efm during an epidural placement ?

Specialties Ob/Gyn

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Specializes in L&D.

What are the practices out there?

It is sometimes impossible to monitor the Fhr during the placement of an epidural, especially with the patient sitting up, and leaning over, as is a very common positon for the pt. to assume for the placement.

There are differing opinions amongst our staff. No-one seems to be quite sure what the "correct thing" is to do?

Is there "a wrong or a right way" regarding monitoring or not monitoring during this time ?

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Specializes in NA, Stepdown, L&D, Trauma ICU, ER.

Some of our nurses completely unplug from the monitor during an epidural. Their thinking is that no strip looks better than 5 miuntes of 60s (or whatever moms HR is) I at least try to keep baby on. If it's absolutely impossible due to moms position, then I just chart 'unable to trace fhts r/t pt sitting up for epidural, maternal HR recording' with a couple bp or spo2 readings to verify that.

I am kinda curious to see what everyone else does

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Specializes in OB.

I unplug the monitor during the epidural, as long as the baby has been looking good. Our doctors dont want the baby off the monitor for more than 15 minutes, so if its past that, and the epidural isnt close to being done, we have to ask the anesthesiologist to pause so we can check heart tones.

If the baby has been having anything funny (like deep variables or something) I make sure to put an FSE on before the epidural.

Of course if they're not ruptured, that would change things, but I havent come across that situation yet!

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Specializes in OB.

I simply chart "Unable to maintain continuous FHR monitoring d/t maternal positioning for epidural placement." If the monitor is picking up maternal pulse during this time (showing 60's or whatever) I document on the strip and the labor record "Rate shown matches palpated maternal pulse" or if pulse ox is on "Rate shown matches maternal pulse as shown on pulse ox"

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Specializes in Nurse Manager, Labor and Delivery.

As above poster stated, you should be charting what is going on at the time. You should be documenting your fetal status pre and post epidural and if you cannot maintain continuous monitoring during the procedure because of positioning, chart as such and defer to your auscultation guidelines. If the placement does take longer than 15 mins, you should stop and be allowed to auscultate the heart tones.

This is a bit off topic, but do you get written consent for your epidurals??

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Specializes in Perinatal, Education.

Read your policy and procedure regarding EFM during epidural placement. It probably addresses this for your facility. Usually, the policy states that EFM be maintained. If so, unplugging the monitor is a bad idea. I always try my best to maintain the tracing, but as others have posted, sometimes it is impossible and then I chart regarding MHR, etc.

As far as written consent for epidurals, I work registry and have seen no consents (they tell me it is included in the admission consent) and elaborate consents with risks and benefits written. I have also been seeing consents for lady partsl birth and possible perineal repair--anyone else?? I can kind of understand why, but that baby is coming with or without a consent!

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We are *required* to monitor the babies during epidural placement. Sometimes that means requesting an ISE before the epidural, sometimes that means that another nurse has to come in and crouch down under the stand that the mom is leaning on so that she can trace the baby while the first nurse documents other things.

I hate assisting with epidural placements.

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Specializes in Nursery, L&D, PICU, SICU.

This is interesting because usually it's just the MDA and RN in the room so it seems impossible to do EFM and hold position and chart at the same time if the pt is sitting up. We remove EFM and toco because the bands would be in the sterile field. We document epidural placement in progress. If the baby has not had a pretty tracing we would have an FSE in place if not we would get another set of hands and do side-lying insertion and try to monitor that way but very rare.

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Specializes in OB/Neonatal, Med/Surg, Instructor.

If the baby has been looking questionable, I'll change them over to an internal (scalp) unless contraindicated. With reassuring FHTs I continue the EFM and document on the strip what is going on re: epidural placement, mom's response, positioning, etc. so I also have a record of how long it took to place the epidural (an occassional issue) and how long we didn't have an accurate tracing. Most of ours are on pitocin (lots of social inductions in our facility) so they have continuous monitoring anyway.

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Specializes in OB.

"This is a bit off topic, but do you get written consent for your epidurals?

Our general consent forms says, lady partsl or c-section delivery of the baby, anesthesia as needed, and care of the newborn.

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Specializes in LDRP.

I just try to keep the pt on as much as possible--it is kind of ridiculous but as long as I can intermittently trace reassuring HTs then I am cool. But man, those long placements wear me out! UGH!

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Specializes in LDRP.
"This is a bit off topic, but do you get written consent for your epidurals?

Our general consent forms says, lady partsl or c-section delivery of the baby, anesthesia as needed, and care of the newborn.

Yes, anesthesia speaks w/ the pt and they sign an actual anesthesia consent form.

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