L&D Assistance, please!

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So our instructor chose a new textbook. It seems very nice, until you have to look for the answer to a problem. It doesn't give any. It tells you to assess for things, but doesn't give you the intervention. It's already driving me crazy. Sooo....here is the problem. I need to catheterize a patient during labor. How do you do that? Do you do it in between contractions or at the peak of a contraction? The first makes more sense to me, but I can't find it in the book. Anyone have the answer, please?

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Think about what's going on during a labor contraction. The downward pressure is tremendous as the woman labors down and everything in the pelvis is compressed. This would not be a good time to insert a catheter since there could be damage done to the urethra or bladder as it is compressed. Not to mention the fact that no laboring woman in her right mind is going to let you close to her with a catheter while in the midst of a contraction!

I would definitely cath her between contractions, quickly, and only if absolutely necessary. Are we cathing her because she's going to surgery or are we cathing her for nursing convenience? Nursing convenience should never be a reason to put a patient at risk for infection.

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Sometimes you won't find the answer in the book. Instructors will tell you that nursing is all about "critical thinking" which is what the above poster did for you.

BTW, there is a justifiable reason to cath a woman in labor....

(1) the bladder is distended and holding back the fetus (use a straight cath to drain bladder....)

(2) the determination has been made to do a C/S so you need to cath the pt.

#1 was done to me with my second (and NO, I did not feel it) but you have to be prepared (unlike my nurse at the time)....

(here is some more critical thinking...)

*IF* the bladder is indeed the cause (holding the fetus back)....and you drain the bladder...what do you THINK is going to happen? DUH! The baby immediately crowned! The nurse freaked and ran for the doctor (who left to take a coffee break!)....in the mean time, baby's head is out, on a regular bed, baby's face is in a puddle of amniotic fluid.....so yep...baby inhales the amniotic fluid. As a result, baby spent 9 days in NICU and was NPO for the first 7 days because he was breathing 130 bpm. NOT TO MENTION that when he inhaled the amniotic fluid, he jerked his head up and tore me up. Ok ladies...what is north of your va-jayjay (as my instructor calls it! LOL!)....???? Tore that sensitive piece of female flesh into 3 pieces...NO PAIN KILLER either! Now think about how many nurses it takes to hold a pt still why MD put a NEEDLE there to numb it out to give stitches?!?!?!? :eek:

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FLmomof5....Bless your HEART! I hope all is well with your child. My third child "popped out" while I was still on a regular bed but that was fine because all of my kids were "sunnyside up" so no breathing probs.

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Well...it wasn't my best delivery! :lol2:

He is fine. He is currently 21 yo and a student in college! :yeah:

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