Nurse perform amniotomies

[LizzyL&DRN]

How many of your hospitals have a policy allowing nurses to perform amniotomies. Our hospital is going to be instituting one soon. I haven't seen it yet, but I believe the criteria for breaking the bag will be vertex presentation(obiviously :)), 4cm and 0 station or something similar to that. We also do all our own FSE and IUPCs which I have noticed some traveling nurses find suprising. Are these nurse performed procedures not commonly done at other hospitals.

[profjanmc]

Most physicians don;t have patients sign an informed consent for amniotomies, they discuss it and then perform it. How about everybody else? Do your docs/CNM's have them sign an informed consent?

[canoehead, BSN, RN]

No consents here.

[RNKitty]

Even though our hospital allows nurses to place FECG and IUPC as well as place an FECG with BOW intact (essentially and amniotomy for fetal distress), I refuse to perform the IUPC placement and amniotomy [WA state]. My reasoning: if the complications require a surgeon to correct, then the surgeon should be performing the intervention so they are immediately available. Besides, we have residents in house who can have their butts on the line for this.

[Dawn27]

an amniotomy is a form of labor augmentation, and your patient has the right to informed consent after being told both potential benefits and risks. findings reported in the cochrane library show that this procedure, though simple to do can speed up labor, decrease the use of oxytocin. and reduce abnormal 5-minute apgar scores. but, at the same time, it removes the baby's "water cushion," opens the mother to infection if she doesn't deliver in a reasonable amount of time, and several studies have noted a marked increase in the risk to mothers of cesarean sections. cochrane reviewers have stated: "an association between early amniotomy and cesarean delivery for fetal distress is noted in one large trial. this suggests that amniotomy should be reserved [only] for women with abnormal labour progress." again, your patient will need to be informed what you are planning to do and the potential implications -- both good and bad -- so she and her partner can decide for themselves whether their answer is "yes," or "no." (a informed consent form to sign for this intervention would be useful).

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informed consent can be verbal, it doesn't always necessitate a signature, in the uk we do not request a signature on a consent form before amniotomy, however i would record in the woman's notes, why the procedure was thought to be appropriate and that the procedure had been discussed with the woman and she had consented for me to proceed, that's just good record keeping.

[jeepgirl, LPN, NP]

not where I'm from!

[palesarah]

Most physicians don;t have patients sign an informed consent for amniotomies, they discuss it and then perform it. How about everybody else? Do your docs/CNM's have them sign an informed consent?

verbal informed consent (which I document on the flowsheet and the provider documents in their progress notes) for amniotomies and all other interventions besides induction of labor using misoprostyl and C-Section (and in a true emergency when every second counts, verbal for that well)

[SmilingBluEyes]

Verbal informed consent here, charted as such.

[SmilingBluEyes]

verbal informed consent (which I document on the flowsheet and the provider documents in their progress notes) for amniotomies and all other interventions besides induction of labor using misoprostyl and C-Section (and in a true emergency when every second counts, verbal for that well)

You ought to consider having the consent for csection already signed upon admission, along with your lady partsl delivery consent. We do. Our consents include :

lady partsl Delivery

Necessary Anesthesia

Possible Csection (for urgent/emergency conditions)

Care of Newborn

Consent or refusal for blood products.

All these are explained in detail upon admission, including potential for csection, as well as in the office in the latter week visits to their doctors. It saves a lot of time in the event of a TRUE emergency. Also, consider, under certain circumstances, a person CANNOT sign consents (under influence of any narcotics, incapacitated, etc). It makes sense to get this consent ahead of time, when they are alert, calm and non-emergent. Plus, as always, they do have the right to refuse at this point, any of the above. Consents are not best signed under extreme or emergent conditions.