No fundal checks for post-op C-sections?

[daisybaby]

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?

[daisybaby, LPN]

Always did them on c-sections, and none ever complained about it.

Could they be working on the idea that decreased lochia = decreased need to check?

Something along those lines- it was mentioned that because all C/S patients get pit in the OR and in PACU (usually 20 units and then 10 in the next bag, I understand), the thinking is that the uterus should be firm enough.

But even I know that you can pit a mom to the hilt and still end up with a life-threatening hemorrhage.

So I'm in a catch-22: if I'm the only nurse documenting fundal checks, then it's documented that I'm performing something contrary to our protocol. But if I do checks anyway but don't document them, from a legal standpoint I haven't done them at all.

[LadyStorm]

Something along those lines- it was mentioned that because all C/S patients get pit in the OR and in PACU (usually 20 units and then 10 in the next bag, I understand), the thinking is that the uterus should be firm enough.

But even I know that you can pit a mom to the hilt and still end up with a life-threatening hemorrhage.

So I'm in a catch-22: if I'm the only nurse documenting fundal checks, then it's documented that I'm performing something contrary to our protocol. But if I do checks anyway but don't document them, from a legal standpoint I haven't done them at all.

Have you thought about asking one of the doctors for his thoughts? You could say, I have heard in the past some nurses (not implicating your co-workers of course) say that you don't need to check funduses on a post op patient, and I have also heard that you should. What are your thoughts and what is the rationale? Don't know how comfortable you feel doing this. I have always worked in smaller hospitals and got along very well with the docs.

[HisHands, ASN, RN]

I'm currently a US student on the Canadian/US border. In the US we are told to do fundal checks, but in Canada it's contraindicated. I found this out by suggesting to the RN I was under that we do a fundal check on my C-section patient this past weekend. She looked at me like I was crazy and told me they didn't do those at that hospital. Apparently it's per hospital protocol. Anyway, I asked her how they determine placement of the fundus and whether or not there is hemorrhage? She told me that if other signs get really bad (abdomenal distention, board-line abdomen, blood oozing from incision) that they will do fundal checks if absolutely necessary. I was floored... they wait for their mothers to get "really bad" before they properly assess?!?!?! Amazing.

[Fiona59]

Please tell the RN wasn't at Surrey Memorial. They've had some bad post-op infections there. BC tends to have all RNs on maternity units.

I work as an LPN in Alberta in maternity. We check everybodies, whether they want it or not. And I've never heard of anybody in my area developing the infections that they do in BC.