[00:22:48.920] – Trish

Yeah. Same for us with cesarean, unless it’s actually happening.

[00:22:52.570] – Hilary Erickson

Right. Or it’s scheduled. Right.

[00:22:54.120] – Trish

Yeah.

[00:22:54.660] – Hilary Erickson

So consent and don’t feel like you have to do your best handwriting. Most people do a very just trying to get it done. Yeah.

[00:23:02.400] – Trish

And I’m sure we’ve both had those patients just signing it. I don’t care just signing it. Yeah.

[00:23:09.480] – Hilary Erickson

I mean, I don’t think I read through the full admission consent. It’s two full fine print pages.

[00:23:14.790] – Trish

Yeah. And that being said, with these consents that we’re talking about, general ones, the provider should still talk you through anything that’s changing and that they’re wanting to do or any interventions, they’re still going to talk to you about it. So it’s not like if you missed something and you’re like, oh, but I didn’t want that. And that’s not something I want. Then your provider and your nurse, before we do anything, we’re still going to talk to you.

[00:23:39.060] – Hilary Erickson

Yes.

[00:23:39.360] – Trish

And you have an opportunity. You can verbally say no, I don’t want that. Yeah.

[00:23:43.340] – Hilary Erickson

Even if you sign the hepatitis B consent. And then later I’ve had patients change their mind both ways. They refused it and then they wanted it or whatever, then you can change your mind. And it’s hard to change your mind mid C section. Other than that, most things you can change your mind.

[00:23:55.740] – Trish

So I have not practiced since COVID, because, like I was telling you, I was getting ready to take a tribal assignment. Thank goodness I hadn’t signed my paperwork at that point, because I also met and married my husband in a whirlwind. But during the different times of year, you’re going to sign a flu. Like, we’re going to talk to you about the flu and the pneumonia and.

[00:24:15.710] – Hilary Erickson

All those things, the TDAP, if you haven’t had your tetanus. So there are a lot of consent. But I think people get confused with the signed consent, which are literally just paperwork. They don’t really affect my care all that much, except for maybe the hepatitis B vaccine. But everything else is an informed consent that’s verbally done with you and your provider, and most often the provider, your midwife or your doctor is going to chart in the notes inform consent given for a Cesarean section or whatever they’re doing. So those are just they’re not signed. It’s just confusing. I think people think that those written consents are more important when I think those are all just paperwork and not really all that important, that it’s really the verbal things that we do in the room that people really need to pay attention to more.

[00:24:58.440] – Trish

Well, I think it depends on what is actually going on with Mama, on how much she cares about the consent, because if she’s in active labor, she is just going to want to sign it and get it out of her face.

[00:25:08.690] – Hilary Erickson

Yes.

[00:25:09.490] – Trish

And the other thing that we do during admission, which I said Seattle does differently, is start your IV and do lab work.

[00:25:18.160] – Hilary Erickson

Yeah. Most places are at least going to want to do lab work, which you can refuse either of those things. I mean, you can refuse anything, although I think if you refuse to sign the admission consent, we just say sorry. Right.

[00:25:28.880] – Trish

I don’t know anyone to do that because it’s basically just a consent for us to take care of you.

[00:25:35.840] – Hilary Erickson

Yes.

[00:25:36.320] – Trish

I’ve never had anyone refuse that.

[00:25:38.300] – Hilary Erickson

Yeah, but you can refuse the IV, you can refuse the labs. But I would definitely encourage you that if that is your plan, talk with your provider early, because those can have consequences. And you may think you want to refuse the IV, but once you get there and you talk it through with the nurse or whatever, you may change your mind, which is 100% fine. You can just have plans that change.

[00:25:58.870] – Trish

Well, most of my students and my followers on Instagram know that I am like the most laid back, like hippie labor nurse. But I personally did a hip lock or sailing lock. And this is what I tell my students, if you’re going to be in the hospital and you’re going to have a hospital birth, I mean, obviously anywhere but in the hospital, if there is some emergency situation, I personally would want a calm nurse, calm situation to have my IV placed because I have had all unmedicated babies. I do not like the IV. The IV bothers me more than anything else when I’m in labor. I know that’s silly. Minus my Op baby. That bothered me a lot. But other than that, that IV site, and they always put it right in my wrist because I have beautiful, big, fat veins right there. But I personally would rather that than in an emergency situation. Everybody running around and trying to get things done. The last thing I want is someone trying to start an ID on me.

[00:26:57.170] – Hilary Erickson

Yeah. And I don’t think people realize that when the emergency starts, your body, like, takes all those veins, all that good blood flow that’s in your veins, and just shunts it to the middle of your body. So it’s so hard to get an IV in the middle of an emergency, not to mention all the pressure that is on the person who needs to get in that IV. It’s like 6000 times harder.

