I Need Some Help...

  1. This Sounds Really Stupid But I Dont Know How Far To Push The Pt's Before I Call The Dr. In The Room I Am Talking About Prima Pt's And Sometimes I Don't Know If I Am Pushing Them Effectively....when The Head Is Spreading The Labia Or What??? Everyday I Leave My Job And I Feel A Little Bit More Stupid....
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  2. 10 Comments

  3. by   HappyNurse2005
    My experience is based on OB in house and nearby. When the primip is pushing and i see head that is NOT sucking back between ctx. or course, they are usually in to check on them and such.
  4. by   SmilingBluEyes
    I always notify the OB when pushing begins----

    and depending on where they are (during dayshift, they are only a minute or two away)

    or nights (they are at home)---

    I call them to come in either when head is crowning (dayshift) or when baby is at the pubic turning-point, (nightshift). This is, of course, regarding primips as a rule.

    Also if any woman has pushed for an hour without any progress, I call the MD for evaluation.

    I must add it also depends on whether there is an epidural or not. Urge to push is a factor, as well.
    Last edit by SmilingBluEyes on Feb 2, '07
  5. by   Spidey's mom
    ummmm . . . I call the doc when they are complete and the docs are in the room the entire time they are pushing . . . can't imagine not having a doc in the room as a pt is crowning. . . . . No wonder you've delivered a baby or two Deb.

    Y'all are braver than me . . . . or maybe it is rural nursing and more access to the doc. If my pt's doc is not readily available, I have the ER doc as backup. And docs are at the clinic which is attached to the hospital and so just a short walk across a driveway to the hospital.

    steph
  6. by   dawngloves
    Quote from stevielynn
    ummmm . . . I call the doc when they are complete and the docs are in the room the entire time they are pushing . . . can't imagine not having a doc in the room as a pt is crowning. . . . . No wonder you've delivered a baby or two Deb.

    Y'all are braver than me . . . . or maybe it is rural nursing and more access to the doc. If my pt's doc is not readily available, I have the ER doc as backup. And docs are at the clinic which is attached to the hospital and so just a short walk across a driveway to the hospital.

    steph
    WoW! I can't imagine a doc sitting in a room for an hour or two during pushing. I imagine it does have to do with how busy your unit is.
  7. by   Spidey's mom
    Quote from dawngloves
    WoW! I can't imagine a doc sitting in a room for an hour or two during pushing. I imagine it does have to do with how busy your unit is.
    Usually one laboring woman at a time . . . . I think at the most we've had three.

    Yep, it is rural nursing. . . I don't do OB full time - there is no need. I'm on OB call today - no calls yet. I'm the only OB nurse scheduled today.

    steph
  8. by   SmilingBluEyes
    our docs don't generally sit in the room while pt pushing. but the midwives will!!!! they are much more involved that way.
  9. by   NurseNora
    Take careful note of what you see when you call the doc in and how long it takes to deliver from there. Just keep watching and you'll get a feel for how long it will take. Until then...

    Watch the head as it shows at the introitus with pushing. With primips you will usually see the head for some time before they're ready to deliver. When you first see something, is it just swollen caput, a few cms ahead of the skull, or is it the real thing. How many pushes did it take to see anything? How quickly does it move back up when Mom stops pushing? Has the head "turned the corner" yet? By that I mean has the occupit started rotating under the symphysis? You can tell that by watching. At first the head moves down and then back. When it starts rotating under the symphysis you can see the visable caput begin to move up (anterior, towards Mom's front) as well as out (toward her feet). That's a bad description, sorry, I usually have a woman pushing a baby out to serve as a visual aid as I try to describe it to someone. And, of course, how long will it take the provider to get there? In my rural hospital it runs the gamut from those who are there for the entire second stage to those who want to arrive, catch the baby, and go back home.

    Be in as many deliveries as you can. Volunteer to "catch" for other nurses so you can watch the delivery closely. Some doctors enjoy teaching and will be happy to talk to you about what is happening when and why they're doing what they're doing. The more deliveries you watch, the better off you'll be when you have to deliver your first one yourself.
  10. by   JenTheRN
    Small hospital here, about 200 to 280 deliveries a year. We have two staffed RNs on the unit. (No desk clerk, no aid) We have three docs that deliver with us. When we have a laboring patient (usually only one at a time) our docs are usually on the unit (weekends and off time) or at the office which is across the street.

    I will usually let them know each of my checks...(when they are on the unit they usually do it themselves) They come in the room when pt is complete. If she has some pushing to do they will leave (the room). But they are almost always near by. So far, I've only seen one baby born before the doc was able to get there.
  11. by   nrse4evr
    Our unit is a level 3 unit with Hi,Lo and everthing in between risk. The rn taking care of that pt will usually notify the Dr when the pt is 8cm or sooner whatever the dr wants. When the Dr gets to the hosp he or she comes to see the pt (nights) then goes to the Dr call room and the RN calls when she is set up and ready for delivery. If as another contributor stated, there is pushing beyond 1 hr we call the Dr to let him/her know the progress unless otherwise instructed to do so. We also have Residents. Lately the residents have been pushing with the pt and that drives my nurses insane! We are very protective of our Moms and refer to them as OUR pt eventho they are really EVERYONEs pt. We like to call the resident in when we are ready to BIRTH. Don't want to tie up everybodys time with pushing. Because the pts usually see so many different residents, attendings, med students, we try to maintain control of our pt throughout the delivery so she doesn't really focus on someone she has never met before standing between her legs. Not the best scenario but it is a teaching hosp. We do about 200-240/month
  12. by   nrse4evr
    PS We also try to let every new nurse do a controlled Dr assisted delivery at least once. Then she knows what to do if she has to deliver by herself. Because we are a teaching hospital the pts are asked if they mind if a nurse delivers her baby. We try to only do this on low risk multips who could probably do the delivery better that we do.

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