Do you count?

[ayndim]

I am a pre-nursing student and l&d is a particular interest of mine. Maybe because I have had 3 little ones. Anyway, I watch these shows on the discovery channel and I hear the nurses counting. To me it is just plain annoying. And when I was delivering I think I would have told off anyone who did. Well with #1 my hubby did try to count but the CNM told him I knew when to push and for how long before I got the chance. So do you count when your moms are pushing? If so do any of your moms ask you not to? If you don't do any drs/cnm's want you to?

Just curious.

Thanks

[L&D_RN_OH]

14????????????????????????? who precepted this nurse?

She's actually a travel nurse with 34 years of experience. Granted, she has been a nurse longer than I've been alive, she remembers twilight sleep for heaven's sake...... But I have my own "style" and it doesn't mesh well with hers. Our CNM's don't like her to attend their births, and have said if she was a hospital employee who was staying around for awhile they would have already done something about her. She is just very loud and controlling, IMO. Lots of "hold your breath, no hollering, push harder" etc, etc...........

[mother/babyRN, RN]

very interesting that all through time (and I am open to whatever the pt wants to do), whenever something new "evidence based" comes out, it is suddenly better. I idsagree , as I said but that said, there is no slamming involved . You can't get me to agree that "evidence based" info is against increased census or business during a full moon...That is "not true"...Wrong....Or, according to anesthesia, "evidence based" info states there is no such thing as an "epidural dip" ( wrong)...That said and elaborated upon, I think people should be taught that inital thing of holding the breath because I think they naturally resort to the closed glottis ( I let them do what comes naturally and there is NOTHING wrong with the baby or mom with holding the breath)..Perhaps because if one does it natually, there is a combo...A primip under epidural who doesn't have the urge to push and has the sad misfortune of acquiring a doc who won't allow her to labor down, may have to be taught originally to hold her breath so she can get the feel of things....Not everyone is accomplished at pushing....I think the entire thing is or should be individualized and I am not concerned how much "evidence based" stuff comes my way because the same things do not work for everyone....Still disagree but definitely willing and able to look into it, work with it and see how it goes....

[Energizer Bunny]

I'm thinking of how everyone assumes that if a mom has an epi. that she will not feel the urge to push. I never had that problem with any of mine and with the first they didn't turn anything down, the second, there was no time to turn it down (she was crowning) and the third I couldn't stop pushing. I think this is another area where moms should be listened to and it shouldn't just be assumed that we cannot push effectively because of an epi.

[mother/babyRN, RN]

As I continue to say, always believe the mom..Even if she is incorrect, SOMEthing has changed..And I have had moms who never felt the urge to push with good epidurals, but did feel pressure...That would be because the perineal nerves are usually not as affected by an epidural....Depends on the level of the epidural, position of the baby and talent or skill of the anesthesiologist..

[SmilingBluEyes]

I'm thinking of how everyone assumes that if a mom has an epi. that she will not feel the urge to push. I never had that problem with any of mine and with the first they didn't turn anything down, the second, there was no time to turn it down (she was crowning) and the third I couldn't stop pushing. I think this is another area where moms should be listened to and it shouldn't just be assumed that we cannot push effectively because of an epi.

Kim, no one assumes anything. I am sorry you think so. It's just that as Ob nurses, we have attended countless deliveries with and without epidural and intrathecal anesthesia, and based on experience, MANY of these women cannot feel any urge to push at all. NOT all, but most. Often the blockade is so strong, the need to push is if not obliterated, very weak. There are some anesthesia personnel, who by nature of their methods or medicines used, are able to give women good pain relief yet not have the regional anesthesia block this urge. Yours was apparently one of them. But in my experience, this is the exception, not the rule.

And in any case, I always ask a woman if she feels her contractions and ask her to push with them, if she can. The urge to push is rare, but most women are aware they contract and when. Again, I always take each case very individually. Each woman is unique in her birth experience and should be treated as such.

[L&D_RN_OH]

I'm thinking of how everyone assumes that if a mom has an epi. that she will not feel the urge to push.

I think this is another area where moms should be listened to and it shouldn't just be assumed that we cannot push effectively because of an epi.

I agree with Deb here. Noone assumes a Mom won't have the urge to push or that she can't push. Manye women with epidurals can feel pressure with an epidural but still may have a hard time figuring out exactly how to push especially if they are a primip. I believe I said that I have my pts do a few practice pushes to see if they need any direction. Many times they do not, but sometimes they do, with or without an epidural. Sometimes it takes a few pushes to get the hang of it. This is when we listen to mom and her body to determine if she needs any direction from us. I don't assume anything.

[Dayray, RN]

I think some people are getting mixed up here. It's great to hear about individual labor experiences and the things that you experienced defiantly add to the discussions here but you have to remember that every labor, patient, baby, day is different and although something may have turned out a certain way or a particular technique may have worked for you it doesn't mean that it is the norm.

Also I have to agree that evidenced based practice is only as good as the research that produced the evidence. Results are often influenced by bias or by circumstance. And after all nurses accumulate their own evidence in their practice over time.

It becomes hard to sift threw all these things as some people are very passionate about certain techniques (because they worked for them or because they read an article that promotes them).

