How To Survive OB Clinical In Nursing School

ob clinical baby

Today we talk with an experienced OB nurse and educator about what nursing students can do to survive and thrive the OB clinical in nursing school.


Jon:
All right today, I’m here with one of our content directors [email protected] Miriam Warman, RNC MNN dash MSN dot ed. Welcome to Miriam.

Miriam:
Hello. Thank you.

Jon:
So, first of all, what do all those letters mean after your name?

Miriam:
So I am nationally certified as a maternal newborn nurse. So that’s the MNN. And then I have my master’s in nursing education.

Jon:
So the MNN is it, is it it’s like the CCRN or something like that?

Miriam:
Correct. You just get it for maternal newborn nursing.

Jon:
Cool. So I brought Miriam on because we get a lot of questions about OB, I think it’s an intimidating field and I know when I was going through school, it was intimidating when I had my kids. It was intimidating. So I wanted to bring Mary Mon to talk about some of that. So, first of all, Miriam, kind of talk about your journey in nursing and then specifically about your maternal newborn experience.

Miriam:
Okay. So I graduated nursing school almost 11 years ago and I started med surge, like a lot of people do knowing that I wanted to eventually go into the OB world. So I did a med surge with some hospice beds on our floor for about six months and then transferred to where I am now and have done OB since then. So I’ve done postpartum. And typically what I do is I go to the deliveries and catch the newborns. So catching means you go in and you take care of the baby. Usually resuscitate it as for humans of life and take care of them, do that transition period until they’re stable. And then I’ve also done some NICU stepped down as well. And then went on to I really like to teach nursing students. So I went on to get my masters and now do a little bit of everything. Yeah.

Jon:
Yeah. So w did you always want to do OB or was it kinda like you landed there and fell in love with it?

Miriam:
So originally I had wanted to go into, I did cardiac rehab while I was getting a biology degree in college, my first degree. And I never actually ended up ever doing anything with hearts, although that was my initial start on the nursing track and then just the loved OB clinical when I was in nursing school and knew I wanted to do that from there on out.

Jon:
That’s cool. So no interest before the clinical actually,

Miriam:
No, I was kinda like, oh, maybe. I mean, I wasn’t terrified of it, but it wasn’t really, I had my mind on something totally different. Okay,

Jon:
Gotcha. Yeah, I remember so when I did my OB clinical had already had one child and I’ll say like the nurses and everything that took care of our son when he was first born were just phenomenal. It was actually the nurses who caught the issues that were going on with him. And, and so it was really neat to see that and then be able to rotate through that even though I didn’t ever really spark an interest in it. Right. So let’s talk specifically then since it was clinical, that really got you interested in what I want to talk a little bit about today is the student in OB clinical. So from your experience now, working there and teaching and precepting, what makes a nursing student successful in OB?

Miriam:
So it can be really scary, I think, because you’re used to taking care of those like sick little ladies with pneumonia or something like that. Now, all of a sudden there’s babies being born. So I think just keeping in mind, just this is observation, most of the time observe, ask questions so that you’re really learning it. So people that even think I never want to do OB you will, at some point cross paths in your nursing when you’re an actual nurse whether you’re an ICU and you have a mom, that’s all of a sudden gone into DIC and is admitted for that. So you will, at some point still deal with a pregnant person or someone that’s just had a baby, no matter where you work, really,

Jon:
You know, it’s funny, you mentioned that because one of my very first, I, it was my first patient actually out of school in the neuro ICU was a mom who had a hemorrhagic stroke while delivering. And it was a tragic case and everything, but it was actually a postpartum mom right there. First patient in the neuro ICU.

Miriam:
Yeah. There, I mean, things happen. It should be a good happy time, but unfortunately, you know, things happen. So they travel along the hospital, then you’ll come across them.

Jon:
So it seems like the, maybe the best thing you’re suggesting is really just ask questions, dig in, understand what you can, regardless of where you want to go.

Miriam:
Exactly.

