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.
Keep it EBP....where is the study. You posted some other really good studies. Where is this one?
I'm not the one who made the statement. I was just being TIC. I don't know of any research indicating that goign to the hospital early slows the labor process, although it wouldn't surprise me, as I've seen enough of it, anecdotally.
when I was taking my Bradley classes in preparation of childbirth, my instructor said something that really sat with me. Most animals (mammals) seek our dark, safe places to give birth. Away from lights, predators etc. That labor progresses more easily when in such an environment. That there are actual animal studies that have shown that labor temporarily arrests when the mother is in/suspects danger, and then resumes when she gets to her safe spot or nest.
Well, as logic would follow, the same applies with us humans. The more relaxed we are, the less stimulation, the more safe we feel, and the easier labor will progress. However, hospitals are high stimulation places. Our culture/society expects otherwise healthy women to come into the hospital give birth. Stick her with needles and hook up wires and strap her into bed. Yet, hospitals are by and large a place where people go when they are sick and/or dying. That alone can make them a scary place for many and send their anxiety level through the roof. And you betcha that that type of anxiety definitely can stall/slow labor.
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.
you are speaking of high risk patients here, who without a doubt should be in the hospital and under obstetrical care. However, these were not the types of patients being referred to earlier. Apples to oranges my friend.
CNMs with proper equipment, referral network, and appropriate transportation system in case of emergencies isn't what I would consider the typical homebirth. I am all for that kind of system, and it sure would save me a lot of work if more patients did this.
Not all states require CNMs some still (maybe all) allow lay midwives or midwives with extremely limited formal training. I can't believe that these lay midwives have near the safety record as CNMs.
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.
Not my point at all, i meant that doing anesthesia...you would run across a higher percentage of problem patients not that anesthesia was causing them.
WTBCRNA - do you combined spinal/epidurals, or just epidurals?
I do both, but lately mostly just epidurals. The CSEs have been shown to have slightly higher success rate over just doing epidurals. I personally haven't seen that much difference.
CNMs with proper equipment, referral network, and appropriate transportation system in case of emergencies isn't what I would consider the typical homebirth. I am all for that kind of system, and it sure would save me a lot of work if more patients did this.
Not all states require CNMs some still (maybe all) allow lay midwives or midwives with extremely limited formal training. I can't believe that these lay midwives have near the safety record as CNMs.
This is one big assumption. Yes, many states severely restrict midwifery practice, but that doesn't necessarily = a lack of appropriate training.
A CPM attended my birth, though at her free standing birth center. She however attends home births as well.
She is NRP trained and is also an emergency responder when she isnt attending patients/births and her EMS company right around the corner from the birth center. She also as backup physicians that work with her at a local hospital that she is free to transport at any time. Her statistics are public and her transfer rate 5% and her c-section rate (after a transfer obviously) is only 3%. Most transfers are due to maternal exhaustion than emergent conditions. Most labor related emergencies give many warning signs prior and if any of those should arise, she absolutely transfers her cases out.
Its not like CPMs and lay midwives don't monitor labor-its just that they might not use machines to do so. Dopptone and stethoscope are enough to listen to fetal tones. A manual bp cuff, stethoscope and a watch are all that are needed to listen to and monitor mom's vitals.
Specializes in Nurse Leader specializing in Labor & Delivery.
CNMs with proper equipment, referral network, and appropriate transportation system in case of emergencies isn't what I would consider the typical homebirth. I am all for that kind of system, and it sure would save me a lot of work if more patients did this.
Not all states require CNMs some still (maybe all) allow lay midwives or midwives with extremely limited formal training. I can't believe that these lay midwives have near the safety record as CNMs.
the first study was specifically about CPMs, not CNMs.
Besides, that's not what you said. You said you didn't believe homebirths could possibly be as safe as hospital births. You didn't specify the type of birth attendant.
My original statement was assuming that the birth was attended by a skilled, qualified birth attendant. I apologize if I was unclear or ambiguous on that point in my statement.
Not my point at all, i meant that doing anesthesia...you would run across a higher percentage of problem patients not that anesthesia was causing them.
Currently where I work we deal with exclusively lower risk patients, but still there are a lot that probably wouldn't be suitable for homebirths even under the best circumstances. I did my training at a high risk L&D military hospital that was the referral center for all of DC and surrounding areas so my perspective maybe a little skewed.
the first study was specifically about CPMs, not CNMs.
Besides, that's not what you said. You said you didn't believe homebirths could possibly be as safe as hospital births. You didn't specify the type of birth attendant.
My original statement was assuming that the birth was attended by a skilled, qualified birth attendant. I apologize if I was unclear or ambiguous on that point in my statement.
Not really your fault you were assuming one thing and I was assuming another.
I did like the articles. When I will get time to read them fully is another question, since I just started back to school again today.... Maybe this will be my last degree, if not my wife might shoot me!
and this is an article relevant to the subsequent discussion prompted by your post. Its a historical perspective of the emergence of a medicalised/technological birth
Maybe this will be my last degree, if not my wife might shoot me!
klone, MSN, RN
14,857 Posts
I'm not the one who made the statement. I was just being TIC. I don't know of any research indicating that goign to the hospital early slows the labor process, although it wouldn't surprise me, as I've seen enough of it, anecdotally.