Does your hospital have a policy on no walking after ROM?

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Just curious. One of the hospitals here mandates strict bedrest (not even up to the bathroom) after ROM. Is this a common practice?

Specializes in L&D,Wound Care, SNC.

Where I worked in the U.S. no ambulation with ROM, regardless of station. Where I work now walking when ROM is encouraged so long as cephalic presentation and well applied. They are pretty adamant on continuous monitoring, but we have telemetry monitors.

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Specializes in L&D/Antepartum, Neuro.

ROM in an automatic admission regardless of dilitation and since we are a hospital obsessed with continous fetal monitoring there is some level of confinement to the bed but they are allowed to get up to the BR provided the head is well engaged.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

OMG keep them MOVING if at all possible. Ambulation and warm showers, position changes, movement---- are critical to proper fetal descent/cardinal movements and most importantly, the comfort of the mother. Agree with unengaged or uncertain presenting parts, of course. But this tends to be the exception not the rule.

The only reason we would not have them walking is if they have pitocin and/or epidural drip going. But they can move about the room, sit in glider, on toilet, etc. with the monitors on, still!! And I encourage it if at all possible.

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We have a group of docs that don't care at all. Whatever you want after ROM is fine with them. We have another group that doesn't let them move from the bed after ROM and 99.9% of the time as soon as soon as we have ROM, then it's off to IUPC's and FSE's anyway.

I wish we could send them home and let them stay at home but if a patient presents to our triage with ROM, they WILL have a baby in 18-24 hours period. If that means a C-section then so be it.

If we have a ROM >18 hours, the baby is started on ATB of the Peds choice, even if the CBC is normal and baby has a normal (and stable) temp. Preventive care measures they call it.

So then if baby dies from a reaction to antibiotics parents can sue because the abx aren't indicated. There are risks to these "protocols"we impliment. Myself as a nurse would refuse to give the abx period.

Thank god I"m not an L&D nurse.. more and more I'm sooo thankful I didn't chose that path. Altho I love the area and work as a doula... no way could I agree with half the protocols set in some facilities.

No walking after ROM... that's the silliest thing. When I had my kids.. I was up walking around with undies and a pad on. Walking halls, playing cards at table in my room. Same with several people I've been with as a doula.... pure silliness and we wonder why our C-section rates are so high. We go against what our bodies do naturally. Lay on your back push against gravity... and don't let nature do things... AROM, pit, yada yada. (Yes some women truely need it)... many do not.

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Specializes in Community, OB, Nursery.

IV Abx sounds a bit over the top. We do blood cultures on baby is mom is ROM x 18 hours or greater, and sometimes I think that even that is over the top, esp if all 18 of those hours were not in the hospital.

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Specializes in OB, lactation.

We have one doc whose orders say it's ok "if vertex well applied" ... BUT they all insist on continuous monitoring from the minute they are admitted so most of our patients are strapped to the bed (they do get unplugged for bathroom in not ROM'd).

Also, most patients are AROM'd ASAP, so that doesn't leave many without ROM anyway, especially on the day shift when an MD is more likely to be there and do AROM.

We have one telemetry unit that we don't ever use (I mean literally never, I didn't even know we had it for a couple of years until I saw it in a storage cabinet), for some reason. I just asked my clinical coordinator about it but she didn't appear to be interested in pursuing its use.

I hate it that our pts can't walk! We also NEVER use our nice jacuzzi tubs/showers for labor. :(

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That's crazy. The only time I ever seen no movement after AROM is if the head was really high and even then it was no getting up for 1 hr post AROM so the head had a chance to descend. Once well engaged they are free to move again. Keeping them in bed with ROM serves no purpose unless the head is high.

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We have one doc whose orders say it's ok "if vertex well applied" ... BUT they all insist on continuous monitoring from the minute they are admitted so most of our patients are strapped to the bed (they do get unplugged for bathroom in not ROM'd).

Also, most patients are AROM'd ASAP, so that doesn't leave many without ROM anyway, especially on the day shift when an MD is more likely to be there and do AROM.

We have one telemetry unit that we don't ever use (I mean literally never, I didn't even know we had it for a couple of years until I saw it in a storage cabinet), for some reason. I just asked my clinical coordinator about it but she didn't appear to be interested in pursuing its use.

I hate it that our pts can't walk! We also NEVER use our nice jacuzzi tubs/showers for labor. :(

Curoius what is the c-seciton rates?? :( Sad these women cannot go thru the natural process of childbirth for some silly policies someone decided to make up. What ever happened to the statements "Do no harm"? While pit/AROM/csecitons are needed for some the rates are far to high... LOL your facility would HATE me as a patient.. I'd refuse everything!

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Specializes in Midwifery.
No...I've never heard of something so foolish! At my hospital, patients with ruptured membranes with no complications (no mec, no GBS+ status) and in no labor go home to await induction or labor, as long as they are cephalic.

:yeah:

What she said!!!

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Specializes in Midwifery.
Our facility has a strict bedrest policy after ROM. Not even to the bathroom. It's bedpan only, or foley if they have an epidural in place. This doesn't mean I completely agree with this policy under the right circumstances, but it's what we have in place now.

Sorry but that is the funniest thing I have heard! BEDPANS!!!!!!!!!!Contrary to the belief of the people who write these policies women don't just drop cords out if they've SROMed and walk around - that is such crap - and I'd be telling patients on the side too - who are we to make women stay in bed? I guess your epi rate is thru' the roof? Being stuck on a bed when one is in active labour is agonising! Heres to breaking the rules:redpinkhe

Even with a high head we let pts up - encourage it actually!! The only women in our unit who are RIB are the ones who are too sick or have an epi - our rate is about 20% - so plenty of women walking the floors!

As for bedpans our labour ward has about three - we have close to 2000 babies per year - they rarely get used! Thats what the dunnies' for - if I wanted to spend my life panning pts - I'd go work in ortho!!

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I'm feeling very grateful to work where I do. We have no such policy. It's absurd to think that they should try to prevent a very rare cord prolapse in exchange for all the common complications that would come from bed rest.

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I went straight to the hospital after my membranes ruptured, following doctors orders, and was in bed for five hours for monitoring. Needless to say, labor did not begin on it's own as I wasn't even allowed to get up to use the bathroom. Finally after 7 hours in the triage they told me they would induce. I thought their no walking policy was ridiculous- and it most certainly prevented natural progression of my birth- although I did end up doing a natural birth on pitocin- which was much more difficult- especially due to the fact I wasn't allowed to move out of my bed. But that's L&D for you anymore. And soon I will be just another nurse telling poor laboring moms they can't get up and walk due to risk of a prolapsed cord as I will have to follow the policies.:uhoh21:

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