Comfort Measures...

I am not in L&D, but in nursing school when I was completing my preceptorship within the L&D dept of a small regional hospital I remember a patient who had outlined her birth plan. If I am not mistaken, she really didn't want to come to the hospital for the birth of her baby but needed to due to a small complication. Her plan was VERY specific on how she wanted her birth to go. Some of the things I remember are no pain meds, she wanted to be the one who gave the first bath and she wanted to take her baby home immediately after the birth. There were other things in there (what she wanted to do during labor), I just don't remember. Anyway, the staff within the department were all a flutter over it. They had never really encountered such requests and were pretty bitter about it. I couldn't understand why. I have friends who did home births, water birthing centers, all sorts of non-traditional births. I was (am) open to the idea of doing what the mother requests all long as there is no harm to the baby or the mother. This department was only open to the way they have always done things, IV's, pit if needed, constant monitoring, laying in the bed and up with BRP, etc. I really thought it strange they were so opposed. BTW, I don't remember the complication this mother was having, but they did not do high risk births at this facility, so I don't think it was too major. As I am typing this I think she had to be induced for whatever reason, so she was going to have to be on an IV and monitoring. This was a few years ago, so I apologize for my foggy memory :) I do remember that she had to sign a waiver of some sort and meet with the physicians and director a couple of times prior to the birth. Sorry for the long and rambling post, again, I thought it was very strange and almost a hostile situation.

Non-pharmaceutical comfort measures: position changes, ambulation, birthing ball, tub, shower, TENS unit, K-pad, cold washcloth, warm blankets, counter pressure to the back, hip squeeze, standing and rocking with the mother in a "labor slow dance" (it's best if we can enlist the FOC for this, but I've done this myself with patients), soothing music, aromatherapy (usually lavender, but I've had one midwife use ylang ylang), electric candles and dim lighting.

Pharmaceutical comfort measures: IV Fentanyl, epidural

Our facility is pretty unique because it's pretty much the closest one can get to a FSBC or home birth while still being in the hospital. We have a pretty liberal policy on monitoring (as far as continuous vs. intermittent) which allows a lot more freedom to move around and try different things. I have even witnessed an orgasmic childbirth while working here. It's pretty rare, and almost unheard of to happen in a hospital setting! I've had women give birth, in the bathtub, in the dark! Only me, the midwife, and the woman's husband in attendance.

Birth plans are common and encouraged here, and it's not unusual to have women say they don't want to be asked about pain or pain scale or pain medication. So in those situations I let them know that I won't ask, and if they want to discuss their options, they can ask me. Then I chart that, and that covers me for the pain assessment requirement (I will still chart pt behavior for pain assessment).

Our policy is that every patient must have an IVL. If they are adament that they do not want fluids running or pit or something, and have arranged that with the physician, that's fine. But we still have to have the lock. Things can change SO fast in L&D and when they're taking a turn for the worst, you don't want to be trying to get a site going.

We have birthing balls, fetal telemetry units for ambulation, we have bars that hook onto the beds so people can squat or hang on to them if they choose. We have rice bags we can heat up, we can help with massage, etc. Of course we also use breathing techniques. We have available, epidurals, stadol, and nubain, as well as tylenol and benadryl throughout labor generally.

Patient's can shower, although we do not have tubs in our facility to allow for water births.

klone just about covered it all! :) The only other thing I would add is-if for any reason the patient has to be (or wants to be) in bed and lying on her back-have her bend her knees with feet flat on the bed, place your hands just under her knees and apply pressure-almost as if you're trying to push her femur farther into her hips (OK, don't really do that, just imagine that's what your doing-just far less pressure) ; ) Also, for back labor, sterile water papules. I have used these many times and have never had an unsuccessful experience-every woman has had significant relief for about two hours. While mama is in the tub, get a graduated cylinder or some other container and fill it with warm water from the tub and pour slowly in a clockwise motion over her tummy during contractions.

Just to name a few.