Admission during labor

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What is your hospital's policy on admission for a labor patient? Minimum dilation when no ROM? Automatic admission with SROM?

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Specializes in Multi-Specialty, L&D, Mother/Baby.

If they think they're in labor, we have ot monitor them, we'll check them...usually we'll have them ambulate for an hour, and recheck in an hour, see if there's any cervical change. If baby's reactive and no cervical change and not ruptured, generally they'll go home

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We don't have any policy on admission it's a case by case thing. If they come in thinking they are SROM and we deicde they are we admit, if they think they are in labor we watch a little while if they are due and dialated and the doc feels like it he might admit them but not if it's close to his time to go home unless they are changing if they are advance dialated they are admitted....no policy just the mood of the day

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Specializes in LDRP.

SROM=admitted

there is no "minimum" cervical dilation official requirement, though i personally think it should be 5cm :) In theory, your cervix gets checked-5 or more you stay. 1-3 you walk, get rechecked for progression. 4 is the dicey area-primips at 4 probably stay (of course, assuming they are contracting). multips at 4? not necessarily.

Depends on the doc and the day. Some particular docs would admit them at 1cm and contracting just b/c the are "past due" (aka 40w1d aka doc doesn't want to get out of bed. you admit her, you don't have to come for a few hours. you want to d/c her, you actually have to lay eyes (and hands) on her). Some will make you go home even ifyou are contracting painfully but cervix not changing. Some days they are offered therapeutic rest. Some days not. This doc might do Ambien and Percocet, this one might do Demerol and Vistaril.

Depends on the doc, the day, the hour, the patient :)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's case by case. Usually we admit when they are contracting enough to make cervical change, or if they are SROM'd. That is the general rule. But of course there are exceptions.

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Specializes in OB.

It varies. SROM = admit (and usually pit if they arent contracting)

I don't like to admit people until they are 4 cm and contracting.

I had a pt. a few weeks ago who had been 4 cm for a week, she came in with uncomfortable, but irregular contractions, we did therapeutic rest, she was still 4 a few hrs later so I sent her home. She came back 2 hrs later at 6cm LOL Yay!

But it varies a lot I guess.

I have admitted people at 3cm, such as someone who comes in at 1cm, goes home and comes back later that night at 3cm, and clearly more uncomfortable.

Sometimes it's a really hard call.

I have also sent a primip home at 3 cm, clearly uncomfortable and had her come back a few hours later 8cm. I felt bad about that one, but it all worked out. You cant predict!

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It varies. SROM = admit (and usually pit if they arent contracting)

I don't like to admit people until they are 4 cm and contracting.

I had a pt. a few weeks ago who had been 4 cm for a week, she came in with uncomfortable, but irregular contractions, we did therapeutic rest, she was still 4 a few hrs later so I sent her home. She came back 2 hrs later at 6cm LOL Yay!

But it varies a lot I guess.

I have admitted people at 3cm, such as someone who comes in at 1cm, goes home and comes back later that night at 3cm, and clearly more uncomfortable.

Sometimes it's a really hard call.

I have also sent a primip home at 3 cm, clearly uncomfortable and had her come back a few hours later 8cm. I felt bad about that one, but it all worked out. You cant predict!

I got sent home with my 1st one because I was closed after my mom took me in because I complained of a back ache all day (doc had told me 2 days prior oh at least 2 more weeks and I was right at 38 wks then) the husband got off work and drove me home walking up the steps I thought great now I'm peeing (no gush) tossed and turned a while and decided it was worse went back about an hour later and was 3 then after 30 minutes I thought this is going to be back if I have that average 12 hours to go so asked for med oops too late I was complete from getting back to the hosp to having a baby was not quite 2 hours so that back ache was doing something...and my doc had gone out of town. I was told any day now with #2 & #3 on the 1st of the month (due the 27 & 20th) had each of them on the 30th of those months the 3rd one being induced but it only took 20 minutes once that pit hit....just sinful to drop a baby so fast...4th one was a c/s for breech...give me a vag delivery anyday.

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Specializes in geriatrics, L&D, newborns.

We admit for ROM. For contractions, we have a 2 hour protocol. We monitor, check the cervix and then re-check in 2 hours. If no cervical change, then pt. can go home without being seen by doc. Sometimes the doc will want us to keep the pt. overnight - still as an outpatient - and he will see them in the AM.

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SROM=admitted

there is no "minimum" cervical dilation official requirement, though i personally think it should be 5cm :) In theory, your cervix gets checked-5 or more you stay. 1-3 you walk, get rechecked for progression. 4 is the dicey area-primips at 4 probably stay (of course, assuming they are contracting). multips at 4? not necessarily.

I would think it would be the other way around. A primip at 4 might still have hours and hours to go. A multip at 4 could be complete in half an hour. A grand multip, I wouldn't turn my back on her.

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Specializes in LDRP.
I would think it would be the other way around. A primip at 4 might still have hours and hours to go. A multip at 4 could be complete in half an hour. A grand multip, I wouldn't turn my back on her.

I mean in the sense that a multip can be 4 and not be in labor. if she's contracting, actually laboring and 4cm, then I agree. I personally was 4-5cm 2.5 days before I actually went into labor.

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Specializes in L&D,Wound Care, SNC.
SROM=admitted

there is no "minimum" cervical dilation official requirement, though i personally think it should be 5cm :) In theory, your cervix gets checked-5 or more you stay. 1-3 you walk, get rechecked for progression. 4 is the dicey area-primips at 4 probably stay (of course, assuming they are contracting). multips at 4? not necessarily.

Depends on the doc and the day. Some particular docs would admit them at 1cm and contracting just b/c the are "past due" (aka 40w1d aka doc doesn't want to get out of bed. you admit her, you don't have to come for a few hours. you want to d/c her, you actually have to lay eyes (and hands) on her). Some will make you go home even ifyou are contracting painfully but cervix not changing. Some days they are offered therapeutic rest. Some days not. This doc might do Ambien and Percocet, this one might do Demerol and Vistaril.

Depends on the doc, the day, the hour, the patient :)

That's pretty much how it is where I work too. If we are not busy the docs are willing to do Morphine rest. But it really depends on the doc and the day.

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Specializes in L&D.
What is your hospital's policy on admission for a labor patient? Minimum dilation when no ROM? Automatic admission with SROM?

If someone has SROM then it's an automatic admission. In most cases, the patient has to show some cervical change in an hour before they are admitted. If they are a 4 when they come it and ctx q 5 minutes but relatively comfortable, they can walk for an hour and if they've changed we'll keep them, if not, usually they'll go home. If they're fighting going home, we sometimes will let them walk another hour and recheck. But again, if no change, they go home. This is all assuming the strip is reactive too.

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