What do you think?

  1. We have a new nurse on our unit who came from a large hospital that did a lot of midwifery deliveries. We are a small rural hospital that does about 30 deliveries a month.
    Anyhow the other night we had a primp that went very quickly, 4 to complete in 1 hr. Anyhow the nurse was actively encouraging the pt to push without the doc being there..the baby was crowning 5-6 cm. The only thing that held it back was the primp perineum. We do not do this when there is no doc in the house..she was on her way. We don't try to deliver these babies on our own..because of the risk of a shoulder, cord etc..
    When I questioned this nurse she was offended and didn't understand why I wouldn't let my patient push..I would encourage her not too, but we all know that mother nature has it's way. This pt was totally coachable.
    What do you think?
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  2. 4 Comments

  3. by   ChristineN
    If "Mom" was ready and willing, and baby was healthy, I don't see a problem.
  4. by   SmilingBluEyes
    We "push" our primips routinely with no doctor at the bedside. Despite rapid progress in the first stage of labor, the pushing phase can take 1 1/2 to 3 hours, very normally, in a primip. Our doctors are more than readily available to come in when we need them, so with primips, I have them push until right before the baby "rounds the corner" (comes under the pubic bone), if the desire to push is really there.

    If the baby makes very rapid progress in the birth canal at first or 2nd push, then I have them stop, if possible. In strong urges to push, that a patient can't fight or stop, and the baby is absolutely coming no matter what I do, I deliver the baby----mom's gonna push no matter what I say in cases like this, you know? And in cases like this, I would rather let her grunt her baby out in a controlled manner than pushing like crazy to tear herself up. They can be coached, as long as we work with them.

    In patients who have epidurals, and lack the urge to push, I simply let the baby "labor down" as low as possible before seeing how they do at pushing and calling in the doctor. It's been for me, a rare primip who pushes a baby out in less than 30 minutes to an hour.
    Last edit by SmilingBluEyes on Oct 3, '05
  5. by   fourbirds4me
    I will push a primip pretty far. We have several docs who have no patience with waiting and will cut an epis with the baby still high and vacuum them out. So I will usually let them crown pretty far if they have an epidural and the doc is on the way. Not so much if they are going natural or are a multip. It is very much a judgment call.
    Last edit by fourbirds4me on Oct 3, '05
  6. by   USA987
    No, if they baby was crowning as you described, I would stop pushing...especially if mom has an epidural...

    She could be a bit overzealous.

    The way I look at it...I don't get paid to deliver these babies, so I'm not going to go out of the way to do it. But if i HAVE to I will. There is, afterall, a reason why my insurance is $100/yr. and the OB's insurance is 100's of thousands of $$$$/yr.

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