Determining Lates and Variables Without Fetal Monitor?

[VickyRN, MSN, DNP, RN]

Working part-time in my tiny community hospital ED. Very infrequently (and of course, very unexpectantly!) an OB patient will present in labor. When this happens, these patients are shipped out ASAP to the nearest OB facility , 25 miles away, unless delivery is imminent. We do not have OB docs or L & D unit in our hospital - just the basics for an emergent delivery, plus an isolette/ baby warmer. We do not have a fetal monitor (too expensive, hospital cannot afford right now). We have an old doppler which can be used to auscultate fetal heart tones, but it is my understanding that lates or variables cannot be determined with these? Am I correct? I do have some experience with OB, but this was years ago.

[sirI, MSN, APRN, NP]

Hi, VickyRN,

You are correct, there is no way to determine if the FHR is late, even if you thought the rate dropped for you'd have no idea if it was truly after the acme. Variability is impossible as well.

You must have a FH monitor to determine these readings.

[VickyRN, MSN, DNP, RN]

Thanks so much, siri, for confirming what I thought. If an emergent birth occurs, we'll just have to do the best we can with the equipment available.

[Altalorraine]

Thanks so much, siri, for confirming what I thought. If an emergent birth occurs, we'll just have to do the best we can with the equipment available.

Considering that there is no evidence that outcomes are better with the use of EFMs, your patients should be just fine with intermittent monitoring.

Are your staff NRP certified?

Altalorraine

[VickyRN, MSN, DNP, RN]

Considering that there is no evidence that outcomes are better with the use of EFMs, your patients should be just fine with intermittent monitoring.

Are your staff NRP certified?

Altalorraine

Most are certified with PALS, but not NRP.