confined to bed after 4cm?

SmilingBluEyes · Nov 18, 2003

I do not support this policy but we nurses CAN see what drives it...

The out-of-control litigation rates out there, obviously push doctors and hospitals to do things that are NOT sound at times. AND while NO Insurance co. may have a word to SAY about fetal monitoring frequency, just have a thing go wrong and SEE how quickly each MINUTE of labor/delivery is scrutinized, torn apart, and dissected to it's most minute detail...THEN defend why the patient was NOT more closely-watched. I don't know about you, but the experience of having MY nurses' notes put up on powerpoint and on the wall, in HUGE print, dissected by litigants HORRIFIES me.....YES I admit, in a way it drives SOME things I do....I think all the time "is this legally defensible?"

We all know medicine and nursing is part- crapshoot, part amazing skill. All we can do is strive for EVIDENCE-BASED practices in medicine and nursing. CONTINUAL fetal monitoring and putting patients to bed IS not based on solid evidence...but things can and do happen. We have to all be willing to take the risks (patient/familes included).

Dayray, RN · Nov 18, 2003

Walking during labor is great it relives pain and helps progress labor. My patients are only confined to bed if they have an epidural. even with pit I still get them up to the BR and will put them in the rocker or birth ball (as long as I can keep the monitor on).

Even if there was a policy about confinement at a certain dilation my patients would all mysteriously go from 3 cm to complete.

As for her explanation "what if your water broke and cord prolapsed" thats bologna. Cord prolapse is a remote possibility for anyone but it usually happens if a patient is artificially ruptured to early. If you were walking around and your water broke, cord prolapse would be pretty unlikely.

All you need to do is talk with your doc and have him write an order allowing ambulation past 4 CM. of course if you are started on pit you would have to be on continues monitoring but up to that heart tones Q 1 hr are plenty.

As for the IV, although its ultimately your choice I think a hep lock is a good idea especially considering your complications.

The stir ups I think would be easy to get around. I would be really surprised if the nurse planed to push with them. They probably set them up when the doctor gets there. If thats the case just ask your doctor when he gets there if you can use foot pads instead.

Don't be afraid to ask for an order from your doctor. It might be a little unnerving to the nurse but if you are reasonable with her I don't think she will hold it against you. Also that place really needs to come into the 21st century and this would be 1 step toward it.

littlemrs · Nov 18, 2003

Hehe!

You guys have been sooo helpful and encouraging (and funny!)

I am talking to my doc about it all tomorrow, so it should be interesting to see what he says. (I'm kinda nervous about it.)

I anticipated somewhat that I was going to have pushback on things in L&D, but never anticipated it would be to this, er, extent. :rolleyes:

tonchitoRN · Nov 18, 2003

i just have to reply. i was in the same position as you with the birth of my fourth child 2 years ago. i had some very strong opinions about wanting to walk during my labor. it worked before for me and my intuition said it would work again. the hospital was opposed. the md told me he had no problem with my requests but told me the hospital policy was every laboring patient was to be in bed with the monitor. he was unable to override hospital policy.

to make a long story short, when the time came to say no to the nurse (no i will not stay in bed) i know my patient's rights and know they cannot physically hold me down in bed. i told them i had to go to the bathroom. i was unhooked from the monitor, i went into the bathroom with my iv bag and locked the door. i walked, squatted and ran. in my mind walking helped my labor progress 3 times before and i knew it would help this one. i was right. when they had me in bed i dilated from 2 to 4 cm in 3 hours. that was proof enough for me that their archiac policy was not helping my labor along. i came out of the bathroom and told the nurse i was ready to deliver. the baby was born approx. one hour later. the staff hated me, the md was not happy. i was happy because i listened to my body and let nature do its thing. no drugs were used. no pit. was used ... that's another story.

:)

good luck.

littlemrs · Nov 18, 2003

OMG, tonchinto check your personal messages.

