Non-evidence based practices on OB unit

[queenanneslace, ADN, MSN, APRN, CNM]

I'm currently working on an OB unit where non-evidence based practices are heartily embraced and employed with enthusiasm.

I come from a low-interventive, patient-centered, midwifery background and there are days - well most days - after my hospital shift I come home thinking: "I can't do this. If this is what I have to do to be an OB nurse, then I can't do this."

I'm in the process of being oriented to the unit, so I am following other nurses. I'm not part of the decision making as much as I am shadowing the other nurse. I understand I will have more freedom to 'manage' my patients the way I'm comfortable - and abiding my evidence-based practices - once I'm done with orientation. But I wonder, if this is the way things are done on the unit, will I not be a good 'team player'? Will the other nurses and supervisors expect me to manage labors and deliveries the way I'm being trained?

Examples: counting to 10 and purple pushing, increasing pit per time interval and disregarding contraction pattern and FHR response, (well, until the FHR is really crappy), aggressive perineal 'massage', NPO on admission, not repositioning women in bed (with epidurals) for hours and hours and hours, routine frequent cervical dilatation checks - hourly or more frequently.

I'm rabidly consuming all my AWHONN resources right now. And re-checking what I believe to be true or evidence based - that's it's ok for pt's labor down, repositioning in labor is a GOOD THING, the count-to-10 and hold your breath thing can compromise baby's oxygenation. Etc, etc, etc. I'm just not seeing this at work. There's such a disconnect.

I'm new. I'm an outsider. I understand that coming in and giving everyone the 'that's not evidence based practice' spiel is not going to win me any friends or influence. But I also want to know that I will be able to practice in a way that I believe provides the best patient care in terms of safety, satisfaction and outcomes. For me, it's not about managing or manipulating the patient with the tools of obstetrics, this is not my nature, especially when some of these tools come with risks. I'm not anti-technology (anti-epidural, anti-induction, anti-everything), either. But I would choose a more judicious and cautious approach.

You all here seem to have a good handle on current evidence-based approaches to OB care. Anyone have advice on how to find some middle ground? How do you work in environments where you disagree with the prevalent practices? Does it rock the boat to follow evidence-based practices when most of your colleagues on the unit do not?

There seems to be an unspoken emphasis on 'efficiency' - getting pts hooked up to IV fluids ASAP, so they can get the epidural ASAP, so they can get the Pitocin drip ASAP, so they can get to complete ASAP, and can get pushing without breathing so the baby can get delivered ASAP.

This goes against the nature of my being in so many ways.

Words of wisdom and advice very welcome right now!

[jodyangel, RN]

Yes this seems to be the way of many hospitals...unfortunately.

[OBERrural]

You can't control everyone else's behavior, but you can make suggestions and start getting things changed. Every place I've ever worked, we practice very independently as L&D nurses. The doctor is barely there until delivery. Most of the things you discussed, you should be able to do with your own patients. There is no rule that says you can't change the patient's position. Nobody is going to be the with you for pushing so just let her push the way nature tells her to. Pit the way you want to pit and when your patient gets to complete let her labor down. If other start seeing this, they may follow your lead. Remember, no patient is cut and dry. You have to adapt to your particular patient. Yesterday I couldn't get my patient to change positions during labor and that was fine with me. I'm a very laid back nurse and I think if the doctors see that in you, they will follow your lead! Good luck!

[casi, ASN, RN]

Are there any committees in the hospital that look at evidenced based nursing? Can you bring ideas to them? Can you join them?

[toomuchbaloney]

Watch the way the medical and midwife providers practice. Begin to align yourself with those who hold similar practice ideals and philosophies to your own. Practice YOUR brand of nursing within the policy and laws that govern you.

Good luck.

[queenanneslace, ADN, MSN, APRN, CNM]

Thanks for your responses. As I have this discussion with other OB nurses (who don't work where I do) I'm starting to see that I will have more leeway in how I practice once I'm done being orientated to the unit. It's eye-opening, though, to see what's still happening in OB. I appreciate your perspectives.