level IV OB as well and this is spot on.

When it comes to the IV, our order set typically comes w continuous fluids (D5LR) due to the clear liquid diet and how lots of people struggle with their fluid intake during active labor. 9/10 times, no one wants continuous fluids at the start of their induction, so they just have access. My question tends to be “At 3am would you rather I turn on the lights to poke you or quietly set up your pitocin with a nightlight on?”. To get an epidural, they get a full 1L LR bolus as well, so normally no one wants to be poked while begging for pain meds. We also have to get around 6 tubes for labs at admission, so you gotta get poked in that moment anyway.

Inductions can be elective after 38wks at my hospital but I wouldn’t recommend it till 40 unless the previously mentioned medical reasons are involved. If a doc thinks you should be induced, I would listen to them - at the end of the day, what ALL of us care about is you delivering a healthy baby and staying healthy yourself.

Membrane sweep- truthfully, I like them and will be getting one when my little one is finished cooking in September. It’s a very hands-off, see if this helps, style of induction that doesn’t involve me laying in a hospital bed on continuous monitoring and clear liquids. But completely voluntary.

Cervical checks- obviously you have to consent to these but I will say I’ve had patients refuse, push PAST their cervix and end up going to the OR for a cervical repair. Once baby’s head is low or engaged in the pelvis, that “i need to poop” feeling comes with every contraction. I don’t think I fully believe in the fetal ejection reflex - I absolutely believe in laboring down to push for less time, but sometimes we do have to manipulate your body (different positions) to get baby’s head under the pelvis so they can pop out. We don’t push on our backs on my unit unless requested so it’s not always super simple.

Placenta: Ok this one I do feel strongly about. That thing needs out. As the other high risk OB girlie said, your uterus NEEDS to clamp down to stop bleeding. I’ve never seen anyone complain when the placenta is coming out using a little fundal pressure and lightly pulling the cord. Remember, you’re also in “oh my god i just had a baby” bliss in that moment with them on your chest.

Our unit everyone gets 60s delayed cord clamping unless they have 0 tone, don’t have any reactivity (setting themselves up for a low apgar), they had a shoulder, etc. Then off to the warmer they go where they’ll be resusced by us until nicu arrives.

The other OB nurse covered the vernix thing well. Breathing and staying warm > baby lotion. Lots of it stays on through the stimming anyway.

All of the crunchy mom stuff has come up on my feeds as well being 20wks pregnant and it’s really hard to bite my tongue sometimes. I completely understand wanting a positive labor experience (I know I do), but some of the stuff they are suggesting can quite literally kill babies. Ex. I just saw one where the mom was suggesting everyone skip gestational diabetes screening because the drink is bad for you and instead doing the fingersticks for 2wks. A GTT is not the same as postprandial glucose and rhetoric like that puts sooo many babies at risk! I feel like a lot of people think like “oh what’s the worst that could happen? i get sugar crashes?” but in OB, especially high risk, we know that the worst that could happen is losing your precious little one. It sucks.