Nurse perform amniotomies

  1. 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.
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    About LizzyL&DRN

    Joined: Apr '04; Posts: 165; Likes: 43
    Labor and Delivery Nurse

    19 Comments

  3. by   palesarah
    amniotomies are not in the nurse's scope of practice in my state. Thank goodness, I don't want that responsiblility or liabilty- we have enough!
  4. by   MamaTheNurse
    the hospital I worked did not allow amniotomies and frankly, I'm glad - I've seen too much unexpected stuff happen when the doc did it and I was sure glad he was the one doing it.....
  5. by   camay1221_RN
    We, RN's, don't do amniotomies at the hospital I work.
  6. by   ayndim
    That is kind of scary. Personally, I think only drs/cnms should be doing that. What happens if something goes wrong. The bag of water protects the baby from so much stress. And if something does go wrong who do you think is going to be sued? Hope all the nurses have their own personal liability insurance with that one. My gut says that it is probably not within an RN's scope and that the hospital's insurance is going to point it out when it comes to defending the lawsuit waiting to happen. The nurses will probably be hung out to dry. Bet they say "Well the RN should have known it was outside their scope and refused." No evidence to back that up just my gut instinct.
  7. by   SmilingBluEyes
    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
  8. by   profjanmc
    There is a LIMITED application for amniotomies. Let's say, severe fetal distess, emergency situation, unable to trace fetus, an amniotomy could be performed using a fetal scalp electrode, really small hole, unlikely to produce a cord prolapse. Or at delivery, so the infant can take a breath....THIS POLICY SHOULD BE THOUGHT OUT VERY CAREFULLY or you will get those nurses who will choose to rupture when it isn't the best choice....IMHO
  9. by   madwife2002
    Quote from profjanmc
    There is a LIMITED application for amniotomies. Let's say, severe fetal distess, emergency situation, unable to trace fetus, an amniotomy could be performed using a fetal scalp electrode, really small hole, unlikely to produce a cord prolapse. Or at delivery, so the infant can take a breath....THIS POLICY SHOULD BE THOUGHT OUT VERY CAREFULLY or you will get those nurses who will choose to rupture when it isn't the best choice....IMHO
    Here in Uk Midwives can and will perform ARM (artificial rupture of membranes) for varying reasons during labour. It is common to ARM when inducing labour if cervix is favorable.

    kay
  10. by   SmilingBluEyes
    I guess I want to question WHY a hospital chooses to adopt this policy? Let the physicians and midwives KEEP this HUGE responsibility. It's not something I ever want to do, period.
  11. by   parteiranagua
    Quote from 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.

    I strongly urge you to give a call to your state board of nursing and consult as well with ANA before anything else!!!!!

    Ginny
  12. by   parteiranagua
    Quote from madwife2002
    Here in Uk Midwives can and will perform ARM (artificial rupture of membranes) for varying reasons during labour. It is common to ARM when inducing labour if cervix is favorable.

    kay
    US midwived do it as well depending on their feeling about it.. Active managment of labor is not as popular here with MW , but OB seem to enjoy it!
    Nurses are not supposed to perform amniotomies as far as I know..
    Ginny :chuckle
  13. by   BabyGuide
    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
  14. by   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?

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