[Elisheva]

Do nurses in L&D get adequate training in use of the fetoscope and ausculatation? What percentage of your patients are on electronic fetal monitors?
Everything I'm reading talks about the skill needed to be able to ausculate FHT and that the nurse patient ratio is 1:1. I'm wondering how often that happens?

[MemphisOBRNC]

Most of the nurses I work with have never even seen a fetascope! We tend to rely on EFM so much, most are not comfortable using the doppler intermittently. So many of our patients are inductions or augmentations that we use the EFM on 100%.

[Elisheva]

Originally Posted by MemphisOBRNC

Most of the nurses I work with have never even seen a fetascope! We tend to rely on EFM so much, most are not comfortable using the doppler intermittently. So many of our patients are inductions or augmentations that we use the EFM on 100%.

Wow. The new maternal/child nursing text I'm using has quite a bit about the nursing skill of fetal heart tone auscultation, making it sounds as though only the higher risk mothers/babies may be required to us EFM. I thought that sounded like a pipe dream.

Thanks, Memphis, for keeping it real for me. I'm trying to learn as much as possible.

[babyktchr]

As the above poster said, fetascopes are hard to come by and most have never seen one. Auscultation is one on one care, and most facilities, I would imagine, do not have this kind of staffing. But...I am sure they exist.

The AWHONN intermediate FHM course has a whole section on ausculation of FHT, and it is part of the end skills testing. It is really eye opening to really have to listen to FHT, as opposed to just looking at a strip.

Every now and again I have done intermittent monitoring, but it is a very patient specific choice, and staffing has to be optimal. The patients like it a lot. But here in the real world.............

[Suebee6]

I have SEEN a fetascope...but never had to use one!! We do intermittant monitoring at times but it consists of hooking them up to the EFM for a 20 minute strip.
We do still have one on one nursing care though

[CEG]

According to ACOG, intermittent auscultation is adequate for low-risk women. However, epidurals, pitocin, etc are so prevalent that it has become routine to use it on even those without. The hospital where I am doing my clinical has an alternative birth center with no EFM but many of the nurses resist doing births there because they aren't comfortable with no EFM. Since EFM was introduced the only improved outcome was in fewer neonatal seizures (sometime like .04% fewer). The only other change was an increase in the c-section rate. There has been no decrease in other injuries related to hypoxia, cerebral palsy, etc.

The family medicine practice I go to uses fetoscopes, but they also do homebirths, so they're a little unusual.

[Elisheva]

I was just wondering how things worked in the real world of L&D. I know how a busy med-surg floor is, so I had a difficult time imaging that L&D would provide 1:1 nursing just so a nurse could auscultate FHT every 15 - 30 minutes for a low risk mother. Maybe in a perfect world. I pretty much assumed that EFM would be used 90% of the time because it frees up staff. Anyway, I appreciate your honest feedback and it lets me know that I really need to take the FHM program being given at an area hospital next week.

I really appreciate all the information I get here. You're helping me feel more confident about a return to nursing.

[SmilingBluEyes]

I remember my manager (who was in OB for 30 years ) had a fetoscope hanging on her wall for decoration/novelty. NOPE in 9 years, have never used one or had my hands on one.

[eden]

Well I haven't seen a fetoscope but where I work we use the dopplar and EFM. We tend to rely more on the dopplars where I work because it is low risk and there is so much more mobility for moms but if there is any concern I will put the baby on EFM. Depending on what the EFM shows I will either take them off or continue with the monitor.