No fundal checks for post-op C-sections?

[daisybaby, LPN]

I'm a fairly new RN, in my second job in LDR & PP. Last week, I went in to assess my pt who was a ppd 1 c-section with my preceptor observing. After I was finished, she said "Great job, except that we NEVER do fundal checks on C-sections." Huh?

No one can explain to me the rationale for not doing fundal checks after the patient leaves the OR- the only response was a guess that the docs don't want the opsite disturbed. I have done many postop fundal checks at my former job, and have never interrupted a suture/staple/clip line while doing so. I would think that a C-section pt would warrant fundal checks- wouldn't there be a risk of hemorrhage just as much, if not more, than a lady partslly delivered patient?

It makes me nervous to not to do a careful fundal check of a postop patient. I'd never live with myself if a patient ended up with a bellyfull of blood because I didn't do a proper assessment.

Am I crazy for thinking this way? Does anyone else have a policy of not doing fundal checks on their C-sections? Thanks in advance....

PS: I came from a women's hospital that performed 1000+ deliveries a year. Here, we get maybe 250. Could it be that we are we just behind the times?

[babyktchr, BSN, RN]

Oh my word....I cannot believe that. I would love to hear what the rationale behind that is. Fundal checks on anyone postpartum....thats the law maam.

[vanillabloom]

I'm not a nurse yet, but I've had two c-sections in the past four years and fundal checks ARE still being done and let me tell you they are uncomfortable :) . I think two nurses did it in the recovery room and then again upstairs when I was brought back to my room. I was losing a lot of blood.

I hope you find out your answer....I'm very curious as to why they wouldn't perform them. If I had another c-section and it was not done...I would ask them to do one.

~*Lucie

[NurseforPreggers]

I've never heard of this, doesn't make sense to me. If c-section patients don't need fundal checks we might as well not do them on anyone. The ONLY thing that I can possibly think of is that because of a foley cath being in place the fundus would not get displaced because of a full bladder. That doesn't address the bleeding issue though.

[fromTeacher2Nurse]

I just got home from my second day of L&D/PP rotation. I followed a section patient from the surgery to 7 hours after - her fundus was checked multiple times. The two nurses that did it just made sure they supported the incision very well while checking. She grimaced a lot (it hurt!!!) but it was done!

Hats off to you L&D/PP nurses - you are awesome!

[SmilingBluEyes]

fundal checks are always to be done on all postpartum patients. fundal massage is not always necessary, however. that need is determined by FUNDAL CHECKS!

[mtnmom]

What other crazy information is your preceptor feeding you?

I would check the policy and procedure manual for your unit.

[daisybaby, LPN]

I asked other RNs on the unit about fundal checks on c-sections, as well. Most of them have been there for many years and they all said it's policy not to do them, but no one can say why.

I will take a look at the P&P, as suggested (I feel silly for not having looked it up sooner!). I'm going to do some research on this as well- I don't want to rock the boat as the 'new girl', but if this is really the policy, it should be changed asap.

And I'm going to continue doing my fundal checks on everybody.

[RNnL&D]

What other crazy information is your preceptor feeding you?

I would check the policy and procedure manual for your unit.

I agree. Crazy info! Checking the P&P manual is a good idea. But what about a pathway? Do you follow clinical paths for vag and csection patients? It should be included there. Unless I was shown a specific policy stating not to do it, (and a rationale????), I would continue to assess fundal position.

What about charting? Do you follow a flowsheet format? Is there not a section for fundus and lochia?

[daisybaby, LPN]

On our documentation flowsheet, the RN's document character and amount of lochia, but cross through the space to chart consistency, position, and height of fundus if it's a c-section.

I'm beginning to feel I'm working on a unit that is a lawsuit waiting to happen...

[RNnL&D]

but cross through the space to chart consistency, position, and height of fundus.

What???? That is just nuts. Besides lochia, I would think fundal assessment is the most important assessment on a postpartum patient, regardless of mode of delivery.

[Jolie, BSN]

I'm beginning to feel I'm working on a unit that is a lawsuit waiting to happen...

I agree 100%! What do the AWHONN standards of practice call for? That is what the lawyers will be asking!