No Accels

Elvish, BSN, DNP, RN, NP · Mar 28, 2007

Fetal sleep cycles generally have a max of 90min so that's what our OBs will give a term baby if all else looks ok -- i.e., no big decels anywhere, mom feeling movement.

It really bugs me when docs want to crank up the Pit just because someone's not following the graph, or because they want to practice 9-5 obstetrics. That's JMO.

crysobrn · Mar 28, 2007

We have nurses that are the same way "push the pit" I'm not the best at that:) I mean if I have a questionable strip I don't rush to increase a stressor. Many times our dr's do want us to get to it and "get er done" but it's my license. If I don't like the strip I tell them and then they often will come look and then give a verbal to increase. I usually go with an hour before I would call them. Also if a mom is requesting Stadol I will get verbal before I give it if the variability is min, no accels, even if I don't have decels.

nurse79 · Mar 28, 2007

thanks..good to know!! I'm always curious to know how long to wait with min. variabiity no accels, on pit, and mom wants something for pain. Lots to think about... :uhoh21:

SmilingBluEyes · Mar 28, 2007

Arwen covered it well. I always review questionable strips---first with experienced colleagues and then w/the MD's before "cranking" any pit. Sometimes, they (the MDs) gripe, but better safe than sorry.

Elvish, BSN, DNP, RN, NP · Mar 29, 2007

I always review questionable strips---first with experienced colleagues and then w/the MD's before "cranking" any pit. Sometimes, they (the MDs) gripe, but better safe than sorry.

Bouncing things off people who have more experience than I do is something I do just about everytime I run a strip!!

Susgu · Mar 29, 2007

Bumping up the Pit every 20 minutes doesn't even allow for the mother's body to get adjusted to the current level!

"Pit to distress! Pit to distress!" That seems to be the mantra of many providers/nurses these days, and that's unfortunate!

SmilingBluEyes · Mar 30, 2007

Our policy for pitocin titration is to only take it up 1 or 2 milliunits every 30 minutes until moderate-firm contractions every 3-5 minutes. And if IUPC in place, I do compute Montevideo units to be sure I am on track.Also, never are we allowed to use more than 20 mu/min maximum. We definately do not pit to distress where I work.

Dayray, RN · Apr 3, 2007

knowing how to up pit is more of an art then a science. I wish we didnt have things like pit policies that try to place a template on something that is very individual.

You have to consider the whole picture, what is her cervix?, what position is the baby?, does she have an epidural?, how is she coping with the pain etc etc??

I don't belive in "pit to distress" if you are useing your pit apprpriatly you useualy wont have distress in a baby. decels are easily fixed with interventions if the pit is being used correctly.

95% of my patients have epidurals so the biggest factor for me is position. I have found this to be the biggest reason patients at my hospital have c/s.

I can't really give hard and fast rules except that you must consider position, pasinger and patient as well as power (pit only effects power). if a baby is in the wrong position, your patient isent copeing with the pain or the baby isent fitting power isent doign anything but banging a babies head into the pelvic bone.

as an example I had a multip the other day. when i go there she was 4/50 and 0. had been AROmed and had pit at 4/mu a min. By looking at the chart i could tell they had been sitting on her so they wouldent have to do a delivery before shift change becuse her pit had only been turned up 2 x in 3 hours. with a multip thats not goign to do it. i mean she is alreay dialating but not very quickly. on her 4th baby, you can assume the baby is goign to fit. she had an epidurqal so the pain wasent an issue, she was contracting q 3 so i was pretty sure her uterus would cooperate. So that leaves power and position. I checked her and she was direct OP.

becuse of that I knew that pit wasnt going to make as much differance as turning that baby. as a last ditch effeort you can try and blow the kid out with pit and hope it rotates but it wasnt time for last ditch efforts. so insted i turned her on her side an got her legs far apart with pillows, and stated rocking her hips.

this works really well to turn an OP baby. anyway the OB came in 2 hours later checked her and she was still 4 but the Ob said the baby was now OA. she was upset becuse I had'nt "pushed the pit". I was happy the baby had turned so now all the was left was power. I strated turning her pit up by 2 Q 20. i got her to 16 mu/min and then i saw earlies and the patient was feeling pressure. I checked her and she was 8 very thin and +2. I knew i was in touble. with a 4th baby that cervix should be like jelly, the pressure of a +2 head should push it right out of the way. I paged the Ob from the room tuerned off the pit and set up for delivery with a silastic, by the time the Ob got ther (5 min later) the patient was a lip and very pushy but then the baby took a dive to the 80's. multiple attempts where made to reduce the lip but it wouldent go. we ran to the Or at 6 min down in the 80's. by the time we got there the tones were back in the 120's but with nasty variables.

