Need advice about an idea I have

  1. I would love to do labor checks in couples' homes. This would be done on evenings, weekends, and holidays.

    What legal things would I need to consider?

    I would certainly contact all of the OB physicians in my area for their input. I would like to work with the physicians on this venture.

    Couples come into the hospital to see if they are in labor. Some hospitals have a triage area that looks like a sterile room. Those that are sent home are disappointed.

    If I do this, I would come to the patient's home (hopefully have a copy of the prenatal record) and check the cervix, check for leaking or ruptured membranes, monitor baby's heart rate, do some teaching, dip urine for glucose and ketones, etc.

    I would work out a parameter with the physicians on when to send the patient to the hospital.

    I would document everything and leave a copy for the patient to take with her to the hospital. I would also send a copy to the physician.

    This, I believe, would ease the couple's anxiety about " am I in Labor?" It would also save them a trip to the hospital, only to be sent home. I feel that the couple would be more comfortable in their own home being checked.

    I have labor and delivery experience, and I have also been sent home from the hospital for false alarms. It was difficult to find childcare at night while I was going to the hospital to be checked.

    I appreciate all comments. Thanks.
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    About webbiedebbie

    Joined: Jan '03; Posts: 771; Likes: 77
    Remote Data Review Consultant
    Specialty: 22 year(s) of experience in OB, Telephone Triage, Chart Review/Code


  3. by   ShortFuse_LPN
    I think this sounds like a good idea. I'm sure that your state BON could help answer your questions. I would also check into a malpractice insurance policy.

    Let us know what you find out!
  4. by   nurseT
    This sounds like a great idea. The only difficulty I see would be the liability. I work in home health area. I know from experience that if a client calls and tells me " I fell, or I have a bad HA and my face feels funny" I must advise them to seek medical attn at the ER, just in case something really serious is occuring. If they wait for me to make a visit, it could delay medical care. So, If the expetant mother is having a complication the delay in care could cause a very poor outcome in infant or mother. You might be looking at law suit if that would occur. Instead of labor checks, how about scheduled wellness checks, and prenatal teaching. Include s/s to report to physician. What to expect, etc. Just a few thoughts. T
  5. by   LoisJean
    Debbie! Oh, what a wonderful service this will be! I agree with T and actually I'm thinking about areas where you could be very instrumental regarding teaching especially. There are so many new mom's and dad's to be out there who need more than prenatal teaching--they also need to learn something about parenting skills, what to expect from their newborn, some of the pressures that occur that can tax a parent's nerves.

    Is follow up care and teaching something that you might be able to incorporate into a kind of 'total package' thing? So that your clients can expect a few more visits from you in a kind of supportive after-care way?

    I'm just throwing this out for the thought. I'm not in any way qualified in ob/gyn but I see so many problems on the part of mom's and dad's who become overwhelmed very quickly after bringing baby home.

    Anyway, I love your idea and I hope you see it realized in your life very soon.

    Lois Jean
  6. by   webbiedebbie
    Thanks...there is a lot to think about before I take this thing on.
  7. by   katscan
    I love Lois Jean's idea of the total package.!! It would make you more marketable, I would think.many couples would appreciate your service-even if moms only ask "am I doing this right?" You could help with breastfeeding and give needed feedback etc.
  8. by   shelleybelle
    I definitely agree w/Lois Jean... after I had my son I felt as if I'd been thrown to the wolves and I didn't have a CLUE! Breastfeeding was torture, he didn't sleep, I didn't sleep, I didn't eat, all I did was cry (classic case of postpartum) but I thought I was just crazy and incompetent mother. There are so many new mothers who may know about PP, but unaware of when it's happening to them. I think some immediate post visits would definitely be beneficial - I would've paid anything for that 5yrs ago!
  9. by   webbiedebbie
    Thanks for the ideas! I definitely will incorporate those into this business. I should check around to see if there are any doulas in my city. I know they help with labor and PP home care.

    Shelleybelle, I definitely will take that into consideration!

    Thanks, Lois Jean for the encouragement!
  10. by   JNJ
    In the UK a midwife visits the newly discharged mother and baby for up to ten days - even making two visits a day if s/he feels it is warranted.

    Usually when the infant is 10-12 days old (but up to one month old if the midwife feels she needs to stay involved) the Health Visitor takes over the care, visiting prn, identifying health care needs and finding ways to meet them, not necessarily doing all the 'work' her/himself. There is such a variety of need for both mother and infant.

    In years of health visiting, I found it a very fulfilling job, with every day a little different. The job description is very, very wide, but certainly there is a huge need for the mother and baby part of it in the USA. (Obviously the HV met the mothers prior to delivery.)

    RHVs in the UK run their own immunization clinics (with an MD on the premises) and well baby clinics and follow thru right up to pre school visit. They have powers of referral and are trained to do basic tests on hearing and vision which pick up problems earlier than I see done in the USA.

    RHV requires RN with at least part of the midwifery course and varied RN experience. It's one year in HV college (sociology, social policy, psych., epidemiology, statistics, HV theory and practice, primary care issues, child abuse, public health etc) with fieldwork practice then about six months in supervised practice. The job can be very different depending on geography e.g. inner city, retirement area, immigrant area etc.

    I'm sure an enterprising OB RN could develop a practice for herself in this sort of work in the USA.
  11. by   kcrnsue
    what did you find out? I also was thinking recently about how nice it would be if women wondering if they were in labor could be checked at home. In our area, the nearest hospital is 30-60+ miles away. (the nearest one that does deliveries). There is also a mountain pass to cross. It would be wonderful if their minds could be eased by having someone check them at home.
  12. by   indie
    You might want to read "The Midwife" - sorry, have forgotten the author although the initial B is in my mind. A recent book and Oprah selection I believe. It will give you some perspective on what you might be facing and reinforce the point about getting appropriate liability coverage.

    Good Luck in this; I know there is a need.
  13. by   webbiedebbie
    Update...I haven't pursued this yet. I just back into nursing after a 5 year break. I am working now and building up some experience to back me when I am ready to take this on.

    Regarding "liability"...when a couple walks into L&D, they are assessed by the nurse. Granted, the hospital is responsible for the nurse doing the assessment. The nurse does the assessment and calls the physician or may rely on standing orders.

    What I see for me is to get physician backing. I see no difference in assessing her at home. If there is a problem, she would immediately be referred to L&D.

    What I am trying to help with is the fact that these couples come into the hospital and are checked during the night (during the day, they can sometimes come into the doctor's office to be checked), most are sent home. From personal experience, this was very depressing for me. I would have loved for someone to come into my home to check me and the baby and to reassure me in the comfort of my own home. Sometimes, in the middle of the night, couples bring in their children. This can be very stressing for both the couple and the children who are up past their bedtime. My husband and I had to call a neighber in the middle of the night to watch our two sons. See where I am going with this?

    Anyway, as I said, I am trying to build up "experience" and reliability before I present this idea to physicians. I already have malpractice insurance. Most midwives working in the hospitals do not go to patient's homes, so that is not an option.

    Again, thanks for the responses and I will let you know how this goes.