labor room nursing interventions

[jbshoaf]

Working on a research project with deadline. Trying to find a reference I can cite that addresses the need to remove a foley urine cath when active pushing begins. L/D is not me area (alway worked Cardiology). Obviously, we all know the balloon must be deflated and cath removed to avoid injury to bladder and/or urethra, but I need a source to quote. Would greatly appreciate any comments

[imenid37]

Our post-op pt's w/ PCEA did walk to the bathroom after Foley came out and in the halls, etc. w/ assistance. It was Analgesia NOT Anesthesia. It was good because it was regional and so there was not so much drowsiness. In other words, good pain relief w/o the sedation. I liked it and it is one of the few things I miss about my old job. I don't always think they needed it for 48 hours, but that what it was ordered for. Often, it fell out because the pt's moved around so well. They usually had a basal rate and then dosed themselves prn w/ Fentanyl. There was no local anesthetic in most cases, so they ambulated well. Lots of itching seemed to be a drawback in a fair number of pt's.

[CoffeeRTC, BSN, RN]

Just had my baby.. had the epidural and was st cathed 2 times and up to bathroom about 2 hrs after delivery. No problems. With the C section I had the foley and PCA for 24 hrs.

[mitchsmom]

I was foleyed for my first two epidural deliveries at two different hospitals in different states, I'm thinking it was taken out during pushing. I was up within 2 or 3 hours (I am the pee queen anyway... for a minute I actually wondered if I had diabetes insipidus when I learned about it in Patho!). 1st place I think the epidural was heavier than the second, and I had no PCA. 2nd place I had PCA during epidural. 3rd time was unmedicated and I was up urinating and showering in like 30-45 mins. tops.

A good friend of mine had the same routine at the first hospital, but she was not able to pee by herself for like 3 days so she had to stay and be cath'd several times (they would take it out for her to try, she'd fail to do it, and they'd start all over) until that straightened itself out.

Also just attended a friend's epidural delivery with Foley two weeks ago at yet another hospital. They didn't take it out when she started pushing (but then again I think the nurse already had a feeling she was going to be a c/s, which she was). She also had the PCA with her epidural during labor.

In all of these particular cases, none of us was able to walk with the epidurals, maybe just move legs a little.

Like yall said, different practices in different places. I don't see the value in repeatedly straight cathing though (what do I know, I'm still a student... but just more chance for infection, more work, and I would think more soreness for mom later).

[tntrn, ASN, RN]

In our unit, continuous epidurals are the norm for most of our labor patients. None can get out of bed, although we've had a couple of them try

If the labor goes long, a foley goes in. Most come out during the second stage unless it looks like the second stage will progress to the Bard-Parker option.

Most of the vag delivered moms are able to get up to the bathroom, with help within 2 hours of delivery. And from there right into the shower.l

Our c/s patients go home in 48 hours, so having them on IV or anything other than PO meds doesn't happen. We use Duramorph for most of the c/s, both with Spinal and epidural anesthesia. That holds most patients for 12 hours PO, then they go on PO meds.