fundal checks

Elvish, BSN, DNP, RN, NP · Nov 7, 2008

Funny that you mention your SVDs...we do the q30min x 3, then q4 x 3, and then we go to BID. So once we get past the q30s on SVDs, we're really not checking them much. Interesting. :up:

Didn't see your post re: babies out w/ moms asap earlier. Most of our c/s kids don't go out to mom til around 3hrs post-op. I can count on one hand the # of times we've kept mom & baby together in recovery. Not saying I agree w/ that, just that's how it is. So we're not generally putting baby on the boob immediately after a c/s like we do w/ a svd. We do (or at least I do) encourage moms to be up as soon as they feel like it, even if just sitting on the edge of the bed. Agree that that helps things move along/out both in the uterus and in the intestines.

short1978 · Nov 7, 2008

I was just curious as this was my 3rd section and it seemed like they checked my fundus less frequently than the first two times....although it was cked at least once per day. Gently, but I was cked.

Interesting to see different opinions/protocols.

OzMW · Nov 7, 2008

And just to add Elvish, our women don't get palpated in OT in recovery either. They are post op'ed by general nurses who aren't often mid trained. All very interesting!

Elvish, BSN, DNP, RN, NP · Nov 7, 2008

And just to add Elvish, our women don't get palpated in OT in recovery either. They are post op'ed by general nurses who aren't often mid trained. All very interesting!

Huh. Interesting. Our moms get mashed on at least 4 times (I think) in recovery. Gosh, now I have some food for though to take to work w/ me in a couple days. :)

OzMW · Nov 7, 2008

Huh. Interesting. Our moms get mashed on at least 4 times (I think) in recovery. Gosh, now I have some food for though to take to work w/ me in a couple days. :)

Yow...my uterus aches at the thought of it although in recovery they at least will still have some analgesia happening!

SmilingBluEyes · Nov 7, 2008

We will have to disagree SMBEs - my "anecdotal" evidence is the opposite.
Your woman still had the PPH; still needed transfusing- so did the fundal check prevent it from being nasty or did the drugs and the uterine massage do that? To me they are two separate issues; my point is that regular palpation (to check for "bogginess") of the uterine fundus doesn't prevent PPH; some people obviously believe it can add to picking it up earlier, but I think that's debatable. Now massaging a boggy fundus that is bleeding is a different story!!
And i agree it is better to pick something up before it gets too bad - not sure how well fundal checks do that though!

Pardon me, if I was unclear, please....I did not call it evidence. I called it what it was, anecdotal personal experience . But I will not stop doing fundal checks, and where indicated, massage on any postpartum patient. In my relatively short career (11 years), I have seen enough terrible pp bleeds not to change my practices any time soon. Also, I discussed this thread at work with my much-more experienced colleagues and the health care practicioners, all of whom agreed it was bad practice NOT to check fundi on post-op patients, as well as lady partslly-delivered ones. They could not believe anyone was not doing so as a matter of practice.

Simply put: I cannnot imagine how you know a fundus is boggy if you don't actually palpate it. There is no other way. And I won't chart what I cannot assess, as another member mentioned earlier in the thread.

As I said, I agree to disagree and will not argue with you any more. But I do have one question. Do you have studies you can point me to saying fundal checks on post-op patients are contra-indicated? I really may be missing something here, and would love to learn what I can here.

Anyhow, I wish you good night.

SmilingBluEyes · Nov 7, 2008

And to add - not sure if this makes any difference. Most of our section babys come out to the ward with their mothers. So our women are encouraged to be fairly active from the word go. Not saying we expect them to get straight up of course! But they are often sitting up breasfeeding fairly soon so maybe that encourages the lochia to flow rather than pool??

We also do encourage early activity as well as skin-to-skin bonding and early breastfeeding. All of these things help the post op patient on the road to recovery faster. I think that is becoming common practice in most places in the USA. I have worked 4 different hospitals and we did this in all of them. I was breastfeeding my daughter 30 minutes after she was born by c/s. It was wonderful.