too many interventions in L&D - page 3
do you think there are too many interventions in L&D. It seems lately all our patients are pitted,ruptured, induced and or augmented. Some of our docs give patients arbitrary time limits for each... Read More
Jul 10, '02Occupation: Office Nurse. Joined: Jun '02; Posts: 205; Likes: 32I use to be a pro. baby catcher back in the day. (about 7yrs. ago) I loved every minute of it. Always an emotional time for all of us. Well at least for the nurses and parents. But your right. We always said our Doc's would POP and PIT
everyone. And heaven forbid if someone slowed down and it was getting time for the Doc's bedtime or supper.
I do believe the pts. have a right to an epidural. But they should be in active labor and at least 4cm.
Anyway I guess those days are gone for me. The best delivery I was ever involved in was the birth of my grandson.
What an awesome experience for us all. It didnt matter that I was with 10,000 women who gave birth and even caght several myself. Cant wait for the next grandbaby.Last edit by andrewsgranny on Jul 10, '02
Jul 11, '02Joined: Oct '00; Posts: 8,729; Likes: 8,412We had a woman once who pushed off and on at home for 48h, thencame to the hospital and had a vaginal delivery with pitocin. I have also been involved with a woman who was determined to go vaginal and pushd 6h. In both cases the babie were fine (but in the first case that may have been a minor miracle). So long as I have a good baby, and can feel the infant moving down ever so slightly I am OK to keep going- and most of our docs are too. The disappointing times aare when the mums are doing OK, but just run out of steam before they are done. All that work, and still a section, UGH.
Jul 11, '02Occupation: R.N. Specialty: 27 year(s) of experience in cardiac, diabetes, OB/GYN ; Joined: Feb '02; Posts: 1,947; Likes: 418Hey Mark, just have to tell you that as someone who has had one vaginal delivery ( of a baby over 9 lbs after 22 hours ruptured with no pain med) that it was MUCH easier or at least much less painful to recover from each of my 3 csections...I was back to work 8 weeks after the last one....Much easier, for me, to have sections. If you think where the pain is and you are a woman, you might understand that part of why I feel that way, personally.
To answer your question, I do think there are a lot of interventions or actions that should and could be avoided. We have a few physicians who do not believe in passive descent with an epidural and have people automatically start pushing when they are fully rather than waiting until they feel the urge.
Not too long ago couldn't believe that we had someone rupture a patient through a 1 cm cx with a scalp electrode because he couldn't get the amni hook in...Almost had a heart attack when I realized what he was doing...
Can't stand the social inductions or c/s for failure to progress. I won't even write that in a chart...And on and on and on..This is a great topic!
Jul 11, '02Occupation: R.N. Specialty: 27 year(s) of experience in cardiac, diabetes, OB/GYN ; Joined: Feb '02; Posts: 1,947; Likes: 418Just had two patients from Brazil, where they have a 95 percent c/s rate because they do c/s on demand there (for various reasons that you can imagine.) I am not in favor of this sort of thing, and am glad that I had the opportunity to have a vaginal delivery, though I STILL say, for myself ( and for the majority of people I know who have vbac"s it), the c/s recovery is much easier if you have a long hard labor and delivery. ONLY speaking for myself here. Anyway, this poor couple were overdue and given every single thing as far as pit, iupc, internal- We were watching a horrible strip for three shifts...We got a limp baby. She SHOULD have been sectioned and wasn't...Definitely a tight squeeze...You just never know......
Jul 11, '02Joined: Jul '00; Posts: 11,351; Likes: 387I don't think 95% is right. I read Brazil was almost at 50%, which makes more sense when you think about the fact that a lot of poorer women probably can't get c-sections on demand.
Jul 12, '02Joined: May '02; Posts: 151; Likes: 2Having traveled to and living for some time in Brazil and spending time both in the 'gettos' and with the 'upper class'... I although with no med experience under my belt will have to comment.
I saw many woman have there babies out doors... with the poverty rate (imho) only the upper - upper middle class that could even afford c/s on demand and those who don't relay heavely on mid wives, grandmothers and fathers to bring there babies safely into the world - mostly in the kitchens or bedrooms (if they have these "extra" rooms)....
A number of these mothers still die and often the baby will die... more often then not from other things such as diseases, etc within the first year of birth... the mothers do come down with uteriun infections etc. that can be lethal...
Maybe those of you who are working in the med field will think I am nuts... but once again IMHO and from what I have witnessed..... the statistics that you may read on the topic are usually done at the hospital... and that doesn't count for thousands of Brazilians who have had baby's and haven't had the oppurtunity or lived to have the oppurtunity to tell there stories.....
Jul 12, '02Occupation: Women's Health NP, L&D RN Joined: Jul '02; Posts: 47; Likes: 1Re social inductions . . .
