fetal monitor question

Specialties Ob/Gyn

Published

when using a fetal monitor, what position must the mother be in - must she be lying supine, or can she be in a position in which she is most comfortable?

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Specializes in L&D.

She can be in any position really. Although often times the monitor needs to be adjusted when mom changes positions (especially if she is "fluffy").

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Specializes in Community, OB, Nursery.

I've found monitoring to work in pretty much any way mom wants to lie. A couple things factor in, though, as Jen said. If mom is fluffy, and depending on how many weeks mom is. Full term is not so much a challenge for me no matter what position. Give me a 24-weeker and I'm lucky to pick them up for more than 10sec at a time period. It's been my exp. that with the earlier gestations it's close to impossible to pick up the baby in some positions. Those bitty ones are real movers & shakers.

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thankyou

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Excuse me......supine is the position mom should NOT be in due to risk of hypotension.

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Specializes in Nurse Manager, Labor and Delivery.

Compressing the vena cava can be an issue when lying supine, but most pregnant women can tolerate lying flat for short periods of time. You can make moms more comfy by just "bumping" them, so they are slightly tilted, keeping pressure off that pesky vena cava. You should encourage mom to not lie flat (though most cannot do that comfortably when that belly gets big).

As for monitoring, I try my darndest to allow mom to be in the position that suits her. When mom is on Pitocin or another prostiglandin, I am more diligent in monitoring baby. If mom is laboring au naturale (what the heck is that anymore??) I don't stress it so much.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

the mother should be in a position that suits her comfort level and is safe for her baby. Generally that is anything excluding laying on her back (supine).

If a baby is having problems, left lateral is the preferred next position to try.....then the other side.

But never, ever supine.

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Specializes in N/A.

Pardon my ignorance but what does "fluffy" mean?

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Specializes in L&D,- Mother/Baby.

Fluffy means a bit of extra addipose tissue (Overweight, fat, as wide as they are tall etc.)

When mom is in complete lateral position, I find moving the monitor to the far side of the abdomen (the side that is up) will pick up the baby well.

Some women have that 'basketball' belly and no matter where you position the monitor, it tilts up and without constant pressure on it, it won't pick up. And we all know we can't sit in the room holding it. You may have to get creative. I have tied a third belt around mom so that the knot is putting pressure on the monitor in the right spot. Sometimes a fetoband works. (It resembles a wide tube of fabric that stretches and is 12-18 inches wide. It eliminates the need for belts. It holds both the toco and the US in place.)

If all else fails, ISEs work no matter what. :nurse:

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Specializes in L0-high risk OB, PP/NBN, Med/Surg.

Doesn't anyone use Leopold's maneuvers to find the fetal heart & assist in placing the fetal monitor? I love the clicking sound of a direct placement over the fetal heart! Plus it is evidence based practice. Fluffy women & wigglers are a challenge, but knowing where you can best pick up FHTs helps in finding & keeping them on screen when necessary.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I use Leopold's on all my new patients to assess position of baby and to see if the head is engaged or not.

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Specializes in L&D,- Mother/Baby.

Though I'm still not good at determining position, I use Leo. to find the fetal back.

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