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March 07, 2011


Hang in there.
You neglected to mention another coffin nail of accelerated MSN programs churning out crappy nurses with terrible nursing skillz and bedside manner. But they can ipod, ipad, blackberry till the cows come home.
Oh God, are you going to move in a year or two? I haven't even met you yet, and I mourn this.

P.S. I know several women with the coil. If you don't like it, it can be removed. Just keep tryin' till you find something that you like.

P.P.S. As a Jew, isn't it time you had your come to Jesus experience? Well now's your chance! All joking aside, you can be reassured by the
one student on campus with a Yarmulke. Come and bring your diversity, please!

Don't forget to budget an exponential decrease in Sean's free time the closer he gets to tenure review. It makes even the most sane people lose their everloving minds.

(That was one of the nails in *my* coffin of life as a PI...)

You know, as a new nurse myself I question the idea of going straight to a degree like that. I'd advise you get your RN and just BE a nurse for awhile. You'll find theres a lot to learn all over again, and that there is responsibility enough without being in some higher position. I believe there are reasons behind the climbing of the ladder...experience and wisdom that come with months, years in practice. But you'll figure it out, Jo. You always do.

I could not love my copper IUD more if it had come with a free jar of Nutella. And word has it that the increased bleeding can be mitigated by taking an NSAID before and during one's monthly - I haven't done so because I haven't HAD to; my post-coil periods are still totally fine.

Micaela, don't worry! Sean doesn't even come up for review until 2016, and even then, of course, we would hope to stay!

Jenn, duly noted. (Yikes.)

And Melissa and Micaela, yeah. I was wondering about that. I had a crazy plan to do six times as much work to get those skillz but now I think, why? Why not just do it slow?

Oh, and I was raised Presbyterian. Y'all, I used to be a church camp counselor! For years! Don't that beat all?

I could move undetected among the ranks...no one would know until I busted out the matzah at Pesach!

I just had my paragard removed to start trying for another kiddo. I LOVED that thing. Insertion was uncomfortable and pinchy. I had some crampy feelings for a bit after. One heavy period and then everything was normal. The strings soften up in about 8 weeks. Non-hormonal birth control is priceless. When I am ready for BC again, I will definitely get the copper coil.

I thought it was funny that when I went in for the removal, the nurse sort of cringed and asked "Oh, you hated it?" I was like "Heck no! That is the best BC I've ever used!"

So relieved. I may get to meet you yet!

School + kids is always dicey, but it's worth it, and it's good for them to see you in school. I think you have a good plan. Do they offer childcare at said university? Some do.

Do you think I could use Paragard if I'm one of 2% or so of women whose bodies reject Mirena? I "thought" I was on that for about 9 months, but when I had my next annual and asked why my monthlies were so heavy and if the doctor could trim the string, I was told the darn thing was dislodged. Talk about a freakin' heart attack! I, too, never want to use BC again because I am enough of a wreck without more hormones, but I definitely don't want any more kids.

as an ob/gyn resident and lurker...

by dislodged do you mean it was completely out (expelled), or it was in the wrong spot?
If it was expelled or ended up half in the cervix because of fibroids or atypical uterine anatomy, you could have the same problem with the paraguard. with more or less normal anatomy, incorrect placement is a problem with technique or bad luck- but not something that would be recurrent. So there's no reason to think it would happen again with the paraguard (or another mirena for that matter). on the plus side, as long as the iud is in the uterus somewhere, the exact position doesn't affect contraceptive efficacy (or the hormone effect in the case of the mirena). So if it was intrauterine, you probably were just unlucky all the way around in not responding to the hormone.

also regarding ectopics (i wanted to make this comment before when you mentioned not being an iud candidate b/c of having had an ectopic)- the link between modern iuds and ectopic pregnancy was found in case control studies with an improperly selected control group. The actual finding was that among pregnant women those with an iud were more likely to have an ectopic than those without one...but iuds are such effect bc that the actual risk of having an ectopic is lower with an iud than with essentially any other birth control method. so acog/abog (the governing body for ob/gyn) have been saying for years that history of ectopic is not a contraindication to having an iud, but it's been slow to filter from academic centers to clinics. (that pharma companies are not motivated to pursue a change in labeling that wouldn't generate much more income- not helpful either)

sorry for the textbook. iuds are sort of one of my favorite things.

teresa, exactly! In fact I was looking at a source that put the IUD's effectiveness on par with sterilization!

