[obeyacts2]

I am a student. I have heard that the fetal monitoring isn't always accurate on thhe "fluffy' patients- meaing the monitor may not pick up all the ctx. Is this true or a myth? Just curious.


Laura

[anitame]

It can be more difficult to detect the contractions with heavier patients but it's not impossible. You just need to find the best spot; sometimes this takes some time. Then you need to reposition the toco after position changes, etc. Unless the patient is on Pitocin or has less than ideal fetal heart tones, I don't stress too much about the toco.

[ShandyLynnRN]

definitely true! I have had patients that no matter how I repositioned the toco, or repositioned the patient, I could not pick them up! That's when I would just palpate and give them the remote marker button to push when they had them.

[at your cervix]

I also have had pt's that I could not pick up contractions due to "fluffiness". If they are on pitocin, especially with an epidural, I ask the MD to place an IUPC (nurses can't do it in my state). Sometimes it is even impossible to palpate, after all, if you can't feel the uterus because of all of the "insulation", you can't tell how strong contractions are by palpation!

[SmilingBluEyes]

It's true as far as monitoring strength and even occurence of contractions are concerned. And it can be tough to pick up and keep fetal heart tones on the monitor. Often, VERY fluffy patients on pitocin will wind up with an IUPC so we can accurately monitor for hyperstim. and adequate labor. I am glad I am able to put in IUPC's and FSE's myself; it makes life easier. Unless a patient is GBS positive or infected, we are given free reign to judge when internal monitoring is necessary and implement it. I am judicious in internal monitor use, but will not be afraid to use it if conditions warrant it and it would be beneficial.

[parker in arkie]

internal fetal monitoring

**picturing the CORKSCREW****

:-(

[ShandyLynnRN]

Originally posted by parker in arkie
internal fetal monitoring

**picturing the CORKSCREW****

:-(

Just incase you didn't know, a fetal scalp electrode is a small wire with a tiny coiled wire at the end that slips under the babys skin. Sometimes it can leave a very small red mark, but I have never seen a baby have problems from it.

An IUPC, internal uterine pressure catheter, is about the size of a foley cath, harder plastic, and is inserted between the babys head and the uterine wall.

Neither are uncomfortable for the mother, except for the vag exam required to place them, and the fact that with IUPC they can't get out of bed.

[parker in arkie]

Shandy,

I've had the device used during the birth of one of my four children. It was very uncomfortable and is a pathway for infection. And getting out of bed is often "just what the laboring mother" NEEDS to find a more comfortable position.


From my experience, once the electrode was placed, I was instructed to lie on my back and stay that way. Lying on my back slowed the labor resulting in pitocin. It also made me very uncomfortable (back labor) which meant more demoral. NOTE: I was in a teaching hospital and by the time labor was over I had an oxygen mask, IV, demoral, the internal monitor, an episiotomy, and any other intervention they could possibly think of. My 8lb 10oz baby girl was also placed in NICU for 3 days before I was allowed to have skin to skin contact with her. She had developed an infection. After 7 days in NICU, they released her directly home without an explanation for the infection.

Who knows????


I didn't mean my previous post to be offensive. I had a bad experience and the thought of the "corkscrew" makes me wince.

My husband was also not allowed in the delivery room...oh I could go on and on about this birth...suffice it to say, it was AWFUL and set me on the path to becoming a Nurse-Midwife.



One other thought and I will, I PROMISE I PROMISE, shut up about it, how do we know that babies don't have a problem with it? The babies can't tell us...

IFM makes premature rupture of membranes a neccessity.

[ShandyLynnRN]

oh, I didn't take offense to your post at all!

I am sorry that you had such an awful experience! As far as I know (atleast in the hospitals that I have worked at) it isn't common practice to not allow the laboring mother not change position with a scalp electrode on. It was the IUPC that I was referring to.

I am all for non-interventional labors. I would rather never see internal monitoring used. It IS warranted in very few cases, but I agree, we can't know for sure that it doesn't bother the baby. I was referring to post-delivery. I meant that I never saw a baby wince when the place where the FSE was was touched or something.

Good for you for going for your CNM!!! I think that's great!

[parker in arkie]

THANKS Shandy...

just wanted to make sure I didn't offend you. It's WAY PAST MY BEDTIME. lol


have a good night!!!