nurse only attended births

nimbex, RN · Apr 29, 2003

I very interested in your post, and asked a senior L&D RN, who's info I could trust to give you a view of our hospital.

We have an aggressive clinical ladder group in L&D who have a tracking form for all nurse delivered babies and precipitous births while on pictocin (with a nurse titrated order).

This clinical ladder, all nurses, gathers info and statistics, presents it at monthly staff meetings with education on how situations could have been handled differently.

because it is nurse based, she stated that compliance with filling out the form is greater than 90% because there are no write up's and action taken against the bedside nurse, unless unsafe practice trends out to a particular RN.

If a specific doc becomes an issue, the information is given to the medical director, AKA chief of OB staff.

She stated that this has led to many policy changes to protect the patient and nurse.... which were nurse driven, so staff buy-in and burocratic nonsense didn't exist.

So while I don't have first hand experience.. I hope the info from this nurse can help... especially if you have clinical ladder.. if not, why not form a nurse driven committee to help solve this?

Risk management would also be an excellent resource.

good luck

nimbex, RN · Apr 29, 2003

I very interested in your post, and asked a senior L&D RN, who's info I could trust to give you a view of our hospital.

We have an aggressive clinical ladder group in L&D who have a tracking form for all nurse delivered babies and precipitous births while on pictocin (with a nurse titrated order).

This clinical ladder, all nurses, gathers info and statistics, presents it at monthly staff meetings with education on how situations could have been handled differently.

because it is nurse based, she stated that compliance with filling out the form is greater than 90% because there are no write up's and action taken against the bedside nurse, unless unsafe practice trends out to a particular RN.

If a specific doc becomes an issue, the information is given to the medical director, AKA chief of OB staff.

She stated that this has led to many policy changes to protect the patient and nurse.... which were nurse driven, so staff buy-in and burocratic nonsense didn't exist.

So while I don't have first hand experience.. I hope the info from this nurse can help... especially if you have clinical ladder.. if not, why not form a nurse driven committee to help solve this?

Risk management would also be an excellent resource.

good luck

SmilingBluEyes · Apr 29, 2003

Originally posted by nimbex
I very interested in your post, and asked a senior L&D RN, who's info I could trust to give you a view of our hospital.

We have an aggressive clinical ladder group in L&D who have a tracking form for all nurse delivered babies and precipitous births while on pictocin (with a nurse titrated order).

This clinical ladder, all nurses, gathers info and statistics, presents it at monthly staff meetings with education on how situations could have been handled differently.

because it is nurse based, she stated that compliance with filling out the form is greater than 90% because there are no write up's and action taken against the bedside nurse, unless unsafe practice trends out to a particular RN.

If a specific doc becomes an issue, the information is given to the medical director, AKA chief of OB staff.

She stated that this has led to many policy changes to protect the patient and nurse.... which were nurse driven, so staff buy-in and burocratic nonsense didn't exist.

So while I don't have first hand experience.. I hope the info from this nurse can help... especially if you have clinical ladder.. if not, why not form a nurse driven committee to help solve this?

Risk management would also be an excellent resource.

EXCELLENT POST.....one I would suggest we do if nurse-only deliveries were more common where I am. They are not , however, and 99% of the time, the MD's come quickly when we tell them to. And yes, every time a nurse-only delivery occurs, we have to write up an occurence report also, but this is not for PUNITIVE reasons, but to CYA. THAT is what OCCURENCE/INCIDENT reports are FOR after all. NOT to punish, but to CYA and learn from.

good luck

SmilingBluEyes · Apr 29, 2003

Originally posted by nimbex
I very interested in your post, and asked a senior L&D RN, who's info I could trust to give you a view of our hospital.

We have an aggressive clinical ladder group in L&D who have a tracking form for all nurse delivered babies and precipitous births while on pictocin (with a nurse titrated order).

This clinical ladder, all nurses, gathers info and statistics, presents it at monthly staff meetings with education on how situations could have been handled differently.

because it is nurse based, she stated that compliance with filling out the form is greater than 90% because there are no write up's and action taken against the bedside nurse, unless unsafe practice trends out to a particular RN.

If a specific doc becomes an issue, the information is given to the medical director, AKA chief of OB staff.

She stated that this has led to many policy changes to protect the patient and nurse.... which were nurse driven, so staff buy-in and burocratic nonsense didn't exist.

So while I don't have first hand experience.. I hope the info from this nurse can help... especially if you have clinical ladder.. if not, why not form a nurse driven committee to help solve this?

Risk management would also be an excellent resource.

EXCELLENT POST.....one I would suggest we do if nurse-only deliveries were more common where I am. They are not , however, and 99% of the time, the MD's come quickly when we tell them to. And yes, every time a nurse-only delivery occurs, we have to write up an occurence report also, but this is not for PUNITIVE reasons, but to CYA. THAT is what OCCURENCE/INCIDENT reports are FOR after all. NOT to punish, but to CYA and learn from.

good luck

moz · May 29, 2003

Sorry so long in replying, thanks for all your responses.

