Andrew_LandD

For us, there really isnt a clock either. What really matters is the big picture of how the baby is tolerating labor, the progression of labor (Friedman Curve), how long the mother has been ruptured, vital signs, etc. Andrew

At our hospital, we dont have a procedure per se for documentation. But we do document procedure start/stop time, solution type, return visualization, etc. Andrew

I have worked at many hospitals, I tribute this to being in the military. I have worked at a resident teaching facility to being so autonomous that you prey the doc gets in before the delivery. (Although it is fun to catch a baby everyonce in awhile.) I have become friends with many doctors and have heard their side of the story alot of the time. NOT saying that I agree with what they do, BUT, do you know how often doctors get sued because they didnt do what the patient wanted and just that one time their were bad outcomes. Or the doctor let a pt push for 4 hours, and the pt ended up with a 4th degree and then went for a c/s. I am in no way sticking up for docs, but I do know that most of the time they are doing C.Y.A. Or they have been burned before or sued, or knew someone that has or had been sued. Luckily, I work in a military setting, and our docs are there pretty much all the time. This is also were a midwife is the department head of OB. Where do you see that in a regular civilian hospital? The pushing thing for 2 hours is a golden rule among many nurses. If it is a primip then you are allowed one more hour of pushing. If the strip looks good, then possible one more hour if the pt has the umph to do it. But I have never seen pushing past 4 hours, and usually not past 3. I have seen 2 very bad outcomes for people that have pushed for 4 hours. Well, I always try to present all aspects of the big picture, its always easy to point at the other party, so I like to be fair. Trust me though, you do have your moron doctors that have tee times they have to make. They come out and say "break out the c/s consent." And your like WHAT? Well enough rambling, back to studying. I have my AWHONN FHMPP instructor course tomorrow. WHOHO! Take care everyone, may the L&D god or goddess be by your side! Andrew

For the most part I do agree Mark. There are many interventions. I work in a very small hospital where we dont have a nursery. It is not uncommon for the doctors to call arrested descent, or CPD, or stop interventions because they dont want anything to happen at night. The part that I dont agree on is that I feel the pts do have the right to choose an epidural for pain management. Its just making sure they get it at the right time. Here we make sure moms are in active labor before they receive an epidural. I know that it is common practice for some hospitals to give epidurals when women walk in and request it. This I dont agree with at all. But then again its not my choice. One thing I have seen alot of labor nurses do is once the patient gets an epidural they let the pt stay in that same position until delivery. I have to constantly remind them that the pt should change positions at least q30 minutes to facilitate labor as well as maintain good pain management. We have to do our part as well. Well, Im glad I found these boards! Great topics! Andrew