New l&d nurse clinical decisions

Katie71275 · Nov 1, 2014

It's really up to the nurses(and OB) discretion. Some docs don't want the pit off at all. However, if you are charting interventions such as oxygen on(which oxygen I don't even think has any benefit), then you should be charting that your Pit is off. I have about a year and a half on L&D and usually would discuss with more experienced nurses (Or when in a teaching hosp, the residents) re if Pit should be turned off or not. Have you have a fetal monitoring course? If not, I think it would be beneficial to understand the physiology behind the decels. Early decels or even some variables, I don't usually mess with the Pitocin, prolonged decels, it's off, as well as recurrent lates, depending on reactivity of the strip.

cayenne06, MSN, CNM · Nov 3, 2014

It can be helpful to print out your protocols for things like pitocin drips for easy reference. I work as an RN in LDRP and I am a CNM student, so i see the issue from the provider and the RN viewpoint. Yes, sometimes I feel the nurses are too quick to turn off the pitocin, but honestly when I am working in the RN role I am just as quick to turn it off/down! We can have the pit off for... I think 20 minutes? without having to restart at the beginning. But even if you have to restart at the lowest dose, that is okay. Turning off the pit doesn't mean you are "calling" a c/s. More often than not, we give a bolus, reposition mom, maybe O2, an FSE etc depending on what is indicated. The strip improves, pit is restarted and mom goes on to have a SVB.

Oxytocin is one of the most commonly used drugs in labor and delivery, so we all tend to get a little too comfortable with it. It is actually a high alert drug with significant risk for harm, so it is definitely better to err on the side of caution.