Where do your Miscarrages admit into

  1. Hello all - We are having a very heated debate at our hospital. Our OB dept will not admit any Pt who has had a miscarrage unless they are over 22 weeks
    They say (OB dept) that they are a Mother-Child unit - and these pts can go to a MedSurg floor (not a mother anymore they say). Well I can tell you that our MedSurg Nurses are the best, but they know nothing about checking Fundes and how much blood , etc. We had a very close call when a 19 week women lost her child and bleed so much she had to have an emergency Surg. Thank God the Nurse that had her on the Ortho floor had the sense to get the doc on the phone right away. She previously called the OB dept and they said they were to busy to check on her. Well - there is also the greif therapy / PRIDE instructions that these patients also need (our hospital offers a burial place for all miscarrages / any fetal remains and does a service every six months - Very Cool I think) and our MedSurg Nurses are running after 6 - 7 Pts on days and I am afraid these type things would be missed - So my question (after all the ranting - Thanks for listening) "Where do your miscarrages / DNC admit into and do they recieve any special care?"
    Thanks to all and God Bless - JHUBRAIN
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    About JHUBRAIN

    Joined: Feb '02; Posts: 53
    Clin. Edu

    26 Comments

  3. by   USA987
    I work in L&D. We usually take miscarriages/fetal demises 16 wks. and up. After they deliver we try to accomodate their wishes as to where they want to stay...postpartum or med/surg. Some patients don't want to be on a postpartum floor where they can hear babies crying and lots of happy families around. Of course sometimes we can't put them where they want because there are no beds available.

    I know some floor nurses say they don't know anything about fundal checks, etc., but I do feel that it's important for them to learn it. If they have any questions we are always happy to run over and help them out. I am sorry that you felt that your L&D unit wasn't very helpful. In L&D I've had to take care of patients with SVT, acute asthma attacks, renal failure, PICC lines with TPN/Lipids, etc. None of the above are within my area of specialization...but we do our best to take care of them when they are here to have their baby. Our med/surg staff has been a wonderful resource to us as well. Please don't misunderstand, I wouldn't expect a med/surg nurse to come and deliver a baby.

    And remember, pospartum nurses are running around caring for 6-8 patients at a time as well if they are doing couplet care.

    Have a wonderful day.
  4. by   jeepgirl
    Honestly... I think it is best that they are not admitted to OB or PP. My reasoning on this is the fact that there are crying babies, stuff in the rooms for new moms, decor that focuses on new babies and mommas, etc. I wouldn't want to be walking in the hallway seeing moms push their new babies around. That would make me feel really sad.


    All med surg nurses should know these skills and probably need an inservice on them on a regular basis if they do not routinely get these sorts of admits. But putting them on the floor does help. One of our local hospitals has a sign that they hang up.. its like a leaf with a drop on it. if you see this sign, you know that this parent has suffered the loss of a child... so you know not to come in asking "oh, how is the baby?" etc. That is nice. That hospital puts these moms off the OB / PP floor. Now, I do think that OB should be more willing to come and help you guys when you call for it. I would put in a call to your manager so they can talk to the OB manager.
  5. by   Q.
    Quote from USA987
    I know some floor nurses say they don't know anything about fundal checks, etc., but I do feel that it's important for them to learn it. If they have any questions we are always happy to run over and help them out. I am sorry that you felt that your L&D unit wasn't very helpful. In L&D I've had to take care of patients with SVT, acute asthma attacks, renal failure, PICC lines with TPN/Lipids, etc. None of the above are within my area of specialization...but we do our best to take care of them when they are here to have their baby. Our med/surg staff has been a wonderful resource to us as well. Please don't misunderstand, I wouldn't expect a med/surg nurse to come and deliver a baby.

    And remember, pospartum nurses are running around caring for 6-8 patients at a time as well if they are doing couplet care.

    Have a wonderful day.
    Great answer and I totally second that.

    Where I used to work, we also wouldn't admit patients for miscarriages under 22 weeks; technically speaking anything under that is considered a spontaneous abortion and not a pre-term birth. 22 weeks and under they should be cared for on a GYN med/surg floor.
  6. by   BETSRN
    Quote from JHUBRAIN
    Hello all - We are having a very heated debate at our hospital. Our OB dept will not admit any Pt who has had a miscarrage unless they are over 22 weeks
    They say (OB dept) that they are a Mother-Child unit - and these pts can go to a MedSurg floor (not a mother anymore they say). Well I can tell you that our MedSurg Nurses are the best, but they know nothing about checking Fundes and how much blood , etc. We had a very close call when a 19 week women lost her child and bleed so much she had to have an emergency Surg. Thank God the Nurse that had her on the Ortho floor had the sense to get the doc on the phone right away. She previously called the OB dept and they said they were to busy to check on her. Well - there is also the greif therapy / PRIDE instructions that these patients also need (our hospital offers a burial place for all miscarrages / any fetal remains and does a service every six months - Very Cool I think) and our MedSurg Nurses are running after 6 - 7 Pts on days and I am afraid these type things would be missed - So my question (after all the ranting - Thanks for listening) "Where do your miscarrages / DNC admit into and do they recieve any special care?"
    Thanks to all and God Bless - JHUBRAIN
    OB's less than 20 weeks do NOT come to us unless they are miscarrying. All miscarriages come to us because our unit is the most appropriate place for the patient to be (regardless of the gestational age).
  7. by   z's playa
    All miscarriages (vag bleeding) under 20 weeks are directed to ressus or Obs. Gyne is called down only after the Chief Resident sees the pt.
  8. by   DutchgirlRN
    Quote from z's playa
    All miscarriages (vag bleeding) under 20 weeks are directed to ressus or Obs. Gyne is called down only after the Chief Resident sees the pt.
    Pregnant women regardless of the gestation go to the OB floor. Whether they are still pregnant, threatening to abort or have aborted/miscarried. I cannot imagine putting a patient experiencing a miscarriage on the med/surg floor. That baby/fetus was their child no matter the gestation and they deserve to be on the mother baby unit unless of course they themselves would decide that's not where they want to be. With that said I believe the majority of aborts recover and go home from same day surgery. I've had two miscarriages both of which I recovered from and went home. No overnight stay.
  9. by   fergus51
    I've worked in hospitals that put these women on med-surg, some that put them on PP and some that put them on ante-partum units. IMO, antepartum was the best place. They had nurses who really understood what they were going through and really cared. On PP, the nurses were also just as knowledgeable and compassionate and I think that's the second best place IF they can get a private room. The downside is the fact that there are babies around, but their exposure to them is limited if they have a private room and they have the support of staff. Med-surg is ok if the woman wants to avoid babies altogether, but I have never found it to be great as far as staff is concerned. We actually had some staff make really inappropriate comments in one hospital, so we changed our policy and admitted all miscarriages to PP.

