Pushing at "10"

Specialties Ob/Gyn

Published

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?

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I believe strongly in allowing the woman to "labor down" before having her push. As long as the strip is okay and there is no reason to hurry the mother can be saved from a long and exhausting pushing phase if she is allowed to wait until she has a strong urge and the baby is at least at a +1.

Fortunately, I work with providers who usually agree with this philosophy (unless their kid has a concert they have to get to or something!!)

I hope that when I move to Florida I will work with similarly sensible providers.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I am also one to believe in "laboring down" with epidural anesthesia. WHY ON EARTH PUT THEM TO ALL THE WORK that the UTERUS CAN DO FOR THEM????? That seems so counterproductive...also babies fare better if pushing is not extended hours and hours. If OP, I help the lady change positions frequently to help the baby "rotate" positions. This works beautifully in many cases.

In absence of anesthesia, I let the lady feel an urge to push before pushing This does not ALWAYS happen the minute they are complete. But, THEY KNOW WHEN IT IT TIME AND WILL BEAR DOWN WHEN READY---they don't need nursing staff or doctors to "tell" them what to do. They just need our reassurances things are going "ok". The body is an amazing thing and is much smarter than we are......if we let it do what it's designed to do.....

Glad I work with people with my same philosophies. I would be very frustrated working where you do.

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Specializes in NICU.

I don't do labor, but I have a friend w/ cardiac problem who delivered with the help of an epidural. She never had to push or strain in any way, and the uterus expelled the baby without any trouble. Sounded like a good way to go to me!

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I will usually ask if they feel like pushing. If the answer is "I guess" or "I could try" they are not ready yet!

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Specializes in LTC, assisted living, med-surg, psych.

Pushing before your body says it's ready is PAINFUL.....I was made to do this when I had my last lady partsl birth 15 years ago, and it was the worst part of the whole labor (although I never took so much as a Tylenol during that time). Pushing when your body says GO, however, is more effective because you've got all that power going for you, plus it feels great! But that's just a mom speaking.........I'm sure the doctors know better than we do when we should push.......:rolleyes:

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Four kids -- with one I was told "it's time to push" (this was before I was a nurse) and pushed nearly 3 hours. It was horrible esp. since I wasn't doing an epi. With two others - one with epi and one without - I felt that urge to push and didn't start until I was ready. Bing, bang, boom -- birth within 15 minutes of feeling the "urge". Ugh - let it go natural!!

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It's a judgment call. I usually try a few practice pushes to see if the baby comes down with a push. It's hard to explain but if you check while the mom pushes you can tell weather or not its worth pushing or if they just need time to passive descend.

most of the time I call the doc (who are usually about 20 min away) when I feel like the head is about to slip past the pelvic bone. It just depends on the patient and how far away the doc is. I use passive decent allot and usually push for 5 - 15 min at the end.

So in the case you just explained it's hard to say weather or not you could or should have waited longer. The abx was in for 90 min so depending on what kind it was and what book you read you should have been fine as far as that.

How far out was the doctor? how soon after you began pushing did the babe come?

I think regardless of anything else it was rude and unprofessional for that other nurse to take it upon herself to make those decisions for you. You can't just walk into a room and take over a patient. If she thought the patient should push or that the doctor should have been called, she should have discussed it with you and explained why.

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Ohh, I am a big beliver in letting them labor down, of course if the conditions are right, aka no problems w/ FHT and the patient isn't feeling the urge/has an epidural. I recently got blasted at work for that one...nurses felt well she's complete, why did you not start pushing???? Well, it was a primip, who was infact complete and by exam felt either transverse or OP or a combo, I am not that good yet. So my preceptor tells me she will watch the pt and to take a quick break, Well guess what I come back she is pushing with the patient, and not much progress. I give the patient a break, she doesn't have a big urge to push, tones are ok, some decreased variablity, but good beat to beat so I let her rest for 20 minutes or so then back to pushing...pt ended up w/ a c/s for failure to decend, I was blamed. Got in and the baby's head was transverse, narrow outlet. In other words, I could have pushed w/ her for hours...baby would have never come out. I don't really feel that it was my fault because I didn't make her push the second she was complete the baby was still -1. But the gossip was that I caused it because I didn't have her pushing right away. They also looked at me like I was crazy for having her on hands and knees, the pt loved it and I was trying to do good, had IFSE so I could monitor accurately. So why not???? We are here for the patient to have a safe delivery, it's not a race! JMHO

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

any moron with experience in OB knows transverse arrest is not YOUR fault.

sheesh.

people are SO cutthroat out there. YOU sound like YOU have a good head on YOUR shoulders, acute. Don't let those stupid bats get to you. Sounds as if you did WELL.

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Thanks Blue Eyes!!!!

Its good to hear some reassurance from EXPERIENCED OB RN out there!!!!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

you are MORE than welcome.

keep on doing what you are and don't let the experienced ones daunt you. If they are this nasty, it may mean they feel threatened by you. Toooo bad for them.

I always LOVE to see a GOOD new nurse come on board. I will go out of my way to teach her what I know---cause I like having capable people on my team when the poop hits the fan....

Take care and vent anytime to me.

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