LM813

My hospital practice is in an early demise, we ask the pt. Some don't want to be on L&D unit. For Late term IUFD, we deliver then ask if they want to stay on our unit or go to med/surg.

Have you considered call time? Some birth centers require call time which can be kinda tuff if you have little ones. My hospital requires 24 hours a month. It can be alot, especially when you get called in. Good luck!

Hi - I appreciate your problem. If the physician was really pushing for the patient to come over to be monitored and you told him it was not your unit's policy he should have called the house nursing supervisor and let them handle it. That is the appropriate chain of command. You were not refusing an order, you were simply stating your unit's policy and proceedures. At my small hospital, we see all kinds over from the office for EFM, including 18 weekers. Yikes, I know. Most of the time you can't get it without a doppler anyways. I also agree. Ultrasound would be the indication on the 24 gestation with no FHR in the office. Good Luck.

I have precepted many new OB nurses throughout the years and have found 1 major theme. It seems anytime you have a unit where other nurses help out and cross roles in deliveries and c-sections, the orientees get confused. If the baby nurse were to help out an experienced nurse with any part of the delivery, it is fine. But, if she crosses roles in the presence of a orientee, then the orientee doesn't learn the skill and rational. Also the orientee then is afraid to take over and step on toes. I always let my fellow staff know to stick to traditional roles when I have an orientee around and if that orientee isn't doing something, we need to tell her or show her, but then let HER do it. In your case, that baby nurse should have told you to do it( not sure in this situation though with a labial tear) and why, but not just have took over and then complained about it later. Not a good role model and not helping you out to learn either.

The only time I have seen it done was for a 36 weeker, already PROM and GBS Postive so the MD wanted to get a dose of ABX in but I think it is contra-indicated after 35 weeks.

Fundal asssessment should be performed with patient as close to flat as possible for assessment of fundal height which is measured in relation to umbilicus. Firmness and position (midline, etc) can be done in other positions but height in relation to umbilicus is also part of your assessment and is most accurate flat, so just do it flat to assess all of these things.

Thank you for the info, but what I am really looking for is policies and/or recommendations for fetal monitoring specifically during the actual placement. The anesthesiologist at our facitlity have the patients sitting up which makes monitoring the fetus next to impossible as you pick up maternal heart rate prob 99% of