So, I am a new L&D RN, and just started working at my facility and love it. We have a great set of nurses and docs. I come from a homebirth background, so hospital birth (especially at a high-risk facility) is definitely much different than what I'm used to, but I really like working with this population of mamas.
I think we are really good at trying to implement evidence-based practice. The one thing that seems universally crazy to me is that we are restricting the diets of mamas in labor. I know that it is because of risk for aspiration in the event general anesthesia would be used, but really, how often would general anesthesia be used? The benefits seem to outweigh the risks. So far I have found this article on medscape, haven't researched journal articles yet:
Seems like every mama I work with, especially inductions, c/o how hungry she is and how she can't wait to eat. Seems crazy to me to withhold food or even juice from them.
What is your hospital's policy re: nutrition in labor?
Specializes in Nurse Leader specializing in Labor & Delivery.
Tewdles--just asking a question. Which you didn't answer, btw... :-).
When I had my kids, way back in the stone age, they started an iv and let us walk around. Now everyone is stuck in bed hooked to machines. Fear of lawsuits. IM not-so-humble,NOT "evidenced-based" opinion, labor and delivery is much easier if you are not stuck in bed.
I hate faddish new buzz words. :-)
Actually, it IS evidence based that labor is better when you're not stuck in bed.
I think it's important that medical and nursing practice be based on actual research and best practice, rather than "that's how I was taught 20 years ago." What would you prefer it be called, rather than "evidence based," if you hate that term?
If the pregnancy has been healthy I don't think I would be risking someone's health and their baby's to not go to the hospital with the first pain felt. I think doing some of the laboring at home can be good; I'm not saying you have to turn it into a home birth, LOL!
Plus, going to the hospital too early could actually stop labor. Once you get there you are hooked to IVs and monitors and at my hospital you are not allowed to walk around and you just about have to beg to be allowed out of bed to use the bathroom. Why not labor some at home so you can walk around and help your own labor?
How does coming to the hospital early possibly stop labor? That doesn't make sense. Every hospital is different on their policies. Most hospitals encourage walking around early in labor unless the patient has ROM.
Giving any patient advice without knowing their full health history is dangerous. You never know when a patient is going to be a true crash C-section (placenta acreta/cord prolapse etc. these things aren't found until labor all the time).
For low-risk women, homebirth is just as safe as hospital birth, and for most women, spending the majority of her time laboring at home is safer, from an intervention perspective, than going to the hospital while still in early labor or as soon as her water breaks.
I would like to see that study. There is no way that homebirth is going to safe as hospital births. There are too many unknown variables that often aren't found until labor/delivery. I have personally had two low risk OB patients so far that have had to have emergency hysterectomies due to placenta acretas that were unknown until their delivery. Both of those patients would have died at home.
I would like to see that study. There is no way that homebirth is going to safe as hospital births. There are too many unknown variables that often aren't found until labor/delivery. I have personally had two low risk OB patients so far that have had to have emergency hysterectomies due to placenta acretas that were unknown until their delivery. Both of those patients would have died at home.
and doing what you do, you are going to see a MUCH higher percentage of problems than is the norm.
as the old saying goes you can step off the curb and get hit by a bus.
I would like to see that study. There is no way that homebirth is going to safe as hospital births. There are too many unknown variables that often aren't found until labor/delivery. I have personally had two low risk OB patients so far that have had to have emergency hysterectomies due to placenta acretas that were unknown until their delivery. Both of those patients would have died at home.
Actually, there IS research to say that homebirth in a low risk woman is as safe as hospital birth. A homebirth attended by a trained midwife with the correct equipment is very low risk.
I find it concerning that labour and birth appears to no longer be what women were phsyically designed for and has now become an even to be medically managed.
Medicalisation of birth (including the restriction of oral intake) has it's time and place, but for most women it is completely unecessary.
I don't understand the practice of restricting oral intake "Just in case". I don't understand the practice of restricting movement if your membranes have ruptured. I just don't get it.
Here in NZ, we have a system of obstetric management whereby most women are attended by midwives throughout pregnancy and also labour and delivery. Doctors dont get involved until there is a real issue, not an imagined "might be" issue. And strangly, our mortality and morbidity stats in relation to labour and delivery for both mum and baby are no higher than in the U.S.
Funny - less medicalisation and still good outcomes ... perhaps labour and birth isn't as high risk as some would have us believe.
Specializes in Nurse Leader specializing in Labor & Delivery.
How does coming to the hospital early possibly stop labor? That doesn't make sense. Every hospital is different on their policies. Most hospitals encourage walking around early in labor unless the patient has ROM.
Most hospitals don't restrict ambulation after ROM, as long as FHTs are good. At least, most hospitals that are actually practicing 21st century medicine.
and doing what you do, you are going to see a MUCH higher percentage of problems than is the norm.
as the old saying goes you can step off the curb and get hit by a bus.
Actually, no it doesn't. The majority of interventions that I do on L&D have to do with neuraxial anesthesia (epidurals/spinals), and studies have shown that they are extremely safe. In at least one study it has been shown that the rate of nerve damage are statistically insignificant between laboring patients and laboring patients receiving epidurals. A patient is a lot more likely to have a complication from IVs, pitocin, or any of the other numerous things done in L&D versus neuraxial anesthesia.
Neuraxial anesthesia has been shown to control BP during labor thus helping to eliminate seizures in pre-eclamptic patients, allow laboring heart patients to have lady partsl deliveries that would have probably otherwise been severely detrimental or even life threatening. Not to mention that neuraxial anesthesia tends to be extremely safe for fetus whereas almost everything given IV has some effect on the fetus.
Most hospitals don't restrict ambulation after ROM, as long as FHTs are good. At least, most hospitals that are actually practicing 21st century medicine.
So far the ones I have worked at still do.....Not my decision.
klone, MSN, RN
14,857 Posts
Actually, it IS evidence based that labor is better when you're not stuck in bed.
I think it's important that medical and nursing practice be based on actual research and best practice, rather than "that's how I was taught 20 years ago." What would you prefer it be called, rather than "evidence based," if you hate that term?