[00:27:16.390] – Trish

That’s what I tell my girls. I want a very calm, not pressured nurse putting my IV in than someone who is just running in to help. And I’ve not met her.

[00:27:26.960] – Hilary Erickson

Right. And it’s just going to be added to the confusion at the time. I am a huge fan of the sailing lock, huge fan.

[00:27:33.880] – Trish

And I’m very laid back. And like I told you before, when we talk, I tell my girls there’s no hard nose or yeses, you can refuse anything in labor and delivery, but you need to do your education and understand when it’s necessary and when it’s needed. Because all of these interventions that we do, although I will 100% say that they are overused, there are legit reasons for them. And thank you, God, that they were invented because a lot of them have saved a lot of lives. It’s just when they’re used out of convenience is the problem. But the only way that you’re going to know, like, okay, this is good for my situation is through education or this is right for me.

[00:28:15.280] – Hilary Erickson

Yeah. And talking with your provider early on, because I know a lot of people will say they don’t want an IV to me when we admit them and the provider, I’ll call them and they’ll be like, I literally had no idea. We have talked for hours and she never brought it up. And they want to come over then and have a face to face talk with you because it really is a serious choice if you’re choosing not to have an IV because you can bleed so quickly in labor and delivery and they don’t want that. They do not want that. Also, they cannot put in an IV to save their lives. Do never have your OB consider putting in an IV.

[00:28:43.810] – Trish

No, I agree. There are other things that we do better in labor and delivery than the providers. But yes, I agree. And I’m Super laid back. And again, if one of my students or one of my patients is like, for sure does not want Ivy does not want a sample lock, I will support them, but I will just give them my opinion and my best thoughts on that.

[00:29:06.260] – Hilary Erickson

Yeah. And that’s what they’re going to do in the hospital, too. But it does make your nurse nervous the whole time. She’s going to be watching for any bleeding. They probably will encourage you to get a shot of Ptosis after the baby is born just to make sure that you can not bleed as much. But yeah, it just makes everyone really nervous.

[00:29:21.460] – Trish

Yes. Personally, I don’t like IV, so I don’t want one put into me in an emergency at all.

[00:29:30.000] – Hilary Erickson

Usually are in a very wonky place. It could be in your forehead. You have no idea. Yeah.

[00:29:34.770] – Trish

No fun at all. All right, so now they have an IV. A lot of places will run fluids.

[00:29:40.390] – Hilary Erickson

Yeah, they can put in fluids. If you want an epidural, then they’re probably going to start fluids. After this, things change. Like you might be starting an induction, the baby’s head might come out. But really, those four things going to the administrator, us, putting on monitors, asking the questions, quick assessment, IV labs that happens to permit much everyone that comes in and labor. So just expect those few things. And then after that, it’s a crap shoot as to what’s going to happen. If you’re going natural, that’s a great time to then get up and go walk the halls, do your lunges. If your hospital allows that.

[00:30:11.640] – Trish

I wanted to also mention that depending on the size of the hospital, after admitting, you might go to a triage unit before you go to an emitting room.

[00:30:18.900] – Hilary Erickson

Oh, that’s true. Yeah.

[00:30:19.900] – Trish

So it really just depends if you’re coming in for a direct admit for induction or your provider, you went to your office and your waters broke or something, they’re going to send you straight in for a direct admit. But a lot of hospitals will put you in triage, especially if we’re doing a labor check. You’re going to be in there for a couple of hours, and we’re going to do that. Everything we just said, minus some, we won’t do all the consents and all of that, but we will do a cervical exam to get a baseline and then usually check you again 2 hours later. Maybe have you walk. Well, depending now with COVID, have you do something.

[00:30:53.400] – Hilary Erickson

I’m sure we may encourage movement. I mean, that would just be insane to tell them. Just lay in the bed for 2 hours.

[00:30:58.190] – Trish

Yeah. And then we’ll check you again just to see because labor. The only way to really know you’re in labor is if there’s some change happening.

[00:31:05.210] – Hilary Erickson

Yes. Unless we check you and you’re like five, 6 CM, then we’ll shoot you a room.

[00:31:09.580] – Trish

Or like we said, you come in and we looked at you and are like, okay, just put her in a meeting room. We’ll check her in there.

[00:31:15.400] – Hilary Erickson

Yeah. And sometimes we’re wrong. Sometimes we’re like, Dang it. Now I have to change all the sheets.

[00:31:19.980] – Trish

Yeah. Usually not, though. We’re going to say that.

