What do you want your OB patients to get from childbirth class? - page 2

Hi all, I'm new to the boards. I'm a newly certified childbirth educator and I'm not an RN (I'd love to go to nursing school, but I'm waiting until my two children are a little older to start... Read More

  1. by   Mahnikuh
    RNMommy, what's the point of a fundus check? (I know they're medically necessary, I just want to be able to explain why).
    Also, teaching the Moms to do the fundus checks themselves a feasible possibility? i.e., let her do the more aggressive pushing and let the RN just check once for whatever you're looking for?
  2. by   RNmommy
    In the early PP period, a manual fundal check is necessary to assess the tone and height of the uterus. If the uterus is atonous, there will be excess bleeding and possibility of hemorrhage. Additional pitocin (or methergine) may be required to keep the fundus firm. Uterine height can indicate a full bladder, sub-involution, clot formation or retatined placenta. To really get a good assessment of the pts bleeding pattern the nurse should assess the fundus while visualizing the vaginal flow. Pad checking is not nearly as relaible, especially with the at risk patient. For these reasons, we are required to assess the fundus hourly until the first spontaneous void. Then q shift. We do teach the patients to do self fundal massage but it is still considered part of our shift assessment and therefore needs to be completed. I have seen patients fill with clots over 24 hours post delivery. These patients will usually "trickle" but a rising fundal height is a dead give away.
  3. by   Mahnikuh
    Thanks for the info! Very helpful!
  4. by   FrumDoula
    As someone who is in the process of becoming a Lamaze-certified instructor, (though also not a nurse), I would first off like to applaud the first poster's comments. SBE, you are brilliant as always.

    If your students could leave with two thoughts, I would love to see them leave with:

    1. That pain is not the same as suffering.

    2. That a fed nurse is a happy nurse, so bring along some munchies for the staff. I'm telling you, I've endeared myself to nurses before by bringing some food along as a doula! Nurses get hypoglycemic, too!

    By the way, which organization are you certified through? Although I love Lamaze, I am also an increasing fan of Pam England and Birthing From Within.

    Alison
  5. by   BETSRN
    Quote from FrumDoula
    As someone who is in the process of becoming a Lamaze-certified instructor, (though also not a nurse), I would first off like to applaud the first poster's comments. SBE, you are brilliant as always.

    If your students could leave with two thoughts, I would love to see them leave with:

    1. That pain is not the same as suffering.

    2. That a fed nurse is a happy nurse, so bring along some munchies for the staff. I'm telling you, I've endeared myself to nurses before by bringing some food along as a doula! Nurses get hypoglycemic, too!

    By the way, which organization are you certified through? Although I love Lamaze, I am also an increasing fan of Pam England and Birthing From Within.

    Alison
    The minute a laboring couple brings food, it is an immediate red flag that they are going to have a pretty complicated birth plan. Bradley couples usually bring food along and all ahve birthplans that start out with pretty much the same opening sentence.

    Nurses can always find food. Do NOT tell your couples this. It is ridiculous!
    I hope you were kidding.................................
  6. by   rpbear
    I know that most birthing classes teach the natural method of childbirht, this is great, but it is not allways the way things turn out. I think that more epidural teaching needs to be done in the classroom. I am not at all pushing epidurals, but in the middle of hard labor when the mom "can't take it anymore" is not a good time to discuss the risks and procedure of the epidural. People don't hear what you are telling them and they will sign the consent form just to make the pain stop. Then when the pain stops they don't understand why I have to put in a foley and why they cant get up and walk. Hello, I just told you all of this before you signed the consent form and said you understood everything I said! Even if they have no plans of having an epidural, this along with c-sections needs to be covered in class just in case things don't go as planned.

    Thanks,
    Molly
  7. by   BETSRN
    Quote from rpbear
    I know that most birthing classes teach the natural method of childbirht, this is great, but it is not allways the way things turn out. I think that more epidural teaching needs to be done in the classroom. I am not at all pushing epidurals, but in the middle of hard labor when the mom "can't take it anymore" is not a good time to discuss the risks and procedure of the epidural. People don't hear what you are telling them and they will sign the consent form just to make the pain stop. Then when the pain stops they don't understand why I have to put in a foley and why they cant get up and walk. Hello, I just told you all of this before you signed the consent form and said you understood everything I said! Even if they have no plans of having an epidural, this along with c-sections needs to be covered in class just in case things don't go as planned.

    Thanks,
    Molly
    While we all like to think that couples will choose the "natural" way and avoid most medicinal pain relief options, sadly, I do not think that is the way it is today. I am in a low intervention/midwifery friendly hospital and all our docs very mush prescribe to the low intervention philosophy. Even in my place, however, most mothers coming through do NOT want to go the natural route. They want pain relief often too soon (for what we think is too soon) and they want no pain. I think most couples go to classes today just to be able to say they went to class. If they were truly invented in learning, more would choose the longer class series and less would choose the weekend or one day class.

