Hello lovely nurses. I'm confused about something going on in my OB clinicals, and since I'm not a nurse yet, I wanted input from some L&D vets. I've done a LOT of reading over the years about childbirth bc I'm still on the fence about becoming a CNM, and there has always been a common thread: that the lithotomy position is the WORST, most UNNATURAL, DANGEROUS position for childbirth and is done only for the convenience of the practitioner. Actually that might be a direct quote from Our Bodies, Ourselves. Anyway, the hospital where I'm doing my clinicals does EVERY lady partsl birth in lithotomy, with stirrups, no options, no arguments. It also has a 40% C-section rate. I understand that I might be biased, coming from Berkeley CA, where my mom had both my brother and I on all fours in an Alternative Birth Center and went home within 8 hours. But still...lithotomy? Seriously?
How often do you all have to chart? The RN I was with said that while she doesn't agree with the whole immobile lithotomy thing, in a way it makes things easier because she'd have no way to chart q15min and walk with mom or help her out much.
We chart hourly up to 4 cm, and half an hourly after that. Then we chart the FHR q 5 mins when mom starts pushing. Chart Chart Chart. Feels like we chart when the mom farts(toilet humor). Charting flow sheet and progress notes will take up most of your time, and makes it hard to provide the care you might want to.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
How often do you all have to chart? The RN I was with said that while she doesn't agree with the whole immobile lithotomy thing, in a way it makes things easier because she'd have no way to chart q15min and walk with mom or help her out much.
I, as a rule, do not chart much, if at all, when a woman is pushing. She needs me with her, not hovering over paper. Now if it's an extended time, I do make appropriate notations on the FHM paper, and chart those things plus the vital signs after baby is born. Yea, it's very time-consuming ---but it's how I feel I can best care for the laboring mom.
And NO, IMO, charting alone, is no excuse for using lithotomy positioning in labor.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
do keep in mind, as pointed out above, epidural use makes a difference in the choices we have in positioning for labor. And epidurals can vary by practioner. Some are VERY dense----mom can do very little----others are lighter and mom can participate fully in pushing/delivery of her baby.
do keep in mind, as pointed out above, epidural use makes a difference in the choices we have in positioning for labor. And epidurals can vary by practioner. Some are VERY dense----mom can do very little----others are lighter and mom can participate fully in pushing/delivery of her baby.
I play an active part in monitoring the amount of epidural given. If mom feels numbness/leg weakness or inability to bend knees, it's protocol to check for overdose, so I bring that to the attention of the anesthesiologist. The goal is to feel the cx, but no pain. The latest cocktail of drugs in the epidural is meant to allow the sensation of a cx. I haven't had an anesthesiologist argue with me over this yet, but I'm kind of on guard because I am new, and as far as I know, no one else is monitoring overdose - they will only report if the pt still feels pain. But I keep a miniature copy of the printed protocol with my notes just in case I have to make my point.
I don't want to feel responsible when mom is so overdosed that she won't feel a truck run over her, and she ends up in the OR.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Our MDAs are actually excellent in their cocktail and titration of epidurals lately. Too bad however, it's not like this every place. I know that first hand. I have yet, however, had a mom ready and able to squat, no matter HOW good her epidural is.
Our MDAs are actually excellent in their cocktail and titration of epidurals lately. Too bad however, it's not like this every place. I know that first hand. I have yet, however, had a mom ready and able to squat, no matter HOW good her epidural is.
I keep hearing about this mystical creature called a "walking epidural." Anybody's hospital actually doing these? When I asked at my clinical site they basically laughed at me. Mom gets epidural, mom does NOT get out of bed, come hell or high water, until after that baby's out, unless they're wheeling her to the OR. They even have to CHART that mom didn't get out of bed q15m, with the FHR charting. Let's all sing the liability CYA song!
I also don't think I'll go for CNM in NY bc there was an incident at one of the hospitals with (and this is hearsay, so I won't name the hosp) OB docs signing off on things they hadn't done, that midwives weren't supposed to do (intervention-y stuff) and there was a bad outcome, big lawsuit, so midwives all over the city are being laid off. No one wants them here anymore.