[00:31:24.810] – Hilary Erickson

Yeah. So just plan on those kinds of things. Trish makes a good point. Definitely. Triage is we didn’t triage as much during COVID because our triage is open, so that made it a little bit more difficult. But also with COVID, you may end up getting COVID tests when you come.

[00:31:39.060] – Trish

To see that’s what I was going to ask you, because like I said, you stopped bedside nursing during COVID. I stopped right prior to COVID. So I’ve heard all sorts of different things. But I would say things are tapering down now because it feels like although if you’re traveling out of the country, trust me, coming back to the US is harder than any other country. We almost didn’t get home this weekend. I was like, there’s no restrictions in the US why I’ve had my vaccination. I don’t understand. This cost us like $300.

[00:32:15.350] – Hilary Erickson

Yeah. And it may depend on if you’re vaccinated. It may depend on your hospital and the amount of cobalt in the area. It may depend on your history. Who the heck knows?

[00:32:24.130] – Trish

And it may depend on the day because on Friday it may be one thing and on Monday a whole another one.

[00:32:28.460] – Hilary Erickson

Yeah. Or they may be out of pelvic swabs because the way hospitals are running lately. Yeah. So I think the admitting process sometimes is really like people get nervous about it mostly because all those questions can feel really overwhelming. But I promise you, if your mom goes in for a knee or if you got a boob job, they’re asking all these same questions. It really is just very normal, maybe less on the chlamydia, gonorrhea front. But other than that.

[00:32:51.580] – Trish

Well, and the other thing to note is when they go to postpartum, their new postpartum nurse is also going to do some questions in an assessment. Not as much as we do.

[00:33:00.880] – Hilary Erickson

And when you get a new nurse.

[00:33:02.230] – Trish

Yeah.

[00:33:02.630] – Hilary Erickson

They do a quick assessment. They might again ask you about like baby meds, like any birth preferences.

[00:33:07.790] – Trish

Oh, that’s a good point. Birth preferences. Because that I get asked all the time. When do I give that? During admission?

[00:33:13.680] – Hilary Erickson

Just as soon as you can.

[00:33:15.250] – Trish

Yeah.

[00:33:16.090] – Hilary Erickson

And then usually we hook that into your chart. But sometimes worth references change. Like, you don’t want an epidural, you get a new nurse who comes on. She’ll be like, how are you doing? Are you thinking about anything different? I think a new nurse is so great. It’s just a fresh face and like a fresh breath of air in the room. Yeah.

[00:33:31.620] – Trish

And I as a nurse, when I would take on a patient who has been there, I always went through her birth plan as well and talked through it, even though she’s been there eight or 12 hours.

[00:33:41.810] – Hilary Erickson

Yeah.

[00:33:42.370] – Trish

I’ll talk to her about it as well. And I think that’s important. Heather from a life in labor, we used to have a birth course together. And one of the things we have talked about is if you have a birth plan, know why you have what you have in it, understand it because I think a lot of people just will put stuff in their birth. But at least in my career, I’ve seen and when I really start talking to them about it, they’re really not sure why they well, I think a.

[00:34:06.410] – Hilary Erickson

Lot of them get it off the bump or something. Right.

[00:34:08.350] – Trish

Yeah.

[00:34:08.690] – Hilary Erickson

And they just start checking boxes because it sounds good, right?

[00:34:11.640] – Trish

Or they print one that’s prefilled. And I think it’s really the power of the birth plan. I call it a birth map, but the power of the birth map is not the birth map itself. It’s the time and the education and the decisions you’ve made to put into them and just knowing the things.

[00:34:26.990] – Hilary Erickson

Yeah, I think that’s more important than printing it out, too, having it. I had a patient who had a color coding and marker and stickers once, and I was like, I love this so much. I want to take it home.

[00:34:38.550] – Trish

This is off track. Sorry, people, but the funniest one I’ve ever had, we had one where the girl put on she did not want anyone to make eye contact with her butthole.

[00:34:48.720] – Hilary Erickson

All right.

[00:34:49.270] – Trish

Yeah. I was like, don’t plan on it.

[00:34:51.970] – Hilary Erickson

Yeah.

[00:34:52.360] – Trish

And there was something else on it that was really funny, but now I can’t remember, and she wasn’t my patient, so I never got to find out. Like, is this girl just trying to be really funny or does she have some real paranoia about it?

[00:35:06.190] – Hilary Erickson

I mean, that being said, we had a doctor who checked everyone’s bum hole after a repair, so I hope he didn’t make eye contact.