Personally I come here to hear what other nurses have seen in their practice. I have tons of bookmarks for both birth stories and research articles. Don't get me wrong those things can contribute to the discussion here but I don't see them as information I would base my practice on. They can stimulate conversation/consideration but they aren't the end all be all.

P.S.

L&D_RN_OH

Can you tell us more about how open glottis has worked for you? I'm interested

[mother/babyRN, RN]

And again I say, "discussion" means presentation of more than one viewpoint, as has been done here....And, actually when I think about it, people do the closed glottis thing naturally but take air in in order to accomplish it. Thus, take a deep breath and bear down does not mean you have a lungful of air and push that way because the movement is as though you were attempting to move your bowels, which is exactly what the original poster described...So, we're having a non discussion or discussion on "evidence based " stuff which really is basically a difference in the way things are described vs the actual event....I will reiterate..It is all about individuality, so DayRay, if your passionate comment was directed mostly toward me ( which is fine, by the way), my "opinion" and experience coupled with each individuals specific needs simply proves your point...Passionate viewpoints are the only way a debate can actually function...Evidence based material changes periodically depending upon the evidence gatherer and method of gathering..Just like political polls and interpretations of the bible.....Perhaps we should either agree to disagree or respect that we probably in the long run, are all pretty much saying the same thing...

[Energizer Bunny]

I agree with Deb here. Noone assumes a Mom won't have the urge to push or that she can't push. Manye women with epidurals can feel pressure with an epidural but still may have a hard time figuring out exactly how to push especially if they are a primip. I believe I said that I have my pts do a few practice pushes to see if they need any direction. Many times they do not, but sometimes they do, with or without an epidural. Sometimes it takes a few pushes to get the hang of it. This is when we listen to mom and her body to determine if she needs any direction from us. I don't assume anything.

They assumed it at my hospital, and therefore I had more pain than was necessary when they turned the epidural down.

[Zhlake]

I really have had great success with open glottis pushing. With an unmedicated or minimal nubain mother, when they feel the urge to push--the only advice I give them is to go with what feels right to them. I have rarely had a mother not be able to do that. I also give her free reign (and encouragment) to move in whatever position she needs to. The body knows what to do--and a mother who is not under the influence of a lot of medications can go with this feeling. I also don't discourage them from making noise--as this helps keep the glottis open.

As per my personal experience--with DS, I laid on my back and "purple faced" the baby out. Long drawn out pushes. I pushed only a couple of times and horrible perineal trauma. I vowed that next time I would just do what came naturally. I was unmedicated with DD (had nubain with DS) and just pushed as it felt natural to me. They were grunty type pushes--probably 4-5 seconds long, about 3 times per ctx. I was sidelying. After I had been pushing for awhile, I just knew I had to get into hands and knees. I flipped over and she was born. It was fast! My bottom was soooo much better. Easing out the baby was defintely better. I pushed twice as long (30 min as opposed to 15--babies both the same weight) but things were so much nicer afterwards.

Obviously one case study means just about --nothing--but I just wanted to share my own experience with it.

[mother/babyRN, RN]

Moms should do what feels natural along with some coaching that benefits her and baby....Sounds like you had a good experience and I am all about that...

[Dayray, RN]

And again I say, "discussion" means presentation of more than one viewpoint, as has been done here....And, actually when I think about it, people do the closed glottis thing naturally but take air in in order to accomplish it. Thus, take a deep breath and bear down does not mean you have a lungful of air and push that way because the movement is as though you were attempting to move your bowels, which is exactly what the original poster described...So, we're having a non discussion or discussion on "evidence based " stuff which really is basically a difference in the way things are described vs the actual event....I will reiterate..It is all about individuality, so DayRay, if your passionate comment was directed mostly toward me ( which is fine, by the way), my "opinion" and experience coupled with each individuals specific needs simply proves your point...Passionate viewpoints are the only way a debate can actually function...Evidence based material changes periodically depending upon the evidence gatherer and method of gathering..Just like political polls and interpretations of the bible.....Perhaps we should either agree to disagree or respect that we probably in the long run, are all pretty much saying the same thing...

Hmmm?

Actually I thought I was agreeing with what you were saying. Maybe the meaning of my post didn't come across correctly.

What I meant to say was that I like to hear about other nurses professional experiences.

I was trying to say:

I thought your post about your professional experience and others like it were worth more then a link to articles written about evidence based practice or offering only the example of their own birth. I was trying to get that across without offending the people who were posting them.

But it seems that I won't be able to get away with out offending someone. So I'll just say what I was thinking:

"Birth stories and research articles are great but to convince me that open glottis is the way to go I'll have to hear it from a nurse that has been using it and seen it work more then just a few times."

Also although I didn't say it, My limited experience has shown the same as yours seems to have. As I said before I haven't had much success with open glottis pushing. Purple pushing (as I guess it is now called) seems to work well for most people and those that it doesn't work for seem to find their own way with some gentle suggestions or just telling them "ok that was a good push" when they get it right.

I'm sorry if it sounded like I was flaming you, that was not what I meant. I was actually hoping that my comments would encourage people to talk more about what they have seen working L&D (like you had) rather then talking about articles or their own birth.

I'm also not trying to argue that one method is better then the other only that I want to hear what others have learned (while working L&D).