[bagladyrn]

I totally agree with what you are saying. I am equally blunt with my patients, informing of them of their right to refuse any intervention, but informing them of all the risks and benefits of both having and refusing the intervention, including the fact that some interventions may mean the difference between life and death or serious injury to themselves or the baby. I document every bit of this and the patients quoted response.
I don't see this as "scare tactics". I see it as treating them as adults who are taking on the biggest responsibility of their life and deserve to be fully informed.

[33-weeker]

I have no problem with speaking the truth if it is done with respect and in a professional way. I'm the first person to speak up for true informed consent.

I'm also the nursery nurse who makes it a point to tell parents of RDS social inductions/sections exactly why their barely 37-week kid (or their 39 by dates, 36 by exam kid) is having trouble breathing and in NICU on oxygen. I'm all for informed. Too bad I don't get to inform them until after the damage is done.

[eden]

It is scare tatctic when you say "if you don't have EFM your baby's HR can go down but may not be dectected for 5-30 minutes".

The reality is that most labors and deliveries are uneventful and that evidence based practice shows that IA is comprable to EFM in outcomes, with fewer unnecessary c-sections. Just because it's policy to have EFM does not mean it should be the golden standard, especially when evidence based practice says otherwise an AWHONN backs up said evidence with studies.

The really bad outcomes are often the ones where you least expect them and even when everything is in place as it should be, it does not change the outcome and nothing more could have been done. There was a case study of a severe dystocia with apgars of 0/0/1/4/7 where it was unexpected and everything and everyone was in place. Nothing more could have been done and baby is doing super now but even when the outcome didnot look so favorable there was never any talk of litigation because everything that could have been done, was done. No IV or EFM could have predicted this or changed the outcome.

[tvccrn]

Originally Posted by eden

It is scare tatctic when you say "if you don't have EFM your baby's HR can go down but may not be dectected for 5-30 minutes".

I don't think that's a scare tactic. It's simply stating the facts. If she had added"...and by that time your baby could be dead." THAT would have made it a scre tactic.

tvccrn

[eden]

It's not stating the facts because evidence suggests otherwise. Why not tell them that EFM is subject to misinterpretation, is subjective (2 people can interpret the same strip differently) and there is evidence that IA is just as good, in terms of outcomes?

[feebebe23]

My comment to EDEN.....

I completely agree with you. I know that there is not evidence based practice that states continious efm decreased bad outcomes. I know this.....but have you ever seen a totally normal, term, spont. labor, no pit, no nothing baby crash down to the 60s for no reason....cuz I have. And no it usually doesn't cause a bad outcome when you flip mom over give a little O2 and the baby recovers.

This is a story from a friend....at a different hospital.....mom is in early labor 3cm....asks if she can walk around....good nurse says of course you can....nurse says "if your ctx get stronger or your water breaks come right back....mom and dad go walking....down the elevator....outside....moms water breaks.....she nice and slowly returns back inside....up the elevator....back to L&D....where she is placed on the monitor...FHTs 40-50...prolapsed cord.....you get the idea...

My point is while your on my unit and I am your nurse.....your my responsibility.....and I agree that a lot of interventions are unnessary.

When you (the patient) starts calling all the shots ie I won't wear the monitors, I won't have an IV.....you start taking away my ability to assess and insure your safety....

I am all for natural birth....bradley birth....but be reasonable about what your asking your nurse/hospital to do for you....have a hep lock....politely tell your doctor that you would perfer not to have your membranes artificially ruptures....with my naturals I always let them know...you are not strapped to the bed....you have 8 feet of monitor cord to work with.....stand up....sit in the rocking chair....get on the birthing ball....and I always tell my naturals that they are free to unplug and go to the BR when ever they would like, and I offer this at least 1X/hr....its OK to say to your doctor/nurse "I do not feel an urge to push, and I would perfer to not be checked at this time"

You catch more flys with honey.....and that goes both ways in the nurse/patient relationship.

