PCmom

I had the most crazy precip last night. I had a pt. with a dense epidural. She was snoring away. I was seeing some early decels and thought I should check her. She was complete and at 0 station and not feeling any pressure at all so I planned on laboring her down a litte. About a 1/2 hour later she states she feels some pressure so I recheck her and she is at +1-+2 so I grabbed my delivery table and towels for baby. That took me less then 5 min. Came in the room pulled down her blanket to set her up for pushing and found the baby completely delivered between her legs!. I was shocked! She never pushed and she didn't feel it come out. Baby was fine had apgars of 8-9. I still can't believe it. I used to tell moms with epidurals that were anxious and wanted to be checked all the time "Don't woory babies don't just fall out" but apparently they do!

I feel bad for you because I'm sure it's very frustating to feel like you are not getting it, but if the pt. was bleeding "across the room" then absolutely you should have been rubbing her uterus not doing baby bands. Especialy if the was a baby nurse there. Where I work, if you need a baby nurse then you need to be focused on mom. Let the baby nurse do the baby stuff like bands. I'm sorry but if the situation is what you said, then I agree with your preceptor.

Reading through many threads, many people have made staterments that "everyone gets pitocin" It's just made me curious as to why? At the hospital I work at we only start pitocin if needed. Like ROM without labor after 12 hours or so. Or progress slows. Things like that. When I asked a nurse at work she called it labor management and that it cut down on c/s but this doesn't make sense to me. Please inform me on the logic?

We have 3 channel pumps. maint. iv is the first channel. Pitocin is 2nd. 3rd only used if pt is on mag or insulin. We hook the mant. in one port of the hep lock and the pitocin in the other. If we need to bolus we just take the maint. off the pump and run it. The maint. also has Anesth. tubing on it in case of emergent c/s.

Has anyone had a pt. refuse intervention and have a good outcome. I had a pt who had been srom for 17 hours and still refusing interventions when I left. I haven't had anyone do that yet.

I was wondering how long you wait to start Pitocin or other interventions when someone is ruptured but not laboring? What is your usual corse of action?