Opinions on "Therapeutic Sleep"

Specialties Ob/Gyn

Published

Hi!

I would appreciate everybody's opinions on the practice of therapeutic sleep, which at my hospital, is obtaining a reactive NST, then giving either Ambien, or a combination of Morphine and Phenergan IM (typically 15mg/50MG respectively), then letting the pt sleep at the hospital without checking the FHR until the pt wakes up on her own. We typically do this for pt's in prodromal labor and uncomfortable or who are ruptured and not contracting, closed cervix and no risk factors for quick labors. There are several other factors that we consider, but basically this is what we do.

I can't wait to hear your ideas! Thanks.

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Specializes in OB.

We usually do the morphine and phenergen thing too. We typically keep them around 3 hours, then check their cervix and if no change send them home. We don't have to keep them on the monitor, I think most of us just go in every hour and get a quick tracing.

If we give someone Ambien, we send them home with it.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I am all for it. It's win-win. Either it helps a prodromal labor patient get some rest and be able to go home, or she emerges in active labor, hopefully having gotten rest in the hospital. PLUS she knows we are taking her complaints seriously and trying to do something to help her. What's not to like about it?

We use the following options:

In the hospital: morphine 10 mg/Phenergan 25 mg IM (or with vistaril 25 mg)

OR

Nubain 15 mg with Phenergan 25 mg or Vistaril 25 mg IM

3-4 hours' observation on the unit afterward.

OR if they want to go home (or dr wants them to I always ask for something to go home with) They order as follows:

they can go home with Vistaril 50-100mg PO for sleep

OR

Ambien 10mg PO for sleep.

It's really nice if we can at least TRY to help these poor mamas get some rest when they are so miserable.

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Specializes in Rural Health.

I work night shift and we do this with most of our triages who are term. It's the most wonderful thing in the world. Mom loves it that we are taking her seriously, she feels like we care, she gets some rest and she's there if she happens to emerge into active labor. It's perfect.

Usually we make sure we have an reactive NST, we fix her c/o and then give her some Vistirl and let her sleep all night. Once she's up and around in the am, we do another NST and SVE and go from there.

I would say we have about a 50/50 success rate with this method. It doesn't work for all our mommas but I love it when it does :D

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Specializes in L&D,Wound Care, SNC.

Our docs offer it where I work, the hospital I worked at before they did not. I am a huge fan of it for reasons stated previously. Typically we give Morphine 10 mg & Phenergan 25 mg IM or Ambien.

Once she wakes up SVE, NST and go from there.

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Thanks to all of your posts! It's nice to hear other nurses perspectives on their hospitals practice. I love therapeutic sleep too, but sometimes I'm a little scared of it. I've been a L/D nurse for about a year and a half and I feel like I should be monitoring them a little more after I give it. But I know that there strip will be flat after, and I have established fetal wellbeing before...Anyways, I really appreciate your posts! Thanks again.

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Wow...I would have loved this! I got a dose of peragoric and got sent home...2+ days of labor at home.

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Specializes in Community, OB, Nursery.

We do it, but rarely. I wish we did it more. Most of the time if mom is admitted, she gets NST etc. in L/D then transferred to the floor for sleeping, then turned back over to L/D in the AM. Really makes more work for us all, and not sure that moms like it that much either. I understand that it keeps L/D beds open, and I'd much rather get a fulltermer on therapeutic rest than a 33 weeker in PTL any day.

I do wish we did it more. We do 10mg Ambien, and our moms love it.

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Specializes in LDRP.

Yeah, we do it, but we send them home! They come in, latent labor, not changing over 1-2 hours, they are sometimes offered therapeutic rest. (sometimes b/c some docs give it, some don't. )

Usually its Demerol 50mg/Vistaril 50mg IM. This is by far the most popular combo. Then out the door!

One doc likes a Ambien/Percocet combo instead.

One gave just Ambien.

There is 99.5% no observation in triage post administration.

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Specializes in ortho/neuro/ob/nicu.

Brings back memories..in the 80's we would give most of our patients 100mg of seconal or nembutal and 1/4grain of morphine. When they woke up they either were 8-9 cm and then delivered, or if no change went home in the am. (we did not do epidurals or spinals on our unit back in those days) Of course our labor record was a one page bell curve back then, too.

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