Laboring down

Specialties Ob/Gyn

Published

Just curious..i was just wondering what most of you experienced nurses do. If you have a pt. a primip for example with an epidural, who is complete 10/100/0-1 station, feeling pressure..do you have her push or labor down? Well i guess my question exactly is, if she feels the urge but isnt bringing the head down with each attempt, will u just let her labor down more, DESPITE her urge to push with her UCS? I just hate having the pt push tooo soon (for like 2.5 or 3 hrs) then get completely pooped out!! How do i prevent that even when there is an urge, but no descent? I was told pant-blow if possible...thanks guys!!:uhoh3:

Specializes in Mother/Baby;L/D.

Ive never had a pt turn out acynclitic..what does it feel like on the VE or did the MD catch that ?

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Specializes in many.
Ive never had a pt turn out acynclitic..what does it feel like on the VE or did the MD catch that ?

fontanels were way off to the right side and kind of at 12 and 3, if you can imagine that.

it was way crazy that day and the residents hadn't checked her in more than an hour when she started pushing. they were hoping she would be able to turn the baby on her own. by the time they checked her, an hour after she started pushing, it was impossible for them to try to "turn" her. but they let her push another hour and then decided to go for a c/s.

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Specializes in L&D, PP, NBN, PEDS.

I like to allow mom to labor down as long as she can tolerate it. If she is not having the urge to push let her body do the work instead of you.

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Specializes in L&D, GYN, Mother/Baby, Newborn Nursery.

We try to allow our patients to labor down as much as possible, it is usually the docs (9-5 obstetrics) that want to push at 10 CM, no matter the station. As a result, we have called our patients "lips", "rims" when there sometimes isn't one, just to keep the doc out of the way. As a reminder, AWHONN's guidelines ENCOURAGE laboring down, and DISCOURAGE 10 count valsalva pushing, as it lowers the fetal saturation, and as a result, some lower cord gas values!!! Have a great baby!!!

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Specializes in Community, OB, Nursery.
. As a result, we have called our patients "lips", "rims" when there sometimes isn't one, just to keep the doc out of the way.

Nice! :roll

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I do that too. Fudging dilatation is something I have done many times.

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I am green at this and have mostly pts with epidurals, so this is really not an issue with them, but what about the ladies going all natural? can you labor them down?

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Specializes in Community, OB, Nursery.

Absolutely!!! If they are complete but not feeling an urge to push, and baby is looking/sounding ok, no reason to hurry delivery!!! Women's bodies know what to do.

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Specializes in L&D.

My favorite deliveries are the ones where I never encourage the patient to push. I just tell her to listen to her body and do whatever it tells her to do. When they start to push, it's often just little, short grunts. As the baby descends, the grunts become longer and stronger. All I have to do is just tell them they're doing a great job. Unfortunately, many American women aren't that in tune with their bodies and don't know how to listen to it. They've spent too much time watching "Baby Story" on TV and think they have to do it the way they do on TV.

I remember once I had a primip who moved to complete very rapidly. It must have been a quiet night, because all at once I had lots of people in the room "helping" me set up. The residents showed up and before I knew it, she was in stirrups and the docs were yelling at her to push and giving her pressure on the posterior lady partsl wall to give her the feeling of how to push. Just because a woman is 10cm dilated, does not mean she is ready to push. The doc's attempts to "help" her push just caused her unnecessary pain and she started screaming and thrashing around, so he tried harder to "help" her. I was trying to calm her and get people to go away and leave us until we were ready but there was so much flurry and fuss in the room nothing was working. So I wound up saying to the intern, "Get your hand out of there, you're hurting my patient!!" The next time I looked up he was gone and everyone else was looking at me with their mouths open. But I was by then able to suggest that we let her breath through a few more contractions and she'd be able to push soon. Which she was, it turned out to be a nice delivery with the Senior Resident. But I then had to go find the intern and appologize. I hate to appologize!! especially when I'm wrong. I really could have worded it better, but all the fuss in the room got to me too. I could have taught him about waiting for the patient to be ready, but he wasn't ready to listen to a lesson from me after I'd humiliated him in front of so many people. But the patient had a nice delivery and that was the most important thing. When you're being a patient advocate and standing up for your patient's welfare, I suggest you be a little more tactful than I was in this situation.

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Specializes in L&D, QI, Public Health.

Ok, so this is my question. If a woman has an epidural and can't feel much, at what point do you stop laboring down. Is it the station you look at? If so, at what station do you start pushing?

Also, do you cut your continous epi in half whnn the patient starts pushing?

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Specializes in LDRP.

Labor down til you see the ears.....

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Labor down as long as you can! And you CAN turn down or off an epidural-----well the MDA/CRNA can, anyhow-----nurses never do this obviously.... We did that yesterday and it helped a lot.

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