Assessing labor

[m0m2boys]

Our protocol for accessing active labor is if the pt makes cervical change. We usually get a reactive NST and watch them for an hr, giving them the choice to walk for that time period or lay in the bed. Then we re-exam the cervix and if no change, hasta la bye bye. Obviously if they are in severe pain we will get an order for pain meds and reassess cervical change and if none they go home.

I was just wondering if this is how it is done in other hospitals.

Thanks,

LF

[SmilingBluEyes]

For prodromal labor patients who are very uncomfortable, with their permission and consent, we ask for therapeutic rest. This usually will consist of giving pain meds IM such as Morphine/Phenergan or Nubain/phenergan mix and watching them for several hours. We usually give 15 mg Nubain and 25 mg Phenergan or 10 mg Morphine and 25 mg Phenergan IM to accomplish this. This will do one of two things for them in the majority of cases:

1. will get them some rest and slow or stop all the pesky contractions that are not yet bringing about cervical change, yet are bad enough to make mom miserable, allowing them to go home and rest.

OR

2. will get them some rest and have them awake later in truly active labor, at which point we admit them for such and give them their epidurals, if they so choose, or at least they know they are not going home in despair again.

I am a BIG believer in therapeutic rest, particularly on nightshift, when they are most miserable and restless. Ask your doctors about this. It's been such a lifesaver for countless numbers of my patients.

PS HYDRATE HYDRATE HYDRATE. I work hard to get them drink AT LEAST 2 liters of water while in my care for prodromal labor. THAT ALONE can slow or stop those contractions that are making these ladies so very unhappy and uncomfortable in some cases. In any case, unless they are physiologically-compromised, it sure cannot hurt!

[m0m2boys]

For some reason our dr's are so reluctant to give anything for pain. I'm lucky to squeeze an ambien out of them. I will try being more assertive w/ pain management options & dr's. Thank u for your response.

LF

[NurseNora, BSN, RN]

Most places I've worked do something very similiar. Try to encourage the woman to walk rather than stay in bed. Talk about gravity and jiggling the baby into the optimum position. We have a whirlpool bath that our patients can use. Helps relax them into labor or out of false labor. If no tub, try a shower.

If your docs are reluctant to order pain medication, refer to it as "therapeutic rest" as above. How long has she been having contractions, how long since she last slept? We sometimes use Vistaril IM or PO for relaxation. Not as strong as the Morphine, but often helpful.

[SmilingBluEyes]

I know what you mean about reluctance to do this in some physicians. But I put it to them like this: IF we get this gal some relief the chances are, we won't be bothering the dr again so soon. If we do not, they will be back or we will have to keep calling them for help. This usually does the trick.