nurse only attended births

Specialties Ob/Gyn

Published

I started a new job in December at a larger hospital, avgs 30-40 deliveries a month. I know that doesn't sound large but at my last job a good month was 20.

I have personally delivered more babies in the few months I've worked here than the 8 yrs I worked previously.

I was wondering how common nurse attended deliveries are at your facilities.

Last week had a g2, 1st babe pushed hrs and had forceps. This ob-gyn wanted to be called when she was complete. I called him, reported also that she was only a little pushy, he then stated to call him again when I could see head. Well, this kid was high, she would push and he would hit the pelvic bone, then slip back. We tried a few different small position changes, then 30 min of no progress I put her on the birthing stool on the floor. She immediately leaned forward like she was gonna fall on the floor. I got the mom behind her and s.o. in front of her, looked and there was crowning. I hit the call light and no one came to help (found out later it didn't work) the family ran to get another nurse and she delivered while the dr was being called, tight nuchal cord. My other deliveries that I did here the drs just didn't make it and they should have, except one who walked in complete.

At the other hospital the drs at night would come in when they were complete, or making some progress like they would be complete soon. I appreciate that. I like catching babies, but if something goes wrong, I don't want that responsiblity. If I wanted to do that I would get training and become a midwife.

(sorry so long winded)

Specializes in Obstetrics, M/S, Psych.

There is no policy in my hospital to have the doc in house when patients are in active labor. They are only about 10 minutes out. I imagine this is usual procedure for many rural hospitals. Even with complications taken into consideration, this 10 minute window works for us. We do not have anesthesia or OR in house, which is more of an issue to me than having an OB in house, as it can take up to half an hour for them to arrive. Still, even if there were a C/S that needed to be done so emergently that we couldn't wait for anesthesia, local lidocaine would still be an option. Scarey to think about, I admit!

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Specializes in Obstetrics, M/S, Psych.

There is no policy in my hospital to have the doc in house when patients are in active labor. They are only about 10 minutes out. I imagine this is usual procedure for many rural hospitals. Even with complications taken into consideration, this 10 minute window works for us. We do not have anesthesia or OR in house, which is more of an issue to me than having an OB in house, as it can take up to half an hour for them to arrive. Still, even if there were a C/S that needed to be done so emergently that we couldn't wait for anesthesia, local lidocaine would still be an option. Scarey to think about, I admit!

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If the doctor did not arrive at my delivery because he just didn't want to hang around, I would really resent paying him his fee, and would certainly PROTEST!!!!!Patients need to wake up and smell the coffee.

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If the doctor did not arrive at my delivery because he just didn't want to hang around, I would really resent paying him his fee, and would certainly PROTEST!!!!!Patients need to wake up and smell the coffee.

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we have 60 or so deliveries/month. we have 1 dr. who drags his feet when you call, but most are good and try in earnest to arrive. our policy is to call them at 6 cm for a multip or fully for a primip. we usually don't have the pt. push until dr. arrives if they can help it. i've delivered a few babies in my 6 years at this place, but they really were super-fast moms and i don't feel like the physicians could've gotten there any sooner than they did. no way would our docs come in and sit there for every pt. in active labour, but most, even our problem-doc (now that he's been counseled) come when we call. it's cool to deliver babies, but just remember who pays those out-of-this world malpractice rates and why. i don't do it unless i have to. i think your facility's nurses like this job a little too much, but it can easily come back to slap you in the face. a baby died at birth at a delivery i was at a couple of years ago. mom was making really rapid progress and everyone(except maybe the poor physician) who was there was thankful that none of the nurses were delivering the baby and that the dr. had come when we called him. your administration needs to address it. maybe they need to examine what the rate of nurse attended deliveries (not sure where you'd find this info.) is in a similar sized institution or review their own records to see why and who is delivering (nurses) or supposed to be delivering these babies (doctors/cnm's). it could certainly become a liability issue for your hospital. this is esp. true if the case goes to court and mom relates how she was told to "push really hard" before dr. arrives and you end up w/ a shoulder dystocia or something really unexpected. our problem doc insisted that he didn't miss any more deliveries than anyone else, but he couldn't deny the stats that were presented to him. good luck!

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we have 60 or so deliveries/month. we have 1 dr. who drags his feet when you call, but most are good and try in earnest to arrive. our policy is to call them at 6 cm for a multip or fully for a primip. we usually don't have the pt. push until dr. arrives if they can help it. i've delivered a few babies in my 6 years at this place, but they really were super-fast moms and i don't feel like the physicians could've gotten there any sooner than they did. no way would our docs come in and sit there for every pt. in active labour, but most, even our problem-doc (now that he's been counseled) come when we call. it's cool to deliver babies, but just remember who pays those out-of-this world malpractice rates and why. i don't do it unless i have to. i think your facility's nurses like this job a little too much, but it can easily come back to slap you in the face. a baby died at birth at a delivery i was at a couple of years ago. mom was making really rapid progress and everyone(except maybe the poor physician) who was there was thankful that none of the nurses were delivering the baby and that the dr. had come when we called him. your administration needs to address it. maybe they need to examine what the rate of nurse attended deliveries (not sure where you'd find this info.) is in a similar sized institution or review their own records to see why and who is delivering (nurses) or supposed to be delivering these babies (doctors/cnm's). it could certainly become a liability issue for your hospital. this is esp. true if the case goes to court and mom relates how she was told to "push really hard" before dr. arrives and you end up w/ a shoulder dystocia or something really unexpected. our problem doc insisted that he didn't miss any more deliveries than anyone else, but he couldn't deny the stats that were presented to him. good luck!

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I will definately TRY to stall the pt from pushing if I know the doc or MW is very close . Sometimes (most times that is a lost cause). But if the baby is crowning and she is pushing like a maniac I'll caoch her on pushing so that she doesn't blow the kid out and get a severe tear. (she's going to do it anyway )..

My sister in law was one of these her nurse just stood there like a deer caught in the headlights and didn't coach her at all 'cept "don't push" and also didn't protect the perineum and she tore so bad that they had to go a few weeks later to re- repair it

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I will definately TRY to stall the pt from pushing if I know the doc or MW is very close . Sometimes (most times that is a lost cause). But if the baby is crowning and she is pushing like a maniac I'll caoch her on pushing so that she doesn't blow the kid out and get a severe tear. (she's going to do it anyway )..

My sister in law was one of these her nurse just stood there like a deer caught in the headlights and didn't coach her at all 'cept "don't push" and also didn't protect the perineum and she tore so bad that they had to go a few weeks later to re- repair it

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At one hospital I worked at, everytime there was a nurse assisted delivery, an incident report had to be written, IT WAS NOT LOOKED UPON positively, everyone involved was reprimanded, and the case was researched as to why it happened, they did realize that there were times were a nurse delivery was unavoidable, but it was documented very well, as to when the doctor was called, what was said, etc. I would not work in a place where this was common practice. It should be the exception, NOT the rule.

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At one hospital I worked at, everytime there was a nurse assisted delivery, an incident report had to be written, IT WAS NOT LOOKED UPON positively, everyone involved was reprimanded, and the case was researched as to why it happened, they did realize that there were times were a nurse delivery was unavoidable, but it was documented very well, as to when the doctor was called, what was said, etc. I would not work in a place where this was common practice. It should be the exception, NOT the rule.

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our hospital also requires an incident report to be filled out if there is a nurse attended delivery.

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our hospital also requires an incident report to be filled out if there is a nurse attended delivery.

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