Why place mom on her left side???

  1. I am a student doing OB rotation and I have a question about intrapartal nursing care:
    I keep reading everywhere that if the mom is hypotensive during labor the first nursing action to take is to place her on her LEFT SIDE...I dont understand the rationale behind this! I know it has to do with increasing circulation to the placenta...but why the LEFT side? I don't know, I feel there is an obvious answer, but I just don't see it

    If some of you seasoned L&D nurses can clarify this for me I'd appreciate it! Thank You :wink2:
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  2. 9 Comments

  3. by   RN007
    I'm in OB class right now. From what I've learned, having the mom lie on her left side puts the least amount of perssure on the vena cava, thus optimizing blood return to the heart. Hope this helps!
  4. by   KayceeLeeRN
    Quote from RN007
    I'm in OB class right now. From what I've learned, having the mom lie on her left side puts the least amount of perssure on the vena cava, thus optimizing blood return to the heart. Hope this helps!
    Ohmagosh!! thank you so much! I knew it was a simple rationale, but I couldn't put my finger on it...I understand now
    thanks again
  5. by   mamason
    Quote from RN007
    I'm in OB class right now. From what I've learned, having the mom lie on her left side puts the least amount of perssure on the vena cava, thus optimizing blood return to the heart. Hope this helps!
    Yes....less pressure on the vena cava means more profusion which means more oxygen to mom and baby.:yeahthat:
  6. by   shill
    The answer to this question lies in the anatomy of the abdomen, which has to harbor the ever-increasing uterus as the baby grows. The Vena Cava is the main vein that drains the entire lower half of the body. Anatomically, it lies just to the right of the midline--just on the right side of your spine. As the baby gets bigger, certainly the heavier uterus, lying flat on the Vena Cava will (like stepping on a garden hose) obstruct flow up towards the heart. The drainage of the lower half of the body becomes sluggish, which not only increases the swelling of your ankles, feet, and legs, but will also impact on hemorrhoids as well. Decreased return of blood flow to the heart will cause hypotension (lowered blood pressure) down the line, and with diminished arterial blood flow to the uterus, placenta, and baby.
    Sometimes this hypotension is evident when a woman has an ultrasound, during which she lies flat. One of the symptoms of hypotension is nausea that will accompany the light-headedness. In answer to your question, lying on the back is the worst possible position in the third trimester. Lying on the right side is better than lying on your back, but lying on your left side is the best of all, because this is the position which will have the least amount of weight upon the Vena Cava.
  7. by   ragingmomster
    Back to the original poster...did you really mean hypotension or were you shooting for hypertension.

    Some recent studies have shown that right or left side doesn't matter, just get 'em off that vena cava. But if what they're teaching says left, then off to the left she goes.:wink2:
  8. by   flashpoint
    In the ambulance, we try to position pregnant patients in the position of comfort. When that doesn't work, we go to the left side with the head slightly elevated. According to the anesthesiologist that taught out airway classes, elevating the head makes it easier to breathe and since airway comes first, we need to come up with another plan than trendelenburg's to bring blood pressure up.
  9. by   vampiregirl
    Also in an ambulance if a pregnant patient is immobilized for c-spine precautions (auto accident, trauma etc), elevating the right side of entire back (with several rolled blankets) tilts the patient to the left side. This really seems to help the patient breathe easier.

    By the way shill, what a great analogy with the garden hose... I will have to remember that when I am explaining how and why to care for immobilized pregnant patients
  10. by   prinsessa
    Quote from ragingmomster
    Back to the original poster...did you really mean hypotension or were you shooting for hypertension.

    Some recent studies have shown that right or left side doesn't matter, just get 'em off that vena cava. But if what they're teaching says left, then off to the left she goes.:wink2:
    I had hypotension during labor and was told to lay on my left side. They wanted to make sure that both me and the baby were getting enough oxygen. I also had to wear an oxygen mask.
  11. by   DoubleblessedRN
    I know this was already answered, but it is to relieve pressure from the inferior vena cava to allow more venous return.

    When I was pregnant with twins, I was about 26 weeks (I wasn't on bed rest yet) and driving alone in my car on the expressway when all of a sudden I felt EXTREMELY weak, my vision darkened, and my skin was much paler than it usually was. Fortunately, I was in the right lane and an exit was coming up, so I got off, pulled into a parking lot, reclined my carseat and lied on my left side, knowing I was probably hypotensive. I felt WAY better after a few minutes.

    It also sucked when I was hospitalized for pre-term labor. (Not full blown contractions, just irritability on the monitor.) I wasn't quite 31 weeks and I was on a MgSO4 drip and of course, on the fetal monitor. The only time the monitor would pick up BOTH heartbeats was when I lying at a 45 degree angle- yes, you guessed it- the fundus of my uterus was pressing against my vena cava AND my diaphragm, making me feel faint and short of breath. Finally after about 8 hours, I screamed at the Dr, "Either you do something about this or I will, and if I do, I'm going to owe this hospital a lot of money!" So after that I had intermittent NST's.

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