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?
As a moderator, I really want to thank all involved posters for keeping the discussion professional even when there is disagreement. This is the kind of controversial thread I dream of keeping an eye on. (Personally I find the topic an interesting one, too, but that's beside the point.) Just wanted to voice my appreciation!
I don't particularly advocate homebirths, mainly because I don't know enough about them. So I am not completely against them either. I'm not quite sure if something dangerous happens to the mother in the late stages of labor, or if something dangerous happens to the baby if there is time to transport to the hospital.
The biggest problem I have with all this "evidenced-based" buzz word stuff is that there have ALWAYS been studies done etc. Citing studies etc as been done forever. Problem is, many studies are flawed.
You don't know, many times, which are or arent until years have elapsed unless you can personally study the methodology. How many people can do that? So you end up relying on people who have been considered tops in the field.
Which is what we have always done. This "evidenced-based" is nothing new. Just a new buzzword everyone is jumping on. Rather like "due diligence" and "six sigma" etc ad infinitum. We used to stick Swans in everybody and his brother because they were going to revolutionize outcomes. Now we don't--we put them in some people but not like we used to.
When we got all the fetal monitors, we stuck women in bed because their it was thought safe outcomes would be increased. Now we are going away from that again.
There are fads in healthcare as in fashion. We try new things. If it doesn't work we do something else. How do we know what works or not. Studies and follow-up. Evidenced based is no new "revelation".
I am always for trying to improve safety and efficacy.
Specializes in Nurse Leader specializing in Labor & Delivery.
So what's the alternative? Ignore most recent research adn just do whatever the heck you want, even if it's shown that that's not the best or safest way?
I guess I just don't see where you're coming from. If we don't have evidence-based practice, we're nothing but witch doctors.
When we got all the fetal monitors, we stuck women in bed because their it was thought safe outcomes would be increased. Now we are going away from that again.
Not to split hairs, but the introduction of fetal monitors was not evidence-based. There was no evidence in support of their use, they were simply marketed and sold. They were originally intended for high risk women and somehow evolved to near universal use. Now the evidence has shown that they actually worsen outcomes, but we are stuck with them. They aren't even FDA approved having been grandfathered in.
This is the case for many ob practices including routine episiotomy, prophylactic forceps, c/s for breech, etc. Only when we stop starting things that aren't evidence based will be break this cycle.
The danger is that something might not improve outcomes, and it might even make outcomes worse, but it might make our lives (health care providers, that is) more convenient, so it sticks around. Continuous EFM falls into that category; it doesn't improve M&M for either babies or moms but it allows us to keep an eye on baby from a desk. That's not always a bad thing, but it opens the door for the old saw of watching the machine and not the patient, and moves us away from laboring patients to laboring the monitor. "Sorry sweetie, I know you're comfortable in that position, but the monitor's not picking up the baby like that...you're going to have to move."
I'm not saying we ought to stop trying to improve practice, just that it's a double-edged sword and sometimes politics are involved too...
Specializes in Labor and Delivery, Newborn, Antepartum.
At my hospital, 5 of the 6 delivering doctors stick with NPO with ice chips. The one exception has just recently started allowing clears. For her patients, we will offer them jello, broth, tea, etc. But surprisingly, as most of you have said, not many people are interested in food when they are laboring. Because of this and the other 5 NPO docs, we run a mainline of D5LR.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
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. :-)
I thought you asked me if I encourage people to ignore the NPO orders...I thought I answered that.
Personally, I am recuperating from my second significant abdominal surgery in 4 weeks and am not very vested in any of the threads just now.
The biggest problem I have with all this "evidenced-based" buzz word stuff is that there have ALWAYS been studies done etc. Citing studies etc as been done forever. Problem is, many studies are flawed.
You don't know, many times, which are or arent until years have elapsed unless you can personally study the methodology. How many people can do that? So you end up relying on people who have been considered tops in the field.
Which is what we have always done. This "evidenced-based" is nothing new. Just a new buzzword everyone is jumping on. Rather like "due diligence" and "six sigma" etc ad infinitum. We used to stick Swans in everybody and his brother because they were going to revolutionize outcomes. Now we don't--we put them in some people but not like we used to.
When we got all the fetal monitors, we stuck women in bed because their it was thought safe outcomes would be increased. Now we are going away from that again.
There are fads in healthcare as in fashion. We try new things. If it doesn't work we do something else. How do we know what works or not. Studies and follow-up. Evidenced based is no new "revelation".
I am always for trying to improve safety and efficacy.
Here is a good article on EBP. EBP has been around since the early 1990's so I wouldn't personally call it a fad at this point. Nurses and especially nurse anesthetists have been slow about implementing EBP though (case in point not using phenylephrine in pregnant patients because it might harm the fetus which we now know is false or the dogma that still surounds the use of ketamine).
Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
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As a moderator, I really want to thank all involved posters for keeping the discussion professional even when there is disagreement. This is the kind of controversial thread I dream of keeping an eye on. (Personally I find the topic an interesting one, too, but that's beside the point.) Just wanted to voice my appreciation!
Thank you!!!