[00:35:13.470] – Trish

Yeah, hopefully not. Yeah, that would be a whole nother podcast episode. Like the funniest things you’ve seen in labor and delivery.

[00:35:22.930] – Hilary Erickson

Oh, I don’t think anybody wants to hear that. Probably moms who’ve had many babies want to hear it later on.

[00:35:28.030] – Trish

Yes. No. Maybe other labor nurses or the funniest words that you’ve heard.

[00:35:32.750] – Hilary Erickson

I’m out of people’s mouths. Yes, probably.

[00:35:36.560] – Trish

Yeah.

[00:35:37.240] – Hilary Erickson

Anyway, don’t be intimidated by the admission process. It’s so normal and it can be overwhelming. So just communicate that if you’re just like, hey, can we take a break from the questions? I just want to sit here and chill out for a little bit. I promise you, the nurse still has other paperwork she could throw in in between because it is a long process for your nurse as well. When I started, it would take me like 2 hours to get through an admission, and then you could just rattle.

[00:35:59.970] – Trish

It off by memory.

[00:36:01.020] – Hilary Erickson

They’re like, you’ve got to get this down to an hour. And I was like, I can’t even imagine.

[00:36:06.090] – Trish

No, I know. And it’s so funny because I’ve gotten to where at some places, especially because I did a lot of Kaiser with the exact same epic program. I got it down to where I know them by memory. The other thing I was going to say that I think is really important. If you have a good labor nurse, this is not going to be an issue. I wouldn’t say good. I would say season. If you are contracting, you can stop answering. Don’t feel obligated if we’re like, So do you have any history of blah, blah, blah, and you’re in the middle of a contraction? We’ll look over if you don’t answer and we’ll stop and wait for you. Yeah, that’s fine. Don’t feel obligated to speak when you’re contracting.

[00:36:46.300] – Hilary Erickson

Yeah. And sometimes on those real easy questions, like mom, dad, do they have anything specific you can even point to your partner? As long as they know. And I’ll let them answer some of those easy questions like that they can’t answer if you’re safe in your home environment. I wouldn’t take a dad’s answer for that.

[00:37:03.410] – Trish

No. Or anybody. It might be the mother in law that you’re not safe from. I don’t know.

[00:37:09.780] – Hilary Erickson

The dads are always like, I’m the one that’s not safe at home. I don’t care about you.

[00:37:15.210] – Trish

Yes, we like you and all, but we just don’t.

[00:37:18.930] – Hilary Erickson

Yeah. So admission, it’s something everybody goes through. Don’t be intimidated. Make it work for you. If something’s not working for you, talk to your health care team because we can adjust it. But most often we’re just trying to railroad it through so that both of us can get done with it.

[00:37:32.440] – Trish

Yes. And it does feel long, especially if you’re in labor.

[00:37:36.150] – Hilary Erickson

Yes. But if there’s sometimes you want to take a break, the nurse can go out and do other things. She can witness your consent. She can go get your lab work ready, all these different kinds of things. There’s other things she could be doing to give you five or ten minutes off of the questions.

[00:37:48.520] – Trish

Exactly.

[00:37:49.000] – Hilary Erickson

Don’t be afraid to talk. All right. Thanks so much for coming on, Trish. Where can people find you?

[00:37:52.690] – Trish

Thank you so much for having me. So you can find me on Instagram. It’s Labor Nurse Mama or the blog Labor Nursema.com. And also on my new podcast, it’s The Birth Experience with Labor Nurse Mama.

[00:38:04.390] – Hilary Erickson

And I’m sure that’s on all the podcast platforms. Right, Trish?

[00:38:07.440] – Trish

I think so, yeah. My first episode is tomorrow, so we’ll see if everything’s going right.

[00:38:14.210] – Hilary Erickson

Yeah. Not tomorrow when this airs.

[00:38:16.660] – Trish

Okay.

[00:38:16.880] – Hilary Erickson

Because we’re recording this way early. But by the time this airs, Trish will have 400 episodes, let’s hope. Yeah. And Trish also has a birth class. If I am not your cup of tea, definitely check out hers. I would say that Trish has a more calming, earthy, natural tone for herself.

[00:38:32.800] – Trish

That’s looking for check out hers.

[00:38:35.170] – Hilary Erickson

Mine is more like, this is how it’s going to happen. Don’t be worried. Let’s get it done fast, just like I did admission.

[00:38:40.860] – Trish

But that’s what I love about this environment. And this is what I tell my followers is that if my teaching style is not your thing, that’s fine. Just do your due diligence, pick out a good birth class and take one.

[00:38:53.100] – Hilary Erickson

Yeah. Do you have a freebie people can see what’s up with you?