There *is* something we can help do about that. You know there are a lot of women who come into Triage not in labor and are not happy to be sent back home. Comments are usually, "I'm so tired of being pregnant, can't something be done to start my labor?" Some even say they are being induced "next week" (at 39 wks with no risks).
BIG teaching opportunity here! You know the docs don't do it, so it's up to us nurses not to let these comments go by unaddressed.
Re EFM . . .
Once the patient is hooked up, I always pull a rocking chair or other chair next to the bed and encourage her to get out of bed. We also have the birthing balls which they enjoy sitting on as well.
Jul 12, '02Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14I hate the social inductions myself.I have also experience docs ruptureing some of the patients at 1cm and fly high.
well mother baby you seem like an exceptional c/s patient compared to the ones i dealt with. all the ones i have dealt with recovery is so much harder and longer for them. i have had patients that experienced it both ways tell me the same thing. waching them move around the first couple days and comparing their pain scale rating to vag deliveries, and judging by how much pain meds the c/s patients request and recieve, they are much more uncomfortable. I have had patient just few hours after deliver vaginally that act as almost knothing has happened, my wife is one example 4 hours after she was in regular clothes walking outside went down to cafeteria, was very active and in very little pain,after delivery of very large baby. glad to hear your c/s were so uneventful.
Oct 8, '02Occupation: Entrepreneur, L&D RN Joined: Apr '00; Posts: 70; Likes: 3Originally posted by fergus51
Definitely!! Unfortunately we are on one of the lower floors.... Sigh... I hate the fact that women stuck to these machines can't move around and get things going. Instead we have to AROM em to get things moving....Uh huh...right....
Oct 25, '02Occupation: rn Joined: Oct '02; Posts: 14; Likes: 2we definitely do not want the insurance companies involved! That's what happened some years ago with the mandatory tiral of labor deal with previous c/s. Then the lawsuts went through the ceiling because we had poor outcomes. Luckily, my hospital is very family/patient center. Last week I had a patient who was an induction for postdates..41+3, who had truly wanted to be a Bradley patient. she warned me ahead of time that she did not want an epidural..4th baby (ages 12,11 and 1), would take stadol, preferably in .5 mg increments but wanted to be oob as much as possible. She also warned me that she would be noisy but that's how she labors. She was definitely noisy but was easy to get under control to push..last tiem she ended up with a fourth degree because she was NOT in control. I kept her calm and we NO EPIS! and no lacerations. I did have to monitor her because of the Pit but did it with her in the rocking chair, on the labor ball,standing at the beside, squatting (of course, I was on my knees on the floor to do that) and, at one point, standing bolt upright in the BED. It was great..I had a blast. Even as a tertiary hospital, we do all we can to accomodate the patient. We do have an awful lot of interventions nowadays but we can work around them. Thankfully, because of our interventions, we don't have some of the "surprises" we used to have..undiagnosed anomalies, thick mec nobody knew about until the time of delivery, undiagnosed twins, sudden fetal death during labor. Deliver just one stillborn child who 15 minutes earlier had a heartrate on auscultation and you'll never mind monitors again. Also epidurals really help the panicky patient who probably would've ended up with a fourth degree without it. We have the luxury of having a range dosage on our epidurals. I f the patient is unable to feel pressure to push, we can lower the dose...it's on a continous pump. Also we don't start pushing until mom can feel some pressure. If they are complete/+1 or so with an epidural, we'll simply wait and let Mother Nature bring the baby down while mom is still comfortable. Even our residents will go for that. One lst thing..new awohnn guidelines say patient may have epidural whenever she requests it. We are the only service that denies pain relief until the patient hurts worse. Thanks for letting me give my opinion. we have also found epidurals to be quite beneficial for PIHers.
Nov 18, '02Joined: Nov '02; Posts: 102; Likes: 5shay, I am in agreement about "a baby story" my husband wont let me watch it because I get so upset! The first one I saw, the pt. had a prolapsed cord at home, and took her time getting to the hospital! (There was a midwife with her)
Nov 18, '02Occupation: Entrepreneur, L&D RN Joined: Apr '00; Posts: 70; Likes: 3Originally posted by kcrnsue
shay, I am in agreement about "a baby story" my husband wont let me watch it because I get so upset! The first one I saw, the pt. had a prolapsed cord at home, and took her time getting to the hospital! (There was a midwife with her)
And, of course, she was a crash c/s because "the baby's heartbeat was low"
DUH! I remember being amazed at her allowing that film to be shown...makes things real easy if the family sues her!
Nov 21, '02Occupation: Maternal Child, BSN Joined: Nov '02; Posts: 29I agree with NO social inductions.... the docs have increased our c/s rate up to about 40%. This because the "social" inductions have primip's, who are not ready, stressing the fetus. Also, a few prolapse cords because of arom when the patient is +3 and floating. Some of our MD's allow the patient to call the shot and be induced at 37-38 weeks....But what do you do