    I can only speak for myself but in my classes I spend a good eal of time on interventions and their use reasons for, etc. I would rather my couples be informed BEFORE and have time to ask questions rather than be uninformed and disappointed with their experience.

    We do our couples NO favors by not including this in our class information. People make far better choices when they have the material to digest IN ADVANCE as opposed to ahving to make these decisions when they are in pain that they never dreamed possible.

    We don't push epidurals either, nor do we overuse interventions (we do not place foleys with epidurals) like FSE's, IUPC's and the like. But in reality these may be part of the birth and I would rather have my clients know beforehand so that they have less stress during their labors. besides, they can advocate better with their docs and midwives at appointments if they know what is out there.
  8. by   SmilingBluEyes
    Quote from BETSRN
    The minute a laboring couple brings food, it is an immediate red flag that they are going to have a pretty complicated birth plan. Bradley couples usually bring food along and all ahve birthplans that start out with pretty much the same opening sentence.

    Nurses can always find food. Do NOT tell your couples this. It is ridiculous!
    I hope you were kidding.................................
    ROFL I never object when a birthing family member brings me a mocha-latte from Starbucks, however ......and they do that a lot. (I feel utterly flattered they get to know me enough to know how much I love this drink lol).

    I think people are just trying to be nice and usually I will form a pretty good bond with them in the course of the labor. That they bring food or coffee is very nice, but surely not necessary. I just am very warmed by the thought, and that is always what counts.
    Last edit by SmilingBluEyes on Apr 6, '05
  9. by   Jayla
    I'm a PHN and work with healthy start pts--I educate a lot of pregnant moms and this is such an wonderful post! Really helpful information!

    As far as epidurals, I want to teach my patients more about this, but we don't have a lot of material about it at my clinic. Does anyone have suggestions on good teaching material regarding pain control during labor (preferably in english and spanish)?

    Also, any good L&D videos out there (again, english and spanish would be helpful) that don't cost a fortune? I'd love to pop a tape in during a home visit and let them see the real action--especially first time moms.

    thanks!
  10. by   BabyRN2Be
    Not only everything that SmilinBluEyes mentioned, but I also vehemently add that every birth is different and that it doesn't go like the script in "A Baby Story" (I loathe that program as well as "Birth Day"). You know, you watch the hospital scenes as mom comes to hospital (in active or prelabor), she gets checked, an epidural is ordered, cute little banter with the hubby is shown while they break down the bed, and two pushes later, voila, a baby! All done in half an hour!

    I've actually had a few doula clients tell ask me what's wrong when they've been in labor for 5 hours. I tell them that nothing is wrong and ask them why do you feel that labor is going wrong? I get the answer, "Well, I thought this would take half an hour like it is on TV! That's why I didn't sign up for the epidural because I can stand any pain longer than half an hour!"

    I also encourage everyone to make this their birth, and do whatever they have to do to make it special.
  11. by   kmrmom42
    Quote from Jayla
    I'm a PHN and work with healthy start pts--I educate a lot of pregnant moms and this is such an wonderful post! Really helpful information!

    As far as epidurals, I want to teach my patients more about this, but we don't have a lot of material about it at my clinic. Does anyone have suggestions on good teaching material regarding pain control during labor (preferably in english and spanish)?

    Also, any good L&D videos out there (again, english and spanish would be helpful) that don't cost a fortune? I'd love to pop a tape in during a home visit and let them see the real action--especially first time moms.

    thanks!
    Not cheap but very comprehensive two video set that I think is invaluable.
    http://www.injoyvideos.com/IJOneVolOneVer.cfm?id=200
    If your organization can afford two sets it is available in Spanish and English and it contains information about pain medication for childbirth, including epidurals.
    You can get lots of good informational materials from Childbirth Graphics
    http://www.childbirthgraphics.com/
    and from ICEA http://www.icea.org/bkmks.htm

    I have some information on my website about epidurals. You can check that out. I haven't updated my website since I started back to school for my MSN. I will be finishing this week (YAY!) so I expect to be putting some time into it in the near future. I hope the links are alll working but I can't promise anything.
    http://kmrmom42.angelcities.com/
  12. by   kmchugh
    kmrmom42

    My hat is off to you. I went to your website, and think you gave a pretty accurate representation of epidural and spinal anesthesia. I have talked to a couple of moms who thought epidurals were all sunshine and lolly pops with no dangers to them at all. As the guy who puts the epidural in, nothing makes me more nervous. I spend a bit more time talking to these moms, making sure they understand that nothing done in medicine is risk free, particularly epidurals.

