labor/delivery "routines"

  1. As part of my Bradley teacher education, I had to interview the labor/delivery supervisor at out local hospital. Rural south arkansas......

    The statistics she gave me for interventions and medication dismayed me.

    Here are ours:

    I.V. and fetal monitor are standing orders for all mothers per doctors. Bag of waters are broken routinely although the point during labor varies dependent on the doctor.
    90% of patients have episiotomies.
    30% of patients undergo induction.
    30% of patients have cesareans.
    99.9% are medicated for the birth.

    Mothers are not allowed to breastfeed *usually* until after expulsion of the placenta. We do offer rooming in but not until after 8 hours.
    Only 2 showers available to women in labor, no tubs. 1 peanut birthing ball, no one has asked to use it yet. No birthing rooms that a patient can stay in throughout labor/delivery.

    CAn you tell me your averages???

    I'm appalled at ours. Is this the norm???
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    About Browneyedgirl

    Joined: Apr '03; Posts: 151; Likes: 1
    OB nurse; from US
    Specialty: 5 year(s) of experience in Women's Services, Dialysis


  3. by   SmilingBluEyes
    Your place sounds a LOT like the rural Oklahoma hospital where I used to work in L and D. However, it is quite different than where I am now (WA State) ---here is how things tend to go where I work:

    Rooming-in is automatic with all healthy moms and babies. ALL our rooms are LDRP; each has a warmer-bassinet and they are cared for as couplets by one nurse. Only time baby may leave room is for PKU perhaps, or weights, but I do these IN the room if parents prefer. It is THEIR choice.

    Other than that, baby never leaves the sight of parents. Even if to the nursery, I encourage one or both parents to come also, so they can see what we are doing. I find this really fosters a trust relationship and I know darn well I would want to be there if my kiddo were in the nursery.

    Epidural rates are HIGH tho----I am estimating 85% perhaps a bit more.

    Csection rates roughly 25%

    ALL Moms whose babies are well may BF immediately upon birth, prior to or after placenta is delivered ---it is THEIR choice. I encourage BF immediately upon placing infant on mom's chest and delay the bath even meds by 30 minutes or so, so mom/baby may bf and bond. If they need longer, I do place the eye prophylaxis at 30 minutes' age and return babe to mom.

    Far as I am concerned, the Bath can wait for hours, if mom and her family choose. I prefer mom get to "smell" her newborn and touch and hold the child for a few HOURS before bathing. I find they love this (most of them--there are a few who insist on a bath prior to holding baby).

    showers are long as intermittent FHTs look good and they are NOT on pitocin/mag

    IV's are NOT routine, but usually, Heplocks are encouraged. IF there IS NO NEED for meds (e.g. GBS protocol or Pit, we try to work with mom's preferences where possible).

    Several birthing balls of various sizes are available when they want them. I encourage their use whenever possible and show them the various ways they can be used. (e.g. not just sitting).

    Induction rates are HORRIBLY HIGH and they are OFTEN due to "social reasons"---- be they Dr's or patient's, it is not always clear. I don't know the rate, however. Would have to look that up. On that vein, AROM is very common, yes, but usually only upon established labor. It may be done also, when in advanced labor is being halted by intact membranes (according to the doctor). NOT nearly as common as in times past and increasingly rare in cases of positive GBS moms.

    Episiotomy rates are low; (percentage, I don't know, I would have to look up-- but I am thinking less than 25%). Usually, unless there is NO way to get baby out w/o it, they are NOT done. A minor tear is preferable, actually, is our doctors' belief. We DO massage perineums (as RN's and dr's), use warm, moist compresses, and I do encourage short, pulsing pushes when baby starts to crown to avoid tearing. If unanethesized, I encourage "open-glottis" pushing (not closed and no counts to 10 if I can help it). They can push of their own accord and usually know HOW to push and HOW long to....I encourage them to do what feels right. After a few pushes, most moms have a "groove" they get into and they do fine. With anesthesia, I do have to work more with them to push but if we are counting, usually to NO more than 6 or 7--I find there are fewer problems w/decels this way and moms' endurance lasts longer.

    If not choosing epidural or intrathecal anesthesia, use of IV pain meds is very rare.....I don't encourage their use cause they generally are not that effective for long, need mulitiple administrations and of course, all of them DO directly affect the baby. They understand this when we discuss meds. I don't discourage their use, but make moms aware of the facts as well as benefits.

    I use a lot of principles taught in my Labor Progress Handbook whenever possible. The techniques I learned there have really helped me "be there" for my laboring families. Hope this helps you.
    Last edit by SmilingBluEyes on Apr 21, '03
  4. by   Rissi-Roo
    I work at a birthing center (in a hospital) and we have LDRP's and is the same as Deb's or so it sounds re: rooming in and baths and baby stuff.
    We have NICE jacuzzi tubs and submersible telemetry.... Just a great facility.

