How do you explain decel situation to pts?

at your cervix · Nov 24, 2006

I think more important that what you say is how you say it. I am always completely honest with my patients, I remain very calm and say something to the effect of "It looks like the baby may not be getting quite as much oxygen as he/she needs right now so I am going to have you roll to your left/right side and put some oxygen on you and that should fix the problem." I will often then explain exactly why the position change, bolus or other interventions so that they will understand that it is important and not roll onto their back again as soon as you leave the room. If the interventions are not effective, I maintain the same calmness and continue to explain interventions to the mom. If interventions are not successful and FHR pattern is worsening, I will tell the patient, "if this doesn't work, we may need to do this....."

Patients will usually remain calm as long as you do.

KellNY, RN · Nov 25, 2006

I agree. If I'm not concerned (ie one variable after 5 hours of labor and a reactive strip), I'll explain to them that sometimes the way they are laying or the way the baby is laying could be pressing on the cord a little and to remedy that we're going to flip her over. Or I might say something like "Well, just like the baby's heart has these jumps, it sometimes has a dip. We're just going to have you lay on your left side for a bit because baby's tend to like that position better."

If O2 is needed, I'll explain that by saturating her blood, we increase the oxygen flow to the baby. I might say "The baby's heart is going a little slower at times than we'd like. Most likely there's no problem, but we just want to make sure that all our bases are covered--that way if there is a problem, we've addressed it as early as possible"

I will always tell my patients who show any nervousness, anxiety, etc (some just say 'okay', roll over and fall back asleep) "I'm not worried right now, the doctor's not worried right now. If it gets to the point where it's time to worry, I will let you know" and I hold true to that. I never pish posh a situation where I'm worried about mom's health or baby's health.

Good luck.

CoffeeRTC, BSN, RN · Nov 25, 2006

Yep....it is how you say it.

I was going down the tubes (fast) and nearly circling the drain with my first baby (ended up with a really quick and sucessfull c section) My nurses were cool as a cuccumber and I had a feeling how bad things were, DH was clueless. In the end..all was good and I remember asking the nurses..(how bad was it..I was really circling huh? They told me Yep...we were calling your mom for you...(As I was seeing the "lighted tunnel" I was calling for my mom..lol) Best nurses EVAH!

Learned alot from them! A lot of times..it is not what you say, but how you say it. PTs will always look at how the docs and nurses present the info and pick up on it...fast.

Trauma Columnist · Nov 25, 2006

I had occasion to be in the delivery room recently when the infant's heartrate was 60 bpm. One nurse left to call the doctor, the other nurse stayed in the room, placed oxygen and put her on her left side. The other grandmother isn't a nurse and thought this was normal. The two nurses were very good, calm and efficent. My grandson is doing very well - he's beautiful!

I did not tell anyone I was an advanced practice nurse, but the doctor knew that she had seen me in the hospital during rounds but didn't know who I was.

BTW - my expertise is NOT OB so I kept my mouth shut.

SmilingBluEyes · Nov 25, 2006

I handle it the same way as the others. I am the picture of calm even in a crisis situation whereby a stat section is inevitible. I save the falling apart and freaking out for after the crisis, and away from the family. Truth be told, I have seen some of the ugliest strips you can imagine with what you define as 'bad" outcomes only in 2 cases I can personally recall. STAY CALM and STAY WITH YOUR PATIENT....keep talking to them, this is not the time to clam up, no matter how you feel. If you can't think of what to say, just say why you are intervening as you are....and make light of it if possible. One of my favorite lines is, "dang kids are addicted to oxygen-----so better give him what he wants" as I place tight mask on mom.

I always do my best to keep it light. The calmer the patient, the better for her baby. You don't need lots of catecholamines and other stress chemicals streaking around her body at a time when her fetus is already somewhat compromised. It comes with experience and time....trust me.

SmilingBluEyes · Nov 25, 2006

Congrats on your grandbaby, Trauma. I would love to have you around when I am working----you sound like you did well, despite knowing there was trouble.

Trauma Columnist · Nov 25, 2006

Thanks...I really am not versed in OB except for the few emergent deliveries we've had in the ER. However, I am a pretty calm person in any situation. I did know there was a problem but kinda just downplayed it.

Telling the staff that I was an RN wouldn't have been cool nor was it necessary. The doctor knew that she knew me from somewhere but didn't know where and fortunately didn't ask. I had just run into her in the doctors loung a few days before. I didn't know that she was the doctor involved in this delivery until she came in.

mugwump · Nov 26, 2006

Quite frankly I do what I need to do and explain as I go. I am polite but firm. I think the patients while I remain calm can sense that there is a diffrence between pick a side to turn to ( in general conversation) and I need you to roll to your side now. I say it matter of fact baby is n ot "happy" right now heart rate is a bit down, nothing to worry about but I want a perfect baby. I also explain that decels are like treading water and then being held under water for a period of time. A decel in and of itself is not a big deal. What is, is if they happen frequently and for a long period of time. I explain if your hold your breath for a minute under water you'll be tired, sputter water for a while but you'll be find. Now if someone is constantly holding you under water only giving you a minute or two to catch your breath (repetative decles) then you will eventually tire out and not be able to recover. I want to give baby a break. thats why I (intrauterine resecitation)

KellNY, RN · Nov 26, 2006

I also explain that decels are like treading water and then being held under water for a period of time.

I'm not trying to rude or anything, but i think that this would scare me quite a bit. I'd get the image of someone sputtering, choking, exhausted and gasping for breath in a panic and not being able to get it--on the verge of dying or losing consciousness.

Wow-again, not trying to bash, but very scary image.

SmilingBluEyes · Nov 26, 2006

I do the head-dunking imagery. Imagine you are playing in a pool and you are jumping up and down, in the water and out. When you start, you do fine----you have plenty of O2 reserves to handle it; you are having a great time! After a while, doing this over and over, you start to get tired and it becomes harder to keep up the pace. Soon, you want to quit being dunked altogether, and your breaths become more labored and faster. You naturally slow down!!!

The same goes for your baby; his/her heart rate is slowing down cause they are drawing down on oxygen reserves. Our job is to relax the uterus, and give you extra oxygen (e.g. stop the "dunking" )----so he/she can take a breathe and recuperate. And most of the time this alone is all it takes for your baby to get back on track. His heart rate is simply his way of talking to us from the womb, telling us BEFORE things get too bad. He is simply telling us what he needs! IF we listen, we will do ok.

That is the imagery I give them when explaining decels, particularly in labor. I have yet to have a patient freak out or become scared---rather, they seem to understand and are more than happy to cooperate with the interventions we have to do.

mugwump · Nov 26, 2006

Decels can be scarry, however I never t hought my explaination was scarry. I apreciate the feedback though. Sometimes (all of us) explain something or say something that seems so simple and appropriate at the time but to someone else it could put them over the edge. I never thought of that. It just proves that callaboration and running ideas by others is an great idea.