Jon:
Okay. So what do you wish you could tell every student before that first day walking on the OB floor,

Miriam:
Just relax easier said than done you. Aren’t going to be left alone in a room to deliver a baby. You’re not going to be, you know, checking a cervix. You are really there for observation. Anytime I’ve taught clinical or had students like that is all you’re doing is observing. You’re not even really giving medications because these are high risk medications. So specifically in labor now you might give some newborn medications with the nurse, but you are not going to be the only one doing anything. And then make sure you eat, you know, a lot of times there’s a lot of blood and things that happen. So make sure you got a little food on your stomach before you’re rushing back to the, or with a patient and pass them out.

Jon:
So let’s talk about that. Have you seen students pass out or bring up?

Miriam:
I have not seen a student, but you know, those residents, I have caught a couple. They think they’re like all strong and they’re, they’re helping or watching VC sections happen. And you just also didn’t see all the color go from their face in their, on the ground,

Jon:
You know, and I, I remember the first, when I was first considering like medical and nursing and stuff as a career, I shattered a podiatrist and he’s like, you want to come to Orr with me? I was like, yeah, that sounds awesome. But when he started drilling into the ankle, for some reason that just, I had to step out, I was like, I, it’s not like it’s gross, but I just flushed. And I got all dizzy and stuff. So trying to get sound.

Miriam:
No

Jon:
It wasn’t. Now I want to go back to what you initially said about asking questions and just being kinda humble and stuff there. So with my son again, so I’ll always credit the student nurse. I don’t remember her name, unfortunately, but she was in her OB clinical and we, she was taking care of us and our child. And so when Taz was born, she took him over and was kind of doing the little assessment, you know, what she had learned in her clinical skills. And her instructor was there and she went to take, the temperature is rectal temperature and she couldn’t get it, you know? And so rather than her being like, I don’t want to look dumb and like doing something dangerous or anything like that, she, she asked the professor, she’s like, what’s, I can’t get this. Right. And so it turned out he had imperforate anus and just her be willing to stop and be okay with like, cause I’ve been probably caused a lot of anxiety. Like I can’t get a rectal temp, like what’s wrong with me? You know,

Miriam:
Just make up something. Yeah,

Jon:
Yeah, yeah. Right, Right, right. It’s saved his life, you know, and she had an OB nurse practitioner there and we got everything just fell in line. So I think that’s so important to just be humble and ask questions. So along with those lines of, of like being really anxious in clinical and, and all that, and what have you seen help with that? Like what helps a student pause?

Miriam:
So I know it can be hard because when you are first starting out in clinical, you’ve just started the course. So you don’t know barely, or haven’t learned much of anything before you’re already there seeing all these totally different things. So as much as you can prepare, there’s this great pneumonic for veal chop, which you will see this over and over. It has to do with how the fetal heart rate, what the fetal heart rates doing and what the nurses doing to respond to that heart rate to correct it or just to check and see how things are progressing. So understanding that really great pneumonic will help, I think, cause you’ll see what the nurses doing and being able to understand that this is why that’s happening. Also having a really good understanding, the medications are very different in OB world. So just kind of reviewing those and having an idea, cause then you’ll know why things are being given and what it’s for.

Jon:
What are the top three medications a student should know?

Miriam:
So I would say oxytocin. So that’s going to be what’s given to help contractions, but also stop the bleeding after the delivery. So almost every woman will get that at least after delivery. And then also for a hemorrhage. So methergine, and Hemabate are your top hemorrhage drug. So if she’s bleeding too much, so I would say those and then for the newborn to know your vitamin K and erythromycin, because all babies are getting that after delivery. So just kind of knowing when that’s given and why that’s given our important,

Jon:
You know, just like I get and I haven’t touched OB and what eight or nine years or something, but those, the veal chop, and then those three medications are four medications. That’s kind of what I remember

Miriam:
Things that are drilled

Jon:
In. Right. And then DIC, because I saw it in the neuro ICU actually. So I think, yeah, those are super important to understand if you know those, I mean you’ll probably pass your class. Yeah. So yeah. And then back to the bill chop too, I’m not a huge pneumonics fan, but that was one that I just, I had to know because I could not, it didn’t all make sense. Like it’s not natural, it’s not normal. All those like running those compressions and all that stuff. So when our daughter was born, I probably annoyed the nurse luck. Cause I stayed up the whole night watching the monitor and I was still a nursing students, like buzzing them and, and stuff. So

Miriam:
I honestly, I still run through that pneumonic in my head when I know something, I see it and I have to spell it out in my brain to know what the next step is. Okay.

