Pushing at "10"

[fourbirds4me]

Do you require your laboring moms to start pushing when they are complete? Or if they are high or OP or whatever do you allow them to wait awhile for things to become more favorable?

Here is my situation: I am still orienting to my unit but am handling my own patients and deliveries (unless I feel I need help). I had a multip come in 3cm GBBS (+). We hung the abx then called for the epidural. The anestesiolgist who was on call is known to be slooooooowwww. So 90 minutes later the epidural is in. Her IV goes bad during the procedure so I call another nurse in to trouble shoot. She asked me if I had checked her since the epidural. "No I have not" (I don't believe we need to do them as often as we do). She tells me to check her. She is now 8-9. I have to leave the room for minute to answer a call. Well when I get back the other nurse is having the patient push away a rim! She then proceeds to bring in all the delivery equipment and then leaves and pages the doctor and I never see her again.

The baby was -1 so she had some pushing to do. It is my opinion be could have waited for the baby to come down some more. Give the abx more time on board and allow me get in control of the situation.

This is not the only case of this I've seen.... I feel so bad for some of the mom's who push for 2-3+ because they are "10" and they are made to push ........ just because.....

What do you guys do?

[HazeK]

all in favor of "passive second stage" until vtx is +2 say Yeh!

absolutely less work for mom and for me!

I've got 20 more years to do this, so don't wear me out unnecessarily!

Haze

[BETSRN]

I like to allow my patients to labor down and then push when they feel the urge, NOT just because they are fully dilated. Like Karen said, our HCP's are pretty much with us on that one, thank goodness!

[L&D_RN_OH]

You know, I had this exact same situation the other night. Well, almost. My pt had a stong urge to push, sve showed an anterior rim. Mom's urge was so stong, we tried a couple little pushes while I held back the rim. Baby was +2 so we could see head, but to me, the lip wasn't reducing. Another nurse was there, peeked around, said oh, she's going to crown soon. I said, no, she has an anterior lip, we'll just wait. She starts to go out to call the doc, I said no, she still has cervix left.

In comes doc, she checks her. Surprise, surprise. She has an anterior lip. She says why don't we get the pt's complete before they start pushing, yep she has an anterior rim (looking at the other, more experienced nurse). The nurse said "Oh, I didn't check her, Carla did." AHHHHHH!!!!! And did I not say she had a rim and it was too early to call????

Anyway, best advice from the other nurses I work, stand up for yourself.

[teeituptom, BSN, RN]

As you put it what do you guys do.

I close the door and run like the devil is after me all the way back to the ER where I belong.

[mother/babyRN, RN]

Passive decent is the way to go and if a doc doesn't feel that way, we might conveniently forget to call him or her, or just not check as long as baby and mom are ok, until she feels pressure with an epidural.