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.
Jan 30, '05
Oh boy----looks like some people better join AWHONN and become aware of standards of practice.....as well as know what the BON may say about this. The ONLY nurses allowed to perform amniotomy where I practice ( IN WA State) would be CNM (certified nurse midwives). I don't think RN's in any state have within their scope amniotomy. Be careful; I would REFUSE without condition, to do this. If not covered; it's your BUTT if a cord prolapses or other emergency arises after your amniotomy. And yes, I have seen cord's prolapse despite low station. Not a good deal.
what does your Risk Management staff say about this? I would check if you don't know...ours would have a cow.
Last edit by SmilingBluEyes on Jan 30, '05
Jan 31, '05
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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Last edit by Ted on Feb 1, '05