At my last job, if we anticipated the dr wouldn't arrive in time our policy was to call the er doc to come down; most would do the delivery, and we had one would come down and be present.

I think a nurse committee and tracking is a GREAT idea and will mention it to my nurse manager.

Thanks again guys!

SmilingBluEyes · May 29, 2003

Where I work, we have to write up an occurence report for nurse-attended deliveries also. The doctors usually make EVERY effort to be there when delivery is imminent and I am never questioned when I tell a physician it is time to come NOW. THAT is how it SHOULD BE---for all the reasons everyone stated so well before me.

Dayray, RN · May 31, 2003

Wow doctors come at 4 cm?

Where I work its a judgment call on the part of the nurse. We are expected to call the doc so that they arive justin time to catch sometimes they end up there a littel too soon and some get angry others relize that it happens some times. all and all most docs are in and out in under an hour.

earlier this week I had a patient go from 5 -2 and 80 to complet and +3 in like 5 min lol. had my hand in her crotch for 10 min waiting for doc to get there. she did very well and dident push until the doctor got there which was good becuse it only took 2 pushes when docotor did come in.

mark_LD_RN · Jun 5, 2003

DAYRAY-

question for you what was your hand doing in her crotch were you holding the baby in for her:)

I have had had quite a few nurse only attended deliveries. not by choice but it happens, i never hold it in i encourage patient not to push, if it looks like doc might not make it, I will do perineal massagee to try and avoid any tearing. and I am fine on waiting for doc but if baby goes down patients going to push cannot leave a baby down in the 50's waiting for a doc ya know:)

and if a patient started to push on her own I will ask them not to, but if she can not control it, I will never get in their face and yell or demand they dont push, we just go with the flow:)

i would hate the patients memory of her babies birth being of me yelling at her:)

moz · Jun 6, 2003

I agree with you Mark, I don't encourage the pushing, but when they have to, go with the flow. Funny thing, I started this post after it seemed like we had alot of nurse attended deliveries, but we haven't had one in a month now. The doc that wanted us to wait to call til the very last minute was confronted by a night nurse who just told him if he wanted to be here for his deliveries, then come when we call. He was the doc for the delivery I mentioned earlier and the grandmother of the pt told him he wouldn't deliver any more of her grandbabies, and they are an affluent family in the community. So he was bothered by that and told me that he understood "those things happened" but that he wanted us to "take the heat" for him. Okaaaaaaaay....riiiiiiiiiiiight. I won't be doing that, if I am wrong I will admit it, but if its his mistake he can deal with it. But he's been a little better about coming.

mark_LD_RN · Jun 6, 2003

MOZ funny thing is they seem to come in bunches when they do or for me in groups of three. have not had to deliver one in a while now. came close but no cigar:) our docs and midwives are pretty good about getting there. but sometimes the patients surprise them and us and go much faster than expected.just last week I had a patient that was 2 cm almost all night got to 3 cm /90/-1 then in 10 minutes was 10/10/+2 luckily midwife was in house for this patient and delivered her. but you know you can never tell how things will progress sometimes

HazeK · Jun 7, 2003

Originally posted by Jolie
Our docs must come in to the hospital when their patients are 4 cm or greater.

How would it be? My hospital does 400+ deliveries a month, with no "in house" MD or residents. All are either private doc patients or ER 'drop-ins'. No way our docs would leave their offices in the daytime/families in the nighttime to babysit their labor patients! (Yes, I do miss working with good Nurse Midwives)

We do our very best to optimize MD arrival for deliveries, but this is OB, so surprises happen. We do fill out occurance reports, to document the situation around nurse delieveries, not to punish or penalize the nurse. The reports trend MDs who don't come when called, who say they are en route but aren't, etc. Also good to see which nurses are doing the most deliveries...so practice changes can be recommended!

EX: a supposedly experienced nurse has NCB multip up in stirrrups pushing without the MD on the unit! ARGH! Of course, he missed the delivery! Duh! After seeing that she had done this several time, it was recommended to her and the rest of the staff that perhaps having the patient on her side, panting, until the MD arrived would have been a better choice!

personally, I've been in the business of L&D for a long, long time...

stopped counted # of babies I delivered years ago, after passing 100!

Hugs

Haze

judy ann · Jul 12, 2003

I, too, stopped counting the number of babies I have "birthed" in my long career (I even did both halves of a set of twins, but that is another story). I noticed that many of you talked about telling/asking the mom not to push. Perhaps you might have better results if you asked her to breathe. I breathe with her. My conversation is--slowly--"Breathe in----breathe out---breathe in---breathe out"--etc. till the contr is completely ended then I tell her that she did a really good job, and that the baby is doing great! (The thought behind using "breathe" rather than "don't push" is like someone tells you not to think of a pink elefant.--now don't think of a pink elefant. Try not to think of a pink elefant.) Patients have told me that this is much more helpful than what other nurses have done in past pregnancies, and they felt better and were more able to cooperate. Try it. It might work for you, too. I in turn got this from an even older OB nurse. :)