    If you are going to keep getting these patients, why not see if some staff can float for a few shifts in OB to get skilled at fundal checks, etc? If you have a few dedicated nurses willing to be the ones to look after these women on med-surg, then it shouldn't be too hard to train them.
  10. by   akcarmean
    When I had my miscarriage @ 16wks. I was in the ob dept. This was when they had the delivery rooms then the post op rooms seperated. I got to choose to stay in the delivery room instead of going to the post op area where you could hear all the babies crying and things. Then the delivery room didn't have all the mother/baby things they have now. I did end up having to have a D&C, also after going through labor with Pit and everything. Bad experience. Dr. didn't prescribe any pains meds, but had me on Pit to induce labor. It took my husband's cousin who is a paramedic who also does triage @ the hopsital to get something done for the pain. I was in so much pain that I didn't remember who was there to see me. After the D&C I stayed in the room for a couple of days, then they moved me out to another floor for a couple more days but L&D did come and check up on me. They were great.


    Angie
  11. by   z's playa
    Quote from DutchgirlRN
    Pregnant women regardless of the gestation go to the OB floor. Whether they are still pregnant, threatening to abort or have aborted/miscarried. I cannot imagine putting a patient experiencing a miscarriage on the med/surg floor. That baby/fetus was their child no matter the gestation and they deserve to be on the mother baby unit unless of course they themselves would decide that's not where they want to be. With that said I believe the majority of aborts recover and go home from same day surgery. I've had two miscarriages both of which I recovered from and went home. No overnight stay.

    I agree with you're hospital's policies 100%. W/ my 3 miscarriages it was directly to OR then the surgical unit. All overnights but I received transfusions so maybe that explains the overnight stay
    I was actually grateful for that at the time but I do see your point. However I personally would have felt pretty yucky about being around all the babies and new mommies.
  12. by   JHUBRAIN
    If you are going to keep getting these patients, why not see if some staff can float for a few shifts in OB to get skilled at fundal checks, etc? If you have a few dedicated nurses willing to be the ones to look after these women on med-surg, then it shouldn't be too hard to train them.[/QUOTE]


    Great Idea - Thanks to all of you for your great responses - This is why I come here - Thank you all - JHUBRAIN
  13. by   fergus51
    I hope it works out. We did a similar thing for PICC line insertions. We trained a certain number of nurses, some who were on day shift, some who were on night shift, so that practically every shift would have one nurse who could do it. If you do the same for OB, it could work.
  14. by   SmilingBluEyes
    [QUOTE=DutchgirlRN]Pregnant women regardless of the gestation go to the OB floor. Whether they are still pregnant, threatening to abort or have aborted/miscarried. I cannot imagine putting a patient experiencing a miscarriage on the med/surg floor. That baby/fetus was their child no matter the gestation and they deserve to be on the mother baby unit unless of course they themselves would decide that's not where they want to be. With that said I believe the majority of aborts recover and go home from same day surgery. I've had two miscarriages both of which I recovered from and went home.

    Ummmmm, You guys are all forgetting something. The psychological aspect of pregnancy loss. We are not just surgical cases (those of us who have undergone a loss).

    I have been on both med-surg and OB units after my losses. (I have had 5 losses total). At least on OB they realized I had HAD a loss and was more than a surgical case. On med-surg no one thought to see how I was doing beyond vital signs. I am sorry, but no one can care for people who have had a pregnancy loss better than OB nurses. It's what we DO. Just cause a pregnancy is not over 20 weeks, does NOT mean it was not a heartbreaking loss for the couple going through it all. Sometimes, just saying you are 'sorry" is all we need, sometimes we need more......

    Med-surg nurses don't often recognize or have time to deal with the psych aspect of our losses. It's just a fact of life on m/s floors.

    Oh, and we do admit ectopics, miscarriages, etc, on OUR floor (ob) where I work. I believe this is as it should be.
    Last edit by SmilingBluEyes on Feb 14, '05

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