    I did notice a few things in your website that could be changed (I am forever trying to make sure patients and provicers get the most up to date information available.)
    Cynthia Wong, MD, did a study on the effect of epidurals and labor, and found that as a rule, having an epidural shortened the length of stage one of labor. It also seemed to slightly prolong stage two of labor, but that was more than offset by the shortening of stage one. She also found that the use of labor epidurals did not increase the incidence of instrumented birth or c-section. See the following thread in the CRNA board:

    http://allnurses.com/forums/showthre...6&page=1&pp=10

    Also, one thing I like to pass along to just about everybody who will listen: General anesthesia is absolutely the last resort for an anesthetic for a c-section. Nothing will make an anesthesia provider break out in a cold sweat faster than the prospect of having to put a pregnant woman to sleep. Pregnant women have a much higher incidence of GERD, with the attendant risk of aspiration than the rest of the population. Also, there is a significantly greater risk of failed intubations among the pregnant population, generally owing to the fact that pregnant women are edematous everywhere, making inability to visualize the cords a much greater risk. Babies of moms who have a general also come out "floppier," owing to the systemic administration of anesthetic induction agents. As a rule, we only put women to sleep for c-sections under emergent circumstances, those where waiting the few extra minutes for placement of a spinal or epidural anesthetic could detrimentally affect either mom or baby.

    I have had a couple of moms for scheduled c-sections come in absolutely refusing spinal or epidural anesthesia. Whenever that occurs, I have a LOOOOOONG talk with the patient about the increased risks of a general anesthetic. Of course, I never perform any procedure on any patient who refuses it. But, if the parturient insists on a general anesthetic, I will go the extra mile to make sure emergency airway equipment is in the room, and will try where ever possible to have another anesthesia provider present until induction is complete and the patient is safely intubated.

    Overall, though, I think you did an excellent job of presenting options for pain management through your website. I also found the Discovery Channel website that you referenced on the topic of epidurals to be very informative for the patient. (See:

    http://health.discovery.com/tools/bl...ions/epid.html

    it offers a great graphic.)

    The point about length of labor is relatively minor, and I know that there are those who will beat me up for saying that epidurals can decrease the length of labor. I do feel very strongly about general anesthesia for c-sections, however, and would never want it presented to pregnant women as an equally safe method of anesthesia for c-section.

    On my soapbox for a moment (not directed at anything written by kmrmom42): In other threads on this board, it has been insinuated that anesthesia providers push epidurals for laboring women for billing purposes. At one time, that may have been true, but not anymore. The reimbursement for epidurals is very low, compared to the amount of time the anesthesia provider will generally have to spend at the hospital managing that epidural. From strictly a cost analysis, they certainly are not worth the effort. We don't offer them to "get rich" by any means. In fact, most hospitals that offer them do so realizing that they will actually lose money on them. The reimbursement for them comes nowhere near what they cost the hospital (or anesthesia group) in equipment, medicine, and provider time. This is particularly true in smaller hospitals, where there is frequently only one or two laboring women.

    Off my soapbox (for now).

    Kevin McHugh, CRNA
  13. by   kmrmom42
    Quote from kmchugh
    kmrmom42
    My hat is off to you. I went to your website, and think you gave a pretty accurate representation of epidural and spinal anesthesia.
    Thank you Kevin. I value your opinion.
    I have talked to a couple of moms who thought epidurals were all sunshine and lolly pops with no dangers to them at all.
    I agree this is dangerous and I am the person who wrote the curriculum for our Prepared Childbirth classes (and I currently teach them all myself although I am looking for help!). I am very careful to teach that epidurals, like most things in medicine, are not risk free. I include epidural as one of the "tools" for coping with labor and after finishing my classes couples have MANY tools in their labor toolbox besides epidural.

    Cynthia Wong, MD, did a study on the effect of epidurals and labor, and found that as a rule, having an epidural shortened the length of stage one of labor. It also seemed to slightly prolong stage two of labor, but that was more than offset by the shortening of stage one. She also found that the use of labor epidurals did not increase the incidence of instrumented birth or c-section.
    Thanks so much for this. I AM aware of this information and I can tell you that I see this as being true in my every day practice. This is DEFINITELY going to be one of the things I update on my website. I am sure you will agree that epidurals used to be much heavier and they did cause these sequelae but now that is no longer true.

    Also, one thing I like to pass along to just about everybody who will listen: General anesthesia is absolutely the last resort for an anesthetic for a c-section.
    I agree wholeheartedly and teach this way in my class. I always have someone ask if they can request general and so it opens the discussion in which I am VERY clear about this. I will add something to my website to that effect when I revise.

    The point about length of labor is relatively minor, and I know that there are those who will beat me up for saying that epidurals can decrease the length of labor.
    One of the reasons that the epidural may decrease the length of labor is because once the patient gets the epidural we are very likely to use pitocin to insure that it does!

    Thanks so much for viewing my website and for your thoughtful comments. As I said, I value your opinion.
    Have a great day! Karen

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