A Question from a newbie for an experienced l&d nurse

mommy2boysaz · Mar 28, 2009

The easiest position if you have little experience is to have the woman fairly flat. She doesn't need to be completely flat. It all depends on the size of the woman and her uterus, too, but I think this is the easiest position.

romantic, BSN, RN · Mar 28, 2009

The easiest position if you have little experience is to have the woman fairly flat. She doesn't need to be completely flat. It all depends on the size of the woman and her uterus, too, but I think this is the easiest position.

Thank you for your reply.

What about Fowler? Do you always put your patient in a fairly flat position for check?

lamazeteacher · Mar 28, 2009

Since we have to chart at what level the uterus size is, with the umbilicus as the reference point, it would be more accurate to have the patient as flat as she's comfortable being.

Some post c-section patients would prefer semi-fowler's, to have less pulling on their incision. It just takes more experience to do that, and checking with another, more experienced nurse isn't admitting failure. It's intelligent.

Now firming up a fundus that's gone soft is harder for an inexperienced nurse because you'll be causing the patient some considerable pain. Also more lochia rubra will come out, possibly with a big clot that you could miss if high fowler's position was chosen, due to the buttocks covering it.

If, after the fundus firms up (or if it doesn't), and the heavy flow of blood doesn't slow within 5 minutes of massaging it vigorously, it could be that the patient is hemorrhaging. That requires prompt action, so you'd better be able to see that with the patient lying almost flat on her back, and have the certainty you need, to call the doctor back to the hospital, if it's the middle of the night (or not). Again, consult with a more experienced nurse if you're in doubt!

I've had many more patients who welcomed lying flat after their delivery, since they couldn't do that without a lot of back pressure, while pregnant; and it's discouraged because of the possibility of losing consciousness, due to circulation problems.

romantic, BSN, RN · Mar 28, 2009

Since we have to chart at what level the uterus size is, with the umbilicus as the reference point, it would be more accurate to have the patient as flat as she's comfortable being.
Some post c-section patients would prefer semi-fowler's, to have less pulling on their incision. It just takes more experience to do that, and checking with another, more experienced nurse isn't admitting failure. It's intelligent.
Now firming up a fundus that's gone soft is harder for an inexperienced nurse because you'll be causing the patient some considerable pain. Also more lochia rubra will come out, possibly with a big clot that you could miss if high fowler's position was chosen, due to the buttocks covering it.
If, after the fundus firms up (or if it doesn't), and the heavy flow of blood doesn't slow within 5 minutes of massaging it vigorously, it could be that the patient is hemorrhaging. That requires prompt action, so you'd better be able to see that with the patient lying almost flat on her back, and have the certainty you need, to call the doctor back to the hospital, if it's the middle of the night (or not). Again, consult with a more experienced nurse if you're in doubt!
I've had many more patients who welcomed lying flat after their delivery, since they couldn't do that without a lot of back pressure, while pregnant; and it's discouraged because of the possibility of losing consciousness, due to circulation problems.

Thank you!

If I understand correctly, you advise to use the flat or almost flat position every time there is a need to check the uterus. Am I correct?

SmilingBluEyes · Mar 29, 2009

You are best off having them nearly flat. But small framed girls can be checked in Semi Fowler's as well. You not only need to be able to check, but also do a bimanual massage if need be. That is pretty hard in a patient sitting straight up.

LM813 · Mar 29, 2009

Fundal asssessment should be performed with patient as close to flat as possible for assessment of fundal height which is measured in relation to umbilicus. Firmness and position (midline, etc) can be done in other positions but height in relation to umbilicus is also part of your assessment and is most accurate flat, so just do it flat to assess all of these things.

lamazeteacher · Mar 29, 2009

Thank you!
If I understand correctly, you advise to use the flat or almost flat position every time there is a need to check the uterus. Am I correct?

Yes, absolutely.