we sectioned her and delivered a healthy 6lbs direct OP baby girl.

so why did a g4/p3 have a stat section? pit was'nt to blame nor was it fetal intolerance to labor. it was becuase we failed to assess the position and act accordingly. I had turned up the pit (beliving i had an OA baby) and had shoved the head down into the pelvis in a position that it couldent turn out of and couldent fit threw.

when useig pit remember to assess everything, the strip, the position all of it. remember more pit doesnt = faster delivery. you have to consider the whole picture.

allnurses Guide · Apr 3, 2007

I'm cautious with pit too .. .in fact one of our docs gets mad about it saying if you go too slow you make a uterus unresponsive to the pit.

Our docs write different orders than the protocol all the time.

steph

SmilingBluEyes · Apr 3, 2007

I agree pitocin management (as labor management) is a fine art as well as a science. Knowing the mother, watching the fetus and maternal responses to what we do---- and knowing position of fetus all are critical. Also interventions such as position changes are so important. Nothing is much worse than leaving a laboring mommy on her back or in one position for hours at a time. I am a big believer in pushing in more than in lithotomy position, as well. I have no problem assisting moms to side-lying or squatting, standing, sitting on toilet, whatever it takes to help facilitate comfort and efficient labor for mom and baby.

I have had many coworkers and techs tell me they "believe in me" when doctors start talking c-section and I ask them "give me just a little time" and we manage often. I have had techs say " Oh Debbie is there, if there is a chance to do this lady partslly, she will find it, so I am not going back to OR just yet". If this sounds like a brag, I am sorry, I don't mean it to be. Honestly all I do is work hard to keep positive energy in my labor situations, wherever possible---- and I try to communicate that to my patients/families, too. Nothing is much more powerful than a woman who believes in her body and herself in the birth situation, as well as her care providers to help her see thing through and trust us. I also work very hard to move the mommy as much as possible to allow the baby to move into favorable position and dilate her cervix, proceeding to successful lady partsl delivery. Do I have total control? Obviously not, I would be a fool to think that. I just try to stay in touch with my artsy, intuitive side in what I do----and the faith I feel that we can do it, wherever this is hope! I have also had more than one doctor express her surprise we had a lady partsl delivery in many cases......

But then, I completely believe, nursing is as much an art as a science. We seem to have lost our "artsy" side in so many cases, due to high use of epidurals, etc. I hope I never forget that side of myself and if I do, time for me to move on.

Elvish, BSN, DNP, RN, NP · Apr 3, 2007

I agree pitocin management (as labor management) is a art as well as science. Knowing the mother, watching the fetus and knowing position of fetus is critical. Also interventions such as position changes are so important. Nothing is much worse than leaving a laboring mommy on her back or in one position for hours at a time. I am a big believer in pushing in more than in lithotomy position, as well. I have no problem assisting moms to side-lying or squatting, standing, sitting on toilet, whatever it takes to help facilitate comfort and efficient labor for mom and baby. I have had many coworkers and techs tell me they "believe in me" when doctors start talking c-section and I ask them "give me time to turn things around" and we manage often. I have had them say " Oh Debbie is there, if there is a chance to lady partslly, she will find it". If this sounds like a brag, I am sorry, I don't mean it to be. Honestly all I do is work hard to keep positive energy in my labor situations, wherever possible---- and I try to communicate that to my patients/families, too. Nothing is much more powerful than a woman who believes in her body and herself in the birth situation. I also work very hard to move the mommy as much as possible to allow the baby to move into favorable position and dilate her cervix, proceeding to successful lady partsl delivery. Do I have total control? Obviously not, I would be a fool to think that. I just try to stay in touch with my artsy side in what I do----and the faith I feel that we can do it!
But then, I completely believe, nursing is as much an art as a science. We seem to have lost our "artsy" side in so many cases, due to high use of epidurals, etc. I hope I never forget that side of myself and if I do, time for me to move on.

Deb, your check is in the mail for saying exactly what I want to say most of the time!

There is an l/d nurse where I work that employs your philosophy on laboring women and it's amazing the success she has, where some of her lower-touch/higher-tech counterparts end up with lots more FTP sections. The docs always call for her if mom isn't progressing, or if there's a bad shoulder dystocia, or if baby is OP.

And as my dad says, if it's the truth, you ain't braggin'.