[rninwch]

Feebebe23, I understand what you are saying...I empathize with you entirely, but I don't agree with you.

I've done L&D for 12 years and I've seen some really wacky stuff in those 12 years. I think we've all seen babies doing fine, laboring along, no pit just suddenly drop their FHR into the 60s for no reason. I've also seen babies with FHRs looking great on the monitor have uncomplicated deliveries suddenly come out limp and blue.

My problem with constant FM is that every study shows that it doesn't improve outcomes, only increases interventions when compared with IA.

When I was pregnant with my first child I was undergoing a "routine" 2nd trimester ultrasound. The doc was scanning the heart when it just stopped. I don't mean slowed down, I mean as we were watching his heart stopped! It was only for about 10-15 sec, but it wasn't beating then suddenly it started back up slow at first then up to a normal rate.

OK, so I was near hysterical...there was obviously something wrong with my baby. Test, after test after test showed nothing. I was terrified if I didn't feel him move for an hour or so...a few months later he came out screaming his head off without any problems.

My point? Well, if I had been in the hospital and in labor and that would have happened I would have had tons of interventions and maybe ended up with an emergency C/S...the outcome wouldn't have been any different. If we began EFM on every baby starting at 26 weeks we would be delivering a whole lot more babies early based entirely on an EFM strip.

We usually do continual FM, most pts get epidurals, but we don't have centralized monitoring where I work, so if something shows up and I'm busy with another pt or helping in another delivery and don't get back into the pts room for 15 minutes the FHR can be down for that entire time. Personally I would rather use IA than to have a "crappy strip" x 15min and nothing being done about it! Which one looks worse in court???

[HappyNurse2005]

Originally Posted by tvccrn

I don't think that's a scare tactic. It's simply stating the facts. If she had added"...and by that time your baby could be dead." THAT would have made it a scre tactic.

tvccrn

but she did say that, in the OP. to quote hte OP:

I understand that in some circumstances my baby's heart rate may increase or decrease and go undected for 5-30 minutes depending on my stage of labor. I am aware that these changes could result in the injury or death of my baby.

[eden]

Yes I have seen an unexpected twist or 2 where the FHR suddenly decreases but there is usually a reason( quick descent, quick progress in labor, nuchal cord ect). I have also seen babies on the monitor who look beautiful come out needing resusitation.

Asking for IA or refusing a heplock does not limit my ablitity to assess a woman or her baby. At my facility there are not mandatory IV's and I have never had a problem getting access when needed.

I also find that even while on the monitor, yes you can sit/be on hands and knees ect but it can be difficult to pick the baby in those positions. Alot of the time mom's HR comes in stronger and the monitor picks up her HR so what good is EFM when you end up monitoring mom instead? I can easily do IA in the tub/shower/hands and knees or on the ball and be confident in what I'm hearing vs having a baby with a basline of 120 and a tachy mom whose HR is 130 and not know who I am seeing.

I'm not saying EFM does not have a place in L&D ( it can be very useful) but it does not have to be an all or nothing type of monitoring situation.

[feebebe23]

I could not imagin not having central monitoring....ahhhh

And I agree sometimes you do pick up mom not baby with a mom moving around alot.

And yes.....babies decel all the time when no one is looking....as in the entire pregnancy...babies roll on their cords....so i agree with what your saying.....so here's the questions.

mom comes in....a bradley mom....she's 3 cm....having regular ctx....appears umcomfortable/early labor....she would like intermittent monitoring...for me FHTs q30 min means I get 5 min strip every 25 min...making sure before/during/after ctx....so getting an etire 5 min....hey thats just me.....so 25 min has gone by....you go in fhts 60's...how long has baby been down 2 min or 10?....you do all your stuff...call MD/IV bolus/position/O2...minutes go by....off to the OR...baby out well before the 30 min to incision.

All things be equal.....do they have a case? In your opinion?