determining station

I don't do L and D, so I can't really help you. But I have noticed, after years of hearing that an engaged baby was usually at zero station, and that this occurs usually a few weeks before labor, that this is not the case. In the 3 years I have worked in the newborn nursery (we have access to mothers strips) that only 2 people have come in at zero station. Most come in at -2 or -3 station and stay that way until they are pretty far into labor. Maybe just at my hospital?

Hey there. I am slightly beyond a novice in L&D. I have been a labor RN for 2yrs now. So take my advice w/ a grain of salt. I usually have difficulty finding the spines and gauge station by pelvic arch. If the BPD of the head is slightly above the arch it's a -1sta for my assessment. I do agree that textbook 0 stat is when the BPD is even w/ the spines.

I will AROM if the head is -1 or even -2 stat as long as the head does not ballot out of the pelvis w/ a cxt and is well applied to the cervix. The hospital I work for usually is rather agressive w/ delivering in a timely fashion, unless of course the MD has a golf game;) .

Lauren RN

Are RN's performing AROM in Nevada? It's not in our scope wherever I have lived (a few states). It's only an advanced practicioner skill, e.g. MD or CNM in most any place I have ever been.

In NV it is w/in the RN's scope to AROM, place FSE and IUPC's. I have worked w/ several RN's from other states that were not comfortable rupturing because the MD's did so where they were from. The atmosphere in Las Vegas L&D is a lot of elective inductions and elective primary c-sections. Almost any pt that comes in laboring on their own will be put on a pitocin drip if they are not cxting q 2-3mins for 60-90secs. We don't have any birthing centers in town and mid-wives are slim to none. Not that I agree w/ this way of laboring pt's, but this town is so transit that I think some MD's want them delivered before they decide to move on to greener pastures across the country.

Since graduating nursing school 2 yrs ago this is my first nursing job, so I don't know any different. I know from reading articles and stories from others that this is not the way of the labor world in other states.

We are very autonomous (sp?). The MD's get upset if they get called in for delivery and the head is not even crowning yet. So for them to come in and AROM a pt is unheard of here.

This is one of the reasons I joined this site to broaden my horizons. I know the way some MD's practice here are not right. I would never do anything to put a pt or baby in jeapordy! I would love to learn some more non-pharmacological ways to manage pts other than pitocin and epidurals.

Sorry this is so long. To answer your question, yes RN's AROM in NV.

i know its a wee bit off topic, but reading the last post brought back my wonderings. Why in the States do the Docs have to deliver babies?, seems from all the posts I have read in the past that the nurse does all the labour bit, then the doc comes in and catches the baby! does this happen with all normal deliveries? What do midwives do in the states, as here in the UK, its our job to manage labour and delivery, unless it goes to forceps/c-section etc. Just wondering..sorry to wander a bit off topic!

the nurse does all the labour bit, then the doc comes in and catches the baby! does this happen with all normal deliveries?

Yes, pretty much. Where I work, the typical patient may see the doctor once (at which time they break their water, usually during morning rounds- hurry up and break all the inductions), typically for 5 minutes tops; then when baby is on the perineum and really to fall out for another 10-15-20 minutes. If the patient misses morning rounds, there's a fairly good chance they won't see them at all until delivery.

What do midwives do in the states, as here in the UK, its our job to manage labour and delivery, unless it goes to forceps/c-section etc.

Certified nurse midwives (CNM's) here manage healthy pregnancies, labor, delivery and postpartum as well as well-woman care (pelvic exams, paps, birth control, menopause tx, etc.). They usually work in hospitals/ are in practices with doctors (though not always), sometimes do freestanding birth center or home births. They tend to stay with women more during labor than doctors. Complications, c-sections, hi-risk are referred to doctor.

Non-nurse midwives (lay midwives, CPM's, direct-entry MW's) rarely to never work in hospitals/doctor practices & usually do home or birth center births.

We are placing IUPC and FSE but definately NOT in our scope to AROM anyone as an RN.