Elizabells, what incident are you talking about? (you can PM me if you want). I'm in NY and I had all 5 of mine with a mw, 2 of them at home. I had my 3rd at Elizabeth Seton which closed down after St. Vincents refused to give backup care. I'm sorry that because of 1 bad outcome hospitals are denying women a very valuable choice for low-risk pregnancy and labor. My mw stuck with me through the ups and downs and I'm so grateful that she was willing to stick out her own neck and take risks so as to provide women with a choice for their own labors and births. In fact the night I went into labor with dd she was attending a meeting of mw's to work out a plan to convince hospitals and ob's to provide coverage to mw's. She got my beep in middle of her presentation!
Specializes in LTC, HOSPICE, HOME, PAIN MANAGEMENT, ETC.
I, as a rule, do not chart much, if at all, when a woman is pushing. She needs me with her, not hovering over paper. Now if it's an extended time, I do make appropriate notations on the FHM paper, and chart those things plus the vital signs after baby is born. Yea, it's very time-consuming ---but it's how I feel I can best care for the laboring mom.
And NO, IMO, charting alone, is no excuse for using lithotomy positioning in labor.
WOW! Talk about deja vu...what happened!?!? I fought these battles 25-30 years ago trying to institute "family centered birthing" in my hospital! I also taught Lamaze and was certified by the national organization...ASPO (???) I think that was it. American Society For Psychoprophylactics in Obstetrics. Yeah, something like that. It's rough getting old!!! :) :smackingf
We came such a long way that I can't believe it's swung back so far to epidurals & lithotomy!
I gave birth at the same hospital where I worked in L&D & NBN as well as mother/baby when that developed. Mostly L&D. I was a big proponent of breastfeeding as well & helped a lot of moms get started. Anyone remember the battles with NBN over giving nursing babies sugar water????
WOW! Anyway, I labored in every position imaginable and pushed sqatting, sitting on toilet(also good for laboring), all 4's and gave birth sort of semireclining. I was able to reach down and bring my baby up to me as soon as my ex husband cut the cord.
I was a great L&D nurse, and devoted to my pts, even staying over to help them deliver. But I totally focused on my moms (& babies), charting wherever I had to until I could focus on the paperwork.
We also got the husband/support person, "coach" involved in her care.
YEP, those were the days! As they say, "just my 2 cents"
I would just like to know, I saw someone wrote on another thread that there are "no risks" involved in using epidurals. (Can't find the thread right now, not an exact quote).
Now it might seem like trolling since I"m a professed homebirther, but I assure you that I seriously want to hear varying opinions on this. I've given birth 5 times and never used medical pain relief, simply because I believed that it was better for my body and my baby to give birth naturally. I've been very fortunate to have relatively easy, uncomplicated labors and births. I don't know to what extent it was just my dumb luck, and what I can attribute to attitude and preparation.
But from experienced L&D nurses here: Would you agree that epidurals are not risky and don't contribute at all to complications? I'm not asking you to refer me to studies, which I've read already, just what you've seen from your experience. Now, I'm not a very militant natural birther - I made the birth choices that were right for me and I don't push other women not to have medicated births or to give birth at home. But, I do often discuss birth choices with other mothers, and since I'm a homebirther I have a different perspective that they're interested in hearing. I don't want to go around misinforming people though, so if epidurals have basically the same risks and outcomes as unmedicated births, there's no point in encouraging someone to go for an unmedicated birth unless they're oriented that way already.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Epidurals OF COURSE, carry inherent risks and there are reams studies on paper out there regarding their link to many things from increased incidence of maternal fever to higher csection rates. There are also as many studies disproving these things. But anyone saying epidurals are without risk is either uninformed or not working on L/D or in anesthesia. I cannot imagine any professional saying this, who knows anything at all of epidural anesthesia and it's potential risks. Yes, it's relatively rare to have complications linked to epidural use, but they are out there.
:) :smackingf 
As they say, "just my 2 cents"
elizabells, BSN, RN
2,094 Posts
How often do you all have to chart? The RN I was with said that while she doesn't agree with the whole immobile lithotomy thing, in a way it makes things easier because she'd have no way to chart q15min and walk with mom or help her out much.