    We have a EXTREMELY low epidural /med rate... Like around 15%(epidural) (higher med rate). Also a very low c/s rate.
    We use birthing balls and we have a birthing stool (which on another note I thought was great UNTIL I delivered on it and tore in the unfortunate anterior labial area , apparently , I have learned since is common on these stools).
    We only give IV's as needed and people may shower or tub it even on pit.(due to the tele).
    I work in upstate NY and use to work in Durham NC and we didi MANY more epidurals ,,, it seems like a sociatal thing. People just don't even think about them up here they just labor and have the baby and don't even mention an epidural.... It's kind of freaky... I happen to like it a lot ( I just seem to prefer to labor mom's w/o epidurals) Although where I worked (in Durham) we had a much lower rate than the other hosp's in the area like I think 75% where others had almost all of the population got them. I try to tell the people I work with now about the differences and no one seems to think it's weird.... that no one get's them and if they do it's like "OH MY GOODNESS we're going to do an epidural" They don't get that they are common place like everywhere else in the US. ( they arent judging the PT's for getting them , don't get me wrong, just it's different). I guess it must be a cultural pocket here. I can't quite put my finger on it must be in the water:-). I just had to mention this to others who might have some insight or input... I'm not tring to start anythng and hope no one takes offense to my observatoins (I know this topic is a hot button).
    -------------Normal amount of inductions and episiotomies are MUCH lower than 90% but I can't give a figure some do them and some don't Midwives close to never and docs almost never.
    You can come here and work we'd love to have you . We are very non invasive and the nurses are great. In fact now that you mention it you'll like this story. About a month ago I had a pt who had her Bradley instructor there and I came int eh room upon admit and the pt was just grunting.. I quickly called the midwife to come (they din't call her so she wasn't waiting for her ). I auscultated FHT B/D/A 2 uc's and the pt's starts to bear down I had her kind of lean over the bed and had her give me acouple of nice easy pushes and she dilivered like that no laceration. It was great ! The MW was mad that they didn't call her but the pt was so happy that she said that she was probably better off w/o her anyhow:-) I got a nice letter from the Bradley instructor about how pleased the couple was with the birth. The delivery was so calm and gentle it made my day. I know it sounds like I'm braging but well hell.... I AM!!!!! What can I say those kind of births are my bag... although I love all births.... Well .... MOST births......
  5. by   Browneyedgirl
    Thanks for the responses so far. they are ENCOURAGING. I was beginning to feel like I was just a freak of nature. *S*

    Actually, I "hope" putting out what our stats are around here helps to explain why I've gotten so much on the offensive at times regarding routines and natural birth.

    And IF I can't effect change around here, maybe I will move up there when I'm done with school.
  6. by   L&D.RN
    Our hospital sounds about the same as Deb's reply. I think I've seen 2 episiotomies in the last 2 years, and they were for fetal distress and they needed to get the baby out fast. Sometimes the FPs reach for the scissors and we give them "the look" and they hang on a minute and the mom delivers w/o the epis. The OBs almost never do them, and unfortunately, we don't have midwives at our hospital.

    About the epid's, I think our percentage is high too, but we actually get triage calls from patients saying they're on their way in and to "have my epidural ready when I get there." I think it's an area thing, because most people have their minds made up before they even start labor that they are going to get one. When we get report, I always get the "natural" patients, I love them, but have to admit that they are definitely the minority around here.
  7. by   SmilingBluEyes
    Originally posted by L&D.RN
    About the epid's, I think our percentage is high too, but we actually get triage calls from patients saying they're on their way in and to "have my epidural ready when I get there." I think it's an area thing, because most people have their minds made up before they even start labor that they are going to get one. When we get report, I always get the "natural" patients, I love them, but have to admit that they are definitely the minority around here.

    wow beginning to wonder if we are at the same
    have a good day, fellow Washingtonian.
  8. by   mark_LD_RN

    I just looked up the stats on on of the hospitals i work it hope theses help they are fairly encouraging to me at least in some ways

    47% natural no meds at all
    14 % epidural
    39% iv narcotics
    75% vaginal births
    35% inductions
    55% pitocin augmentation
    20% episiotomy rate
    15% repeat c/s
    10% primary c/s of the primary c/s 75% had used labor epidural and 25% were using IV narcotics or natural (no meds) during labor.

    the majority of our patients get full time fetal monitoring,npo except ice chips, bedrest with bathroom privlages. no enemas and only a hibicleans and water prep before delivery.

    we have a few that get by with intermitten fetal monitoring 15 -20 minutes out of the our, ambulate or sit in chair as tolerated, use of warm showers etc. some even get to eat light foods as tolerated. this is the way i prefer to do it with low risk moms
    hope this helps.I used to be a Bradley instructor it is still my favorite method. we just don't see to many of them at my hosptial
    Last edit by mark_LD_RN on Apr 27, '03
  9. by   Browneyedgirl
    Thanks Mark.....

    some of those are encouraging......

    Maybe you should take up teaching again..