And thankfully the evidence-based practice has filtered down to my particular clinic YAY.

Oh, yes, at least as effective as surgical sterilization (more effective than vasectomy and less effective than tubal ligation) for the Mirena, which is what I have and love (now...hated it while spotting and nursing).

My sister is going to get essure. That's the little coil that goes in the Fallopian Tube. It's permanent but non-surgical and effective once the scar tissue forms (confirmed by HSG).

You can have IUD insertion either during your monthlies or during ovulation since the cervix is slightly opened during both of those times. I had it inserted during neither of those times (7 weeks postpartum), and it was fine fine fine. I hardly even noticed it.

I'd like to know why it's not offered to women who have not had a baby. It seems like a 5-year Mirena or a 10-year Paraguard would be awesome for a teenager. Set it and forget it. I know there was a risk with the old-style ones of PID and eventual infertility, but the new styles don't seem like they have uterine perforation as a side effect, and PID should be avoidable if you keep STDs at bay.

My understanding is that the after a baby rule is based on cervical dilation. I knew someone who got a mirena after her first child. However, she had a c-section and never dilated at all. Most of the time your cervix remains slightly dilated after dilating for childbirth even if you didn't hit a "10." This makes it possible to insert the IUD. If you have never dilate, your cervix is too closed and they have to dilate you (which happened with my friend) using a cervical ripener and that is less than pleasant and makes it a more complicated procedure.

Also, could you clarify why you wanted to be an APN? What is it that was going to allow you to do? I had been thinking you wanted to be a midwife or work on a maternity ward? Have you looked at an internship at The Farm for that?

I'm in my final semester of a 3 year accelerated program, and I can tell you that it has WRECKED me. In our program we have PhD's and folks who've gotten masters in other fields, and they all say without hesitation that this is the worst program because of the sheer quantity of knowledge that is crammed in (or at least expected of us to know, whether taught or not) while being treated like undergrads. I don't think this is unique to my program, either. It's a huge transition to go from a BA in Marketing to an MSN and writing prescriptions.

If you want to do nursing, you should definitely do the BSN. I have to say, though, that I wanted to be a primary care provider from the outset, and I was and still am frustrated by the disconnect between the initial "learning to be a nurse" part and the ensuing "now forget that and learn to be an independent healthcare provider" focusing on assessment, prescriptions, billing, etc. They're two very valuable skillsets, and closely linked, but in my opinion, nursing is not a set up for being a nurse practitioner. I could get a lot of flak for that, but I honestly don't mean to demean nursing at all. I love working as an RN. But I love MORE working (in clinicals) as an independent provider.

I feel like the BSN prepared me to be an NP as much as the BA in Marketing.

And had I known before I started this program what it would do to me, my health, my relationships, I would not have begun. I'm glad to be at the end, but I can say that it is not worth the complete brain melting trying to fit it all into three years (let alone two! God!)

Becky -- sure! A certified nurse midwife IS a type of advanced practice nurse, as both require the MSN-level degree. I would actually rather NOT work in maternity unless it was at an awesome birth center or something, because the gulf between evidence and practice is pretty darn wide at most hospitals. And y'all know I can only shut my mouth for so long.

In terms of being able to practice, it seems to make a lot more sense to get a CNM, at least in the part of the country. After my experiences, I would not want to be a midwife who didn't have admitting or attending privileges at a hospital, even with a home-based practice.

That said, I actually have no desire to be catchin' babies right now! :) I like Women's Health a lot but don't feel called to the parturition part. At least not right now.

Jo--sounds like a sane plan. Good luck with the IUD too. I love mine (even w/out the free nutella :D)

Oh and to clarify: by "next year or two" up there I meant "year or two after finishing the MSN program I hope to apply to in the future." So really in about six or seven years.

Clearly my writing skills are just MWAH! perfect right now.

One more vote in favor of the Paragard I had one for a while (had it removed because we were moving back to Tokyo and I thought I might want another baby, and I was afraid a Japanese OB/GYN who had never seen one before would freak out if I tried to have it removed over here). It was so nice not to have to worry about anything!

Yep. Paragard is nice. No worry about taking hormones. Never had any cramping with it, in fact I think it reduced my cramping and PMS. Period a bit longer, but not too bad. Go for it!

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