Jolie, BSN · Nov 19, 2003

I am not trying to defend this policy, as it is indefensible to force a low-risk mom to stay in bed with continuous monitoring. However, when the staff nurses say that continuous monitoring is required by the insurance company, I believe they mean the hospital's malpractice policy, not the patient's health care insurance. Of course, the patient has no obligation to follow the malpractice carrier's ridiculous rules.

And it seems counter-productive, as continuous monitoring has not proven beneficial in reducing negative outcomes for LOW-RISK patients.

As usual, policies are written by people with no idea of real-life practice.

KaroSnowQueen, RN · Nov 19, 2003

I was amazed to read about this policy. My first baby, in 1980, I was 4 cm before I even went into labor. Was ten days overdue, went for ob visit, he told me to walk and walk and walk. If no baby, to come back in am and be induced. I walked from 4pm on, went into labor at 12 mn and had a good baby.

How very strange. :confused:

CarVsTree · Nov 19, 2003

Get a birthing ball and bring it with you. If they tell you to get in bed, just don't.

I know when I was in labor, Kayla was OP and the bed was pure agony. I got in bed for the few dilatation checks my midwife did.

I pushed in the squatting position (she still didn't come out :rolleyes: ). That's where the flexibility comes. I ended up with a C/S but a very healthy baby.

Would have loved a lady partsl unmedicated birth, but things changed. I was unmedicated until we were on for the sx. At least she didn't have hours of epidural meds. Oh, I'm going on and on.

I agree with everyone else have a birthplan and just ignore them if they tell you to stay in bed. Hope you have a fast, fast labor so it isn't even an issue!

littlemrs · Nov 19, 2003

OK, so we had our appointment today. The doc spent about 25 minutes with us! I told him of our visit to the hospital this weekend, and what all the nurses had told us about their labor routines. He insisted on knowing which nurse it was (we didn't remember her name) so he could talk to her about what she told us. (He wasn't mad at her, just :rolleyes: ) Basically, what she said was all BS.

My doc said I could walk up and down the halls until the baby comes out, or stay in the shower the whole time for all he cared, anything I need to do to birth this baby out comfortably and effectively. He is very, very supportive of me going unmedicated, and actually prefers that I do it that way, due to the complications surrounding the heparin. He said, "You know, people all over the world do this all the time with no medications, but here in the US it seems people just can't get their arms around that, and epidurals are used without thought. Our nurses [at this hospital] are just not used to seeing an unmedicated birth, so they don't know what they are talking about." He said he prefers intermittent fetal monitoring to continous. He said a heplock would be preferable to an IV. Etc, etc. Then he said, "It's your birth, not mine." I was stunned. My doctor rules! I never even showed him the birth plan, and I'm thinking about chunking it at this point.

He said he had no doubt in his mind that I can do it unmedicated, he supports me fully in what I need to do, and he is really looking forward to being there when we have our son.

It think his attitude towards birth stems from the fact he trained and spent half of his career in Canada. (Figures.) He's only been in this area for 3 years or so. For this reason, I had an inkling he was going to be pretty accomodating, but I didn't expect this much accomodation.

So, I feel MUCH better about things now.

BETSRN · Nov 19, 2003

I am so gald he is approaching this in this manner. However, you still have to deal with the nursing staff and they are going to be a very integral part of the process. I would make sure you talk to someone else again and take your birth plan with you. Don't throw out the idea of having one. If there is one nurse there like that, there may be others. Also, please do call the L&D suite again and talk to others. It's important to get feedback from more than one person.

bagladyrn, RN · Nov 20, 2003

I'd also suggest going back to the L&D unit and talking to the staff there (maybe start by making an appt. w/the head nurse) to find out which of the staff are most comfortable with unmedicated births and accomodating different methods. Try to get several names so that the chances are good one of them would be there when you deliver. That way you would be lined up with someone who is comfortable accomodating your wishes and knows how to adapt these to changing situations.

I frequently fill this role when as a traveler I am at a hospital where the staff has "always done it this way" and I'm comfortable with different ideas on birthing because I've been so many different places.

mother/babyRN, RN · Nov 20, 2003

WHAT???? That is insane...I would love to see the written policy on THAT.......Sounds interventive in a passive agressive way..I would steer clear.....