Running into the room for every D-cel

  1. I just started at a new hospital and I don't know if it is the lack of experience or what. D-cels happen, they don't ALWAYS need an intervention. So far, everyone I work with, seems to think, EVERY nurse on the unit needs to RUN into the room for every d-cel and immediately move the patient into 14 different positions and give terb.

    I'm coming from a hospital where we almost NEVER used terb. we RARELY used 02 on mom's, we had a VERY low c-section rate, and we let our patients walk and use jacuzzi even when on pitocin.

    We also let babies stay on mom's chest for 1 hour after birth without ANY interventions except drying and stimulating, and keeping baby warm.

    When I mentioned this to the new people I work with, they looked at me like I had 4 heads.

    I'm missing my old hopsital
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  2. 14 Comments

  3. by   SmilingBluEyes
    I bet you are. I would ot like working where you are.
  4. by   33-weeker
    Bless your heart. Things where I work are antiquated, too. That's one of the many reasons I wouldn't work L&D.

    It's a shame that a nurse can't work for a while at a new place to see if she likes it before officially taking the job.
  5. by   waterfall99
    Quote from 33-weeker
    Bless your heart. Things where I work are antiquated, too. That's one of the many reasons I wouldn't work L&D.

    It's a shame that a nurse can't work for a while at a new place to see if she likes it before officially taking the job.
    heh, that's a good idea. Fortunately, this is a travel assignment, so I only have 11 weeks left
  6. by   CEG
    It's the same way at the place I did my clinical. It made me crazy and set the moms on edge since as far as the residents and nurses were concerned those babies were on the brink of death. Of course I saw more c-sections than vaginal deliveries while I was there, wonder why?
  7. by   at your cervix
    I have been an L&D nurse for 9 years now and yes I go into the room for every decel. Well, almost every decel, I don't worry about short V and W shaped variables but, is it really going to hurt anything to change mom's position? NO!! I don't freak the patients out with it though. I let my patients know right from the start that for a variety of reasons I will be frequently helping them to change position.

    Are you saying that you just watch decels and don't worry about them?????? I guess I just don't ever want to explain to anyone that I didn't respond to decels because I didn't want to worry the patient!
  8. by   CEG
    What I witnessed was a patient experiences a decel and everyone sitting around the desk looks at the monitor. Nurse goes in the room and changes position/adds O2. Residents run in, do a vaginal exam, tell the patient the baby is in distress, cervix is only at 6, may be looking at a c-section, we'll keep an eye on it. Meanwhile, pit is running, epidural is in place, and patient is confined to bed. An hour later there are two more decels, same scenario, c-section is called.

    Just seems like the things they are calling a c-section for are more like deep variability than true decels. Also, I have never seen an actual prolonged deceleration. The worst I saw was a 20 second dip to upper 70's and a return to baseline. By the time we were in the OR variability was great and baseline was normal.

    I can see paying more attention to something, but there was either a culture of fear of bad outcome or inability to recognize a normal process of labor. It has been proven that continuous monitoring has lead to an increase in c-sections without an improvement in outcomes. I really felt they were too quick to rush to c-section, which was simply an extension of the drama that went with each non-ideal strip.
  9. by   SmilingBluEyes
    Maybe this is just me, but no, I do not run into the room for every decel. Why would I? I mean, there are more than one type of decel and the complete clinical picture needs to be considered, not just the decels themselves. Consider, you may significantly raise the anxiety level of the laboring mom if you "run in there" each and every time you have a decel on the strip. Either the decels concern you a lot, or they don't. If they are that ominous, you probably have no business leaving the room in the first place, but rather, calling your colleagues to help you out , or getting in touch with the doc/midwife to convey your concerns and get them on deck to analyze the situation and intervene as needed. If you all act nervous and upset and so will your patient---and we all know increased and high anxiety does that mom no favors, and can even worsen the clinical picture for the fetus.

    Hopefully your colleagues are at least calm when they do this----although I still say, you are either that concerned or not. You intervene when appropriate and get the situation taken care of. Or if things are stable, you let it ride, watching closely to be sure nothing changes.