Jon:
Yeah. So talk over, I guess let’s talk over the pneumonic. We’re talking about it, but we haven’t said what it is.

Miriam:
So I’m on one side, you’ll have veal and chop is lined up with it. So the V goes with a C so V stands for variability in the heart rate. So the heart rates just kind of all over the place. And then the reason is your C, which is cord compression. So the court is being compressed. It could be maybe the baby’s head is like leaning on it. So it’s kind of squishing it. So the blood flow is not getting through that cord to the baby, the way that it should your E is going to be early decelerations. So that’s a good thing. And that means head compressions. That’s the age that goes with that. So that, that means the head is compressing on the cervix. So the baby is close to being delivered or she’s fully dilated. So for that case, we would just check the cervix and see are we complete and ready to have baby?

Miriam:
R a is accelerations that’s another good one are a good thing. And the O for that in chop stands for oxygenation or some will say, okay, so this just means maybe it’s like happy, healthy, the heart rates accelerating as the baby moves. So I always tell people, if you think about, when you run up some stairs or you walk across a room, your heart rate is not going to stay the same. It’s going to jump up a little bit. So that’s showing a healthy baby, the baby’s moving around and the heart rates jumping up and then the last one is late decelerations. So this one’s really bad. And this lines up with your P, which is placental insufficiency. So the placenta is not giving oxygen to the baby the way that it should. So that just looks like you have a contraction and the heart rate decelerations after the start of the contraction. And we have on nursing.com that on a cheat sheet, which shows what the strip looks like and shows what you should do for each

Jon:
Awesome. Yeah. I think it’s a really helpful cheat sheet. It’s pretty too. It’s pink and it’s nice. Yeah. Cool. So let’s kind of wrap up here. Do you have any, maybe funny student stories or personal stories that you can share?

Miriam:
Well, so I will say I don’t cry as much in the deliveries, but as a student when you see that first delivery, you can’t help it, like in almost all the students to see. It’s just amazing. And I’ll cry when I get a really good sweet family. But it’s awesome to be a part of that. So that residents passing out, that’s really my big, funny story. Probably seeing them go down and you just can see it’s coming. Yeah. So for my advice for students is just to go in there and ask questions and observe everything and really enjoy it.

Jon:
Awesome. So let’s last thing here. Why education? Why did you go deeper into education and why nursing.com?

Miriam:
So honestly I have had, it’s the one thing I’ve had tons of students tell me, like, you’re really good at teaching us. And even my fellow coworkers will come to me and ask different things, run things by me and I really enjoy it. So I love being knowledgeable about this area and knowledgeable about things in nursing and sharing that with people and making it easier. It’s hard and I know a nursing school, I had some really great instructors that really explain the why. And that’s my big things. I like to explain the why behind the what, so that I truly understand it. And then with nursing.com I just was, I loved creating content and teaching OB. So when I saw that there was a job opening for that, I jumped on it and have loved being a part of the family ever since.

Jon:
Awesome. Thank you. So you guys, there’s so much to learn. It will be, and it is so different. So if you guys do need help, please head over, visit the OB course. We have a pediatrics and OB course, and there’s tons of cheat sheets in there. Tons of practice questions. There’s so much there that can help you and you can get over there, watch some of the stuff for free or try $1 trial. And it’s definitely gonna help you as you go through. So thanks a lot, Miriam.

Miriam:
You’re welcome. Thank you. Happy nursing.

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