nurse only attended births

  1. 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)
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  2. 29 Comments

  3. by   KELLYGIRL
    I agree completely. I wouldn't want that responsibility either. I have only participated in OB as a student, and saw a Dr at every delivery. What do the other nurses say about this?
  4. by   memphispanda
    I don't know what's typical either. What I do know is that my last baby was nurse delivered. It was my third. The nurse called the doc and said he needed to get there immediately (I had only pushed once, but he was crowning). All he had to do was walk from his office, across the walkway, to my room. He made it about 20 minutes after she called, which was about 18 minutes after the baby arrived.

    I hope you find some answers for your situation though...it sounds like you are expected to deal with a lot more than is expected many places.
  5. by   moz
    Most of the nurses seem to be ambivalent, it's happened so often the older nurses just say thats what happens if they don't want to come here and risk waiting. I almost think the newer nurses like it, I do too, to an extent. Its an awesome thing to help bring a baby into the world. I've actually seen a couple who were reallly close, the dr on his way and the nurse actually coaching the pt to push hard instead of pant, or grunt. One nurse in particular told me on one 12 hr night shift she caught 3 babies.
  6. by   sbic56
    Moz

    This happens fairly often where I work as well. Small hospital, obs have no back up coverage, so they don't want to spend alot of time there if they are trying to see pts. in the office, they could be in surgery or especially if it is at night and they could lose hours of sleep. I am not saying it is right, but that is the situation sometimes. I have found that babies that come that fast are apt to have less problems delivering, again not to say having no doc at delivery is a good thing. I have caught around a dozen, two in one shift one night. I would never encourage a patient to push the baby out if I knew the doc was nearby, but I do think we all need to be prepared for the occasional nurse asssited delivery. (I would like to get paid for it, though. Yeah, right.)
  7. by   Jolie
    Does your unit have a policy requiring the doc or midwife to be present in the hospital for patients in active labor? I can't imagine working anywhere that did not have this requirement. Our docs must come in to the hospital when their patients are 4 cm or greater. Even this policy doesn't completely eliminate "surprise" deliveries, but it goes a long way toward cutting back on them.

    Both of my deliveries became suddenly complicated when I was in the pushing stage (one was a complex presentation with her hands to her face, and got stuck, the other prolapsed her cord). I had the utmost confidence in my nurses, but thank God my OB was immediately available to handle those crises.
  8. by   sbic56
    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!
  9. by   Geeg
    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.
  10. by   imenid37
    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!
    Last edit by imenid37 on Apr 28, '03
  11. by   Rissi-Roo
    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
  12. by   OBNurseShelley
    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.
  13. by   imenid37
    our hospital also requires an incident report to be filled out if there is a nurse attended delivery.
  14. 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.

    good luck

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