    I suspect you may work with people who are either not very experienced in OB nursing and fetal heart monitoring, or there is an overall environment of anxiety for some reason. I don't your work situation. I want to be able to trust my colleagues know when to act and how---we are, after all, a team.
    Last edit by SmilingBluEyes on Nov 24, '06
  10. by   SmilingBluEyes
    Quote from CEG
    What I witnessed was a patient experiences a decel and everyone sitting around the desk looks at the monitor. Nurse goes in the room and changes position/adds O2. Residents run in, do a vaginal exam, tell the patient the baby is in distress, cervix is only at 6, may be looking at a c-section, we'll keep an eye on it. Meanwhile, pit is running, epidural is in place, and patient is confined to bed. An hour later there are two more decels, same scenario, c-section is called.

    Just seems like the things they are calling a c-section for are more like deep variability than true decels. Also, I have never seen an actual prolonged deceleration. The worst I saw was a 20 second dip to upper 70's and a return to baseline. By the time we were in the OR variability was great and baseline was normal.

    I can see paying more attention to something, but there was either a culture of fear of bad outcome or inability to recognize a normal process of labor. It has been proven that continuous monitoring has lead to an increase in c-sections without an improvement in outcomes. I really felt they were too quick to rush to c-section, which was simply an extension of the drama that went with each non-ideal strip.
    You said it better than I did.
  11. by   MamaMadge
    I only have a year experience in L & D so naturally, I am nervous about any decel. Our providers do NOT worry about variable (V's or W's) decels with good long term variability (unless pt. is 1 cm and not progressing). I've seen deep variables (60's-70's) that come right back up to baseline with great variability, which means the baby is still well oxygenated. I have been taught to remember the physiology of a decel and that an early decel is usually head compression, a variable is most likely cord compression and a late is utero-placental deficiency. So, with that being said.....it has to depend on what kind of decel you are seeing before you intervene. If the patient is have late decels....position change most likely won't help (can't hurt) but supplemental O2 will and obviously getting the baby out ASAP. If it's a variable, position change will help but O2 isn't necessary if the LTV is good...etc....you all know the routine....it's sad when people are so panicked that they are rushing to c-sections when they aren't necessary to cover their behinds.....Just my humble opinion..
  12. by   SmilingBluEyes
    Any way you can go back, if you are that unhappy?
  13. by   at your cervix
    Quote from CEG
    What I witnessed was a patient experiences a decel and everyone sitting around the desk looks at the monitor. Nurse goes in the room and changes position/adds O2. Residents run in, do a vaginal exam, tell the patient the baby is in distress, cervix is only at 6, may be looking at a c-section, we'll keep an eye on it. Meanwhile, pit is running, epidural is in place, and patient is confined to bed. An hour later there are two more decels, same scenario, c-section is called.

    Just seems like the things they are calling a c-section for are more like deep variability than true decels. Also, I have never seen an actual prolonged deceleration. The worst I saw was a 20 second dip to upper 70's and a return to baseline. By the time we were in the OR variability was great and baseline was normal.

    I can see paying more attention to something, but there was either a culture of fear of bad outcome or inability to recognize a normal process of labor. It has been proven that continuous monitoring has lead to an increase in c-sections without an improvement in outcomes. I really felt they were too quick to rush to c-section, which was simply an extension of the drama that went with each non-ideal strip.
    This seems weird! When you mean deep variablity do you mean deep variables?
  14. by   CEG
    Quote from at your cervix
    This seems weird! When you mean deep variablity do you mean deep variables?
    I am student so bear with me... I am thinking variability is irregular fluctuations between 5-25 bpm. As opposed to decels which would be a decrease of at least 15 bpm for at least 15 seconds. So maybe we had a decrease of 20 bpm but only for 5 seconds (or something like that, I don't remember exactly). So this happens several times but doesn't really fit the pattern of decels exactly. Maybe some of them were late in terms of timing, but they weren't long enough to be true decels.

    Too me it seems like other factors contributing would make this a problem- unusual bleeding, heavy mec, etc. But in the absence of other problems it would just be something to keep an eye on. Maybe oxygen or increase IV fluids if mom is in bed anyway, but certainly no threats of c-section or actual c-section.

    Anyway, I hope that is a passable explanation of what makes sense in my mind, it's scary in there

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