I am only a pre-nursing student, but I had to chime in and tell you all my story....after a 26 hour labor (I did finally dilate to a 10 and pushed for over an hour), I had an emergency c-section in which the spinal wore off and I felt them actually stitching me (they didn't believe me at first--until I attempted to get up from the table--they then doused me in lidocaine). Nobody did a single fundal check on me in post-op or even when I got to my room 8 hours later (yes, 8 hours later). This was at the 2nd busiest hospital in the nation for births. Did I mention that I had over a 10 lb. baby? I was going in and out of consciousness during those 8 hours in recovery and being ignored by the nurses--I soaked through a king-sized bed pillow. I was hemorrhaging and eventually went into shock and ended up having an emergency clot evacuation without any pain meds--right there in my patient room. Oh, and I needed 2 blood transfusions. They told my husband to be prepared to raise his son alone. To think that if I would have had fundal massage/checks, that this MAY have prevented this---just shows how important this really is. Just wanted to share my story! This is part of my inspiration to go back for a second degree to become a nurse.
I work in postpartum. We do fundal checks on our C-Section patients on admission, then every four hours for the next 24 hours, then q 8 hours after that. For vaginal deliveries, fundal checks are upon admission and then q 8 hours.
Of course, that's the minimum. We can always do more if there is cause for concern.
The protocol in my hospital is every 15mins for the first hour, every 30mins for the 2nd hour. Then ever hour x2. Not exactly sure after that since I work in L&D and the pt is usually on maternity after 2hrs in recovery.
Im in the UK. Where I am we dont do any routine fundal checks on post CS women unless there is a clinical indication to do so (pain, increased lochia, temp, abdo changes etc)
We also dont routinely do fundal checks on women post vaginal delivery once they're out of labour ward (again unless there is a clinical indication to do so)
L/D does fundal checks q15min x 4, then when mother/baby gets the pt, we do check q30min x 3, q4h x 48 hrs, then qshift. For vag dels, we do the same q15 and q30, then q4x3 and then BID. Obviously in any case we can check more often if we are worried about something. I have never personally seen a doc specifically order no fundal checks on a post c/s but I have heard of it happening.
Since I worked in Mother-Baby I can tell you our protocol. We would check both c/s and vag upon admission from L&D (after their intial 2 hour recovery) then one hour later. Then C/S would be at least every 4 hours x 24 hours then every 8 hours. Normal vag would be every 8 hours. I would also check after the first couple voids and as needed of course. I believe our L&D checked immediately after then at least every 15" x 1 hour then every 30" x 1 hour. I have never seen orders not to check fundus, but I have seen orders to not massage fundus.
back2thebooks - Wholy crap! I hope you went ballistic on the hospital! Glad everything turned out well for you and baby though!
You know what---I was naive. I didn't know any better. Knowing what I do know now, I feel like the hospital, my OB....they all let me down. I'd like to get a copy of my records. I am just amazed that nobody even told me or my husband to do fundal massage at any point (since they obviously weren't going to).
Thankfully, I do not remember much of my stay in recovery. My husband says that I was going in and out of consciousness and thrashing my arms about. He slept on a metal folding chair by my bed that night---as our son lay in NICU alone (was admitted to NICU b/c I ran a high fever--they put him on IV antibiotics for 3 days).
And to think I went on to have another baby (who was even BIGGER!) LOL
At our hospital once our c/s is back to the floor after the recovery room we do our initial fundul check and then another in 1 hour. the policy then states that we check every 8 hours but for the c/s vitals you do q30min x2 then q1h x3 then q4h... consequently i always throw another fundul check in there with one of the vs.
lisamct... i find it very interesting that you guys don't routinely check the fundus after a section. I've had numerous sections come back and their fundus's are boggy or there are still clots that need to be expressed.
I guess here its just that its another intervention thats generally not needed so why make all women go through what can be a very painful experience if there's not a clinical need to do it. Most of our maternity care is based around the principle that if there's no real justified clinical need to do an intervention then we dont do it. Ive only twice had post c/s women show clinical signs that suggested the need for fundal assessment (although I admit Ive only been doing this for 3 years so have limited clinical experience compared to others)
I actually had a look through our national guidelines after I posted the last time to see what they say and fundal checks arent mentioned at all in our post-c/s care guidelines. As far as post SVD women the guidelines state that checks are not required unless clinical condition suggests a need.