[00:38:56.460] – Trish

We do. We have a really awesome pregnancy postpartum checklist bundle, and they can go to Instagram, to my link and bio. And it’s a pregnancy updates. We’ve put a lot of work in these. You’ll get a weekly email that is full of education and plus some freebies, including the pregnancy checklist bundle, which goes through the different trimesters postpartum labor, all the things.

[00:39:20.630] – Hilary Erickson

Yeah. And I think it’s so important to find out before you pick a class, if you and that person match for sure. Class is kind of funny because I’m kind of like a stand up comic a little bit, and some people do not like that. Some people absolutely love it. But I think some people are like, this isn’t a funny experience, Hilary. I don’t know why you’re bringing in.

[00:39:39.840] – Trish

Well and the same for me, because I’m very blunt and I definitely am not your typical labor nurse in certain ways. I definitely lean towards being like a hippie type Duala Labor nurse, although I am very much about the importance of us and the medical team and all of that. But you’re right, and I do have free birth workshops that I do. We open up our birth courses for live enrollments four times a year, and we do a lot of free teaching during that week. And that way they can come and they’d be like, oh, her voice really annoys me. Or she’s way too blunt. I can’t deal with that or what have you. So I think it’s important to find.

[00:40:17.000] – Hilary Erickson

The person that works for you. There’s a few great hospital based classes out there. I would stay away from the home birthday classes because you’re just not going to learn the same kind of things as you are. I always say mine is hospital based because if you’re having a home birth, do not take my class unless you’re like, just in case I go to the hospital.

[00:40:31.670] – Trish

Well… I have a lot of students who do home births and birth centers. Mine very much focuses on mindset and a lot of the things and a lot of holistic healing and food you can eat for recovery and stuff like that. So I think it is a little bit different. But I think you’re right. I think making sure that because the fact is birth is not predictable. And so I think it’s good to be well rounded. And even if you are out there and you’re planning a home birth, I think it’s really important that you’re listening to this. Obviously, it’s really important because I think a lot of home birth moms who end up transferred to the hospital are really in a world of trouble because they have no idea what’s going on around them. And no matter who you are being admitted to the hospital. And typically for a pregnant woman, it’s the first time she’s ever been a patient herself. It’s a little disconcerting. It’s like going into a foreign country.

[00:41:26.530] – Hilary Erickson

Yeah.

[00:41:26.930] – Trish

So I think it’s important to be prepared for that, because the more prepared you are for things, the less fear you’re going to feel. And you and I both know that fear during labor can really be a beast.

[00:41:36.040] – Hilary Erickson

Yeah. I think there’s so much benefit for oh, yeah. She said this was going to happen and Hilary is clearly an expert even though I don’t feel like an expert a lot of the time, but I am an expert on yes, this is going to happen next, then this is going to happen. And I think it just feels like, okay, like when you’re taking directions from somebody and you’re like, oh, yeah, they said there was a white house. Oh, they said there was a circle K. Okay, good.

[00:41:57.190] – Trish

They said that my head was going to spin and I was going to want to hurt someone during transition. It’s great.

[00:42:02.520] – Hilary Erickson

Perfect.

[00:42:04.770] – Trish

I’m not weird.

[00:42:07.110] – Hilary Erickson

All right, Trish, go ahead and check out Trish, you guys, and we’ll talk to you later.

[00:42:10.940] – Trish

Thank you so much.

[00:42:12.460] – Hilary Erickson

Okay, guys, I really enjoyed that episode. Of course I love talking to a fellow nurse, but I think admission is where a lot of the like now I’m submissive to this hospital happens just because we stick you in that bed, we stick the monitors on you, put an IV in you. That puts you in a very submissive situation and it doesn’t have to be that way. You don’t need to feel that way. We’re not meaning to have you feel that way. It’s just kind of what ends up happening. We kind of have to be above you to put in your IV. It would be hard for us to be, like, at an even level anyway. I just don’t want people to be intimidated by the admission process, so that’s why we went through it today. I hope you guys enjoyed it.

[00:42:48.290] – Hilary Erickson

Stay tuned for next week’s episode where we are going to talk about mom shaming as I peruse TikTok it’s everywhere and I just wanted to chitty chat about it for a bit. And if you’re looking for just pregnancy information, the week after that, I’m actually going to have one of my favorite TikTok doctors on to talk about routine things that we normally just routinely do in the hospital that you may want to refuse, so stay tuned.

[00:43:13.200] – Hilary Erickson

Thanks so much for joining us on today’s episode. We know you have lots of options for your ears and we are glad that you chose us. We drop episodes weekly and until next time, we hope you have a tangle free day.