fetal heart rates

[valene]

what do you do in your hospital? how often do you document fetal heart rates during the second stage of labor? do you do them as frequently when the patient is 10 cm and is not pushing because she has no urge?

We do them q5min second stage regardless of whether they are pushing. Would like to change policy to be q15 min during second stage until they are pushing. (many epidural patients do not have urge for 30-60 minutes after becoming fully dilated and it is not our practice to force them to push with no urge unless there is a reassuring pattern)

thanks

[*Ferty~OB~RN*]

WE assess FHT's every 15 min in second stage, however, some docs like it AFTER EVERY CONTRACTION during this stage, and others just have us spot check every so often.

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MEC HAPPENS.....and I am USUALLY the MAGNET!!!!!

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[SmilingBluEyes]

q 5 min in 2nd stage labor.....both fetal heart tones and maternal vital signs are done in this pattern in 2nd stage labor.

[bagladyrn, RN]

Deb - I've been in places that do the q 5 min during second stage, but found the maternal vital sign part really difficult during that stage. Do you find mothers really annoyed by the BP cuff constantly pumping up during pushing, and the auto BP alarming when uable to get a reading? Can't tell you how many times I've seen them rip off that cuff and throw it!

[L&D_RN_OH]

I was thinking of problems with the BP cuff too. :chuckle I can think of several pts that would have ripped it off. We try to document fht q 5 min while pushing.

[imenid37]

Lots of times,even the q 15 min. maternal vs are impractical when mom is pushing. Usually our docs say take of the bp cuff and sometimes toco too. We just document that these are off per dr___ and do spot checks for prolonged pushing unless we have PIH or another concern (even then we are usually not doing q 5 min as for high risk because it's not practical either). Pulse ox is often dc'd too on epidural pt's (it's our policy to have ekg leads on pulse ox for epidurals) and we put on intermittently and document that it is per physician orders. Mostly we are using continuous EFM in 2nd stage rather than auscultation. Sorry had to edit this due to innaccurate time being written initially. (PMS hard at work in my brain this week).

[palesarah]

our policy is to document FHT q15 min in the second stage for low-risk patients, and q5 for high-risk pts. Maternal VSs q30 throughout. (We consider the second stage to be when pushing begins, not when mom is 10)