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 ?
We actually just had a meeting on this yesterday at our facility: we attempt to keep the monitor on and write on the strip that a placement is being attempted to explain any funny-looking tracings.
A little off topic, our institution also requires that Mom is on a dynamap and EKG during placement - very strict per the anesthesiology group, they want BP, pulse and any changes noted during the test dose. Not sure if this is standard everywhere else, this is the only hospital I've worked at.
I believe that if a Mom indicates earlier in her pregnancy that she'd like an epidural she has an anesthesia consult at that time to sign a release, and if a Mom decides during her hospitalization that she'd like an epidural she signs a release at the time of placement.
Since guidelines for ascultation during labor for patients not on continuous monitoring is q15min in active labor, if all has been well, we can go for 15 min with no recording. Of course, we document that the FHR was lost due to maternal positing during epidural placement. Our anesthesia dept wants continuous pulse ox during epidurals, so it's obvious when the monitor is recording maternal pulse rather than fetal heart rate. We don't remove the monitors. Anesthesia pulls the belts down under Mom's butt while they place the epidural. sometimes it even records better that way!
If the strip has been funky, we'll place an FSE before the epidural.
Not only do we use a consent but now we are doing the "time out" thing they do in surgery (to make sure they aren't working on the wrong arm or leg) also. Hmmm....let's see....why ARE we all gathered here in this labor pt's room and WHY DON'T YOU JUST PUT THE DANG THING IN??? We take the monitors off of our pts. and spot check if it takes longer than it should.
We have consents for both the epidural and for 'lady partsl birth with possible episiotomy' at our hospital. During the epidural we have a pulse ox on mom which records MHR. We use QS charting and do a time out/procedural pause before beginning the epidural, then we chart pt positioning and something like 'unable to trace FHR due to pt positioning during epidural, MHR tracing in the 70's' or something like that. We also do Q3min BP's for 15 min, then Q5 for 15 after the test dose, and our anesthesiologists like us to keep the pulse ox on for at least 15 minutes as well. If the epidural is taking longer than usual, I'll usually try to get some tracing of the FHR.
Specializes in L&D, NICU, PICU, School, Home care.
We specifiacally consent for "Labor Epidural"
If baby is reassuring then I turn off the recorder and document what is happening on the strip (love the keyboard) as much I can while holding the patient in the correct position.
jenrninmi, MSN, RN
1,976 Posts
If we can keep the fetus's heart tones on, I do, if not, we unplug the leads.
Yes, here we get consents signed for anesthesia.