fetal monitoring

anitame · Mar 14, 2003

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, BSN, RN · Mar 14, 2003

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 · Mar 18, 2003

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 · Mar 18, 2003

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 · Mar 19, 2003

internal fetal monitoring

**picturing the CORKSCREW****

:-(

ShandyLynnRN, BSN, RN · Mar 19, 2003

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 · Mar 19, 2003

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, BSN, RN · Mar 19, 2003

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 · Mar 19, 2003

THANKS Shandy...

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

have a good night!!!

SmilingBluEyes · Mar 19, 2003

I feel I need to clarify some points here, after Parker posted her concerns. (which are valid)......

We let moms w/internal monitors free reign of movement as much as physically possible. They can sit up in chairs, walk about or change positions in bed. So sorry your experience was that bad, but believe me, it is not the norm in my care. I definately support and promote comfort for moms in labor and do all I can to make it better for THEM, not convenient for ME. I sometimes HATE that we have to use monitors at ALL and rejoice when I can be intermittent and NON invasive for labor care. And like I said, I use internal monitoring judiciously, weighing the benefits to mom and baby versus the risks. I am MORE than well aware of infection risks--- but hyperstim w/pit and previous existing maternal risks (such as pre-eclampsia labor induction) risks outweigh even this. I use EXTERNAL monitoring a vast majority of the time, working hard to allow free movement and comfort for the mom, not just paying attention to the monitor.

I try to be the LEAST invasive POSSIBLE while ensuring safety and comfort for moms and babies. If I had it my way, I would prefer ALL moms to be up walking, showering, bathing, sitting on birth balls, whatever they choose. Epidural and drug use would be the exception, not the rule. I hold the strong belief: The more natural, the better.

It's just in some cases, intermittent and casual monitoring are NOT warranted while constant and close, careful monitoring IS ----so I have to take myriad factors into account when caring for laboring women. Risks and benefits must be continually weighed to ensure the safest and best experience for our laboring moms. And, naturally, informed consent is a must when using *any* type of fetal monitoring. The moms and their families play an important role in their care planning and decision-making processes in my care. Hope I made myself clear here.

parker in arkie · Mar 19, 2003

Smiling Blue Eyes,

Send me a ticket out of HICKVILLE??

TO THE land of OZ where women RULE??

:-)