OzMW

I have personal experience with these (as a new mum) and little professional experience. The TCB reading said my babys level was fine- serum bili was extremely high requiring two days of photo therapy! How accurate are they supposed to be?

In Australia one needs to be a midwife to care for a woman during labour and birth. In the state I work in it is illegal to provide care during birth unless you are a midwife or training to be one(or a dr or a trainee paramedic). Some places have RNs working in antenatal and postnatal units alongside midwives; but that is due to midwife shortages usually.

A multip at 4cm also could be just a multi OS. If shes contracting I'd keep her and reassess in two hours;if theres no change in dilation (and often a decrease in contractions) I'd send her home if she were happy. A primip at 4 I wouldn't necessarily keep - if she is having irregular contrcations I'd send out for a walk!

We generally send them home if they aren't dilated; if they present again we tend to more often admit them for analgesia. SROM are offered options i.e immediate IOL/home/admission. The ones who go home then come back at 18 hrs for iv and abs; and IOL usually the next day. Most opt not to be induced immediately.

Yow...my uterus aches at the thought of it although in recovery they at least will still have some analgesia happening!

And just to add Elvish, our women don't get palpated in OT in recovery either. They are post op'ed by general nurses who aren't often mid trained. All very interesting!

Yes definitely - gentle checking with no loss - but not that often. No I know your not being snarky - this is truly interesting and its good to reflect I think. Certainly has had me doing so. And unfortunately our section rates are yucko too - 25-30%! Although we do I think probably use less oxytocic generally. For augmentation that is. Interestingly we used to go over board with fundal checking on SVDs - we now only do that once per shift - I suspect that will decrease as time goes on too in low risk women.:redpinkhe:redpinkhe

And to add - not sure if this makes any difference. Most of our section babys come out to the ward with their mothers. So our women are encouraged to be fairly active from the word go. Not saying we expect them to get straight up of course! But they are often sitting up breasfeeding fairly soon so maybe that encourages the lochia to flow rather than pool??

Yep different practices and can I say it's not just something I choose to do - no dr or midwife or nurse in our unit palpates fundus' on post section pts routinely; it seems to be something that is more common in Australia and the UK. And having said that I can only remember a handful of section women having trouble with PPH (once back on the ward that is) in many years. Heres what we do as routine with our women post section: They are recovered in OT for an hour or so post op The come back to the ward with an oxytocic infusion going which we titrate to lochia amount Obs are done 1/2 hrly by 2 hours then hrly by two (they usually have a pca so are done hrly for 24 hours). We check pad, pain level, drain output (not many have drains), wound for ooze; the usual. So I have no idea how different that is to what you guys do ? So how often do you do fundal checks? See to me unless you have your hand on that fundus constantly; by the time you feel a boggy fundus its too late....the risk of PPH has already happened - I don't think I'm making sense....

We will have to disagree SMBEs - my "anecdotal" evidence is the opposite. Your woman still had the PPH; still needed transfusing- so did the fundal check prevent it from being nasty or did the drugs and the uterine massage do that? To me they are two separate issues; my point is that regular palpation (to check for "bogginess") of the uterine fundus doesn't prevent PPH; some people obviously believe it can add to picking it up earlier, but I think that's debatable. Now massaging a boggy fundus that is bleeding is a different story!! And i agree it is better to pick something up before it gets too bad - not sure how well fundal checks do that though!

I disagree! There are other ways of monitoring a womans condition. I'd be interested to see research that supports fundal checks on any postpartum woman ( after the intial post birth period) - as far as I know there is none. We've all had post section women bleed - and in that instance fundal massage is a must if the uterus is atonic! If a post section woman has dodgy obs and lots of abdo pain check her fundus - she may have one up to her boobs full of clot - but routine poking of the uterine fundus on section women is overkill and painful.:heartbeat

We don't palpate fundus' on post CS women - too painful. The only time I would do it is if I'm concerned that the woman has a uterus full of clot. Our vag births get done 1/2 hrly for 2 hours and then once per shift or 3 times per day. I also teach women to do it themselves.

Or maybe telling labouring women that that is the policy but you can't physically stop them from getting out of bed - and that walking is much better for them? Its a policy but it ain't the law!!:redpinkhe:redpinkhe

Sorry but that is the funniest thing I have heard! BEDPANS!!!!!!!!!!Contrary to the belief of the people who write these policies women don't just drop cords out if they've SROMed and walk around - that is such crap - and I'd be telling patients on the side too - who are we to make women stay in bed? I guess your epi rate is thru' the roof? Being stuck on a bed when one is in active labour is agonising! Heres to breaking the rules:redpinkhe Even with a high head we let pts up - encourage it actually!! The only women in our unit who are RIB are the ones who are too sick or have an epi - our rate is about 20% - so plenty of women walking the floors! As for bedpans our labour ward has about three - we have close to 2000 babies per year - they rarely get used! Thats what the dunnies' for - if I wanted to spend my life panning pts - I'd go work in ortho!!

What she said!!!