OB/L&D nurses, some input, please...

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Specializes in med-surg, psych, ER, school nurse-CRNP.

I just want to know if I did anything wrong.

I am currently 34 1/2 weeks' gestation with my second pregnancy (first child). I went into premature labor at 31 weeks and had to receive terbutaline X 3. I was allowed to go home that night, but 4 days later started with the same type pain, recurring q 14-18 minutes. DH could feel my belly tighten up, just like the first time we went in. As I was already on edge with the issues I had had previously, my DH flipped out and back to L&D we went.

I'm not asking for medical advice, I swear. But the difference in how I was treated the first time and the second was like night and day. The first trip, the nurses could not have been nicer. The second, it was a Sunday night, and I was the only one there. I got the distinct impression that I was interrupting the Grammy-watching party.

I was hooked up, placed on my side, and left. The only time I saw a nurse after that was for her to come in and admonish me to "Lay still! I can't monitor you like this!" Which was a shock, as I had not moved from how I was positioned upon arrival. DH even took up for me, but she just kept repeating herself.

Eventually, she came back in and told me that she didn't see any uterine movement, just the baby moving, and that "Doc says you can have an Ambien if you want it." (No clue what that one was about, never said anything about not sleeping.)

I was mortified, partly at being so ignorant as to not be able to tell the difference in fetal and uterine movement, and partly because I felt like I was such an inconvenience. I did follow up with my OB the next day, who put me on bedrest.

So, as an admitted primipara, with no firsthand knowledge of how this is supposed to go, was I wrong to seek evaluation? Would you have thought me an idiot if I had presented to the L&D you work on? I just don't want to go back in for round 3 and look like a fool again if it's not the real deal. And I know y'all will level with me. Thank you in advance.

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Specializes in Maternal - Child Health.

Absolutely right to seek evaluation. And, IMO, you probably were experiencing uterine contractions, regardless of whether or not they showed up on the monitor.

As an APN, I am sure you are well aware of the need to treat a patient and not a monitor.

I would suggest that if you ever find yourself in a situation again where your caregivers "pooh-pooh" concerns about contractions, you ask them to sit with you for a 30 to 60 minute period of time and hand palpate your fundus. Uterine monitors can (and often do) miss contractions depending on placement of the sensor.

I won't offer any medical advice other than to advocate for yourself. Better to walk off the unit having interrupted a quiet night than spend weeks sitting next to a preemie in an isolette.

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Specializes in Medical-surgical nursing.

You know what, I think you did the right thing. Forget that rude nurse- this is your CHILD, you can never be safe enough!! Best of luck :hug:

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I'm not an L&D nurse, but I think you did the right thing. It's always better to be safe than sorry. When my water broke with my 2nd child, I went into the L&D Triage, told the nurse my water broke, she was very rude and said "We'll see about that", I was like I think I know that water is gushing out of me continuously (didn't say that to her), but she was so rude the whole time, she tested it and saw that my water really did break. Then she was so forcefull and rough when she checked my cervix. I just remember it being an aweful experience with her being so cold and treating me like I was irritating her just by being there and I was the only one there that night! Anways, I'm sorry you had a bad experience. Some people just shouldn't be working with the public.

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Specializes in OB.

As I said in the other thread - No you are not wrong to have gone in! If you feel the need to go in again, do so. Do not worry about what "they" think of you. Think only of what is best for you and baby and what will reassure you.

What I do when I have a patient that is feeling contractions not picked up on the monitor is exactly what a previous poster suggested - I sit at the bedside and feel the uterus when the patient tells me she is feeling one. It is sometimes difficult to pick up contractions adequately on an external monitor with the patient in a sidelying position.

I've been doing OB for 24 yrs. now and would not consider you an idiot.

If they give you a hard time tell them you are trying to avoid the Murphy's Law which says that medical personnel will have all the weird complications possible in any given medical condition.

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Specializes in OB.

It's a shame that you got an uncaring nurse who simply didn't feel like being at work that evening!

I think that was the problem, more than you were. No, you were not stupid for going in. It was totally appropriate. However, have you been given a number to call if you aren't sure if it's labor in the future? Can you call the OB dept and get any advice? I don't know if you had already begun to dilate or not during your first episode when you were given the terb, but if not, it is very normal to experience Braxton Hicks contractions in your last trimester. They can be fairly close together and fairly uncomfortable, but typically (not always) they will become more irreg or weaken in intensity if you hydrate yourself and rest. You may save yourself another trip into OB (and another unfortunate interaction with some not-so-friendly nurses), if you try those things first or call your doc or midwife before going in.

You did nothing wrong!

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Specializes in med-surg, psych, ER, school nurse-CRNP.

I had not begun to dilate the first tripo, but that second one, I was dilated 1cm and 50% effaced, a change in 4 days. I had been guzzling water all day trying to stop the darn things. And I was on bed/couch restriction, so lots of rest. I have the number to my OB, which says after hours cases are to present to L&D. If you call my hospital and ask for L&D, you are told that it's 'against their rules' to connect you to that dept.

So, with what I had to work with, there I was, lol.

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No you were not wrong to go in. I would rather have an assessment and find I am not in labour then to ignore something, have a premmie then question myself. Ignore the nurse, she is being paid to be there and assess you.

Do you have a triage number to call. In our facility we have a line for expectant moms to call, they answer a few questions and based in their answers we either tell them to stay home or come in for evaluation. I called in a few times with my first but never needed to go in until it was the real deal.

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Specializes in Obstetrics.

You were 100% right to go in. I'm sorry you didn't have a more caring nurse. :( I hope your delivery and recovery is more pleasant. Good luck!

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When you're talking about possible preterm labor, it is always better to be safe than sorry. I'd much rather have a pt come in for a "false alarm" than have her stay home and come in dilated to 4-5 cm. It sounds like you just ended up with a nurse who has personality issues or was having a bad night. I agree that it would be appropriate to request uterine palpation (although asking for a 30 minute window of palpation is not necessarily a reasonable request). You could also request that the monitor position be adjusted, or that you change positions (contraction monitors often do not pick up well when a patient is lying on her side).

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I think you did the right thing, and should return if you have any other problems. I'd bet apples to oranges if you were to stay home when you should have gone to the ER, those same nurses would be fussing at you for NOT coming in.

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Hi! What you did was right. Never think of yourself as an idiot. The nurse who's been there with you were! I really hate it when nurses act that way! She should be educated again! Sue her if you want, girl! She's been paid for her work and yet, she doesn't treat the patients they were supposed to be treated! With care and dignity! If this has to happen to you the next time, tell that nurse or anyone who will act mean to you that if they don't like they're job, then simply QUIT! hahahah!!! and report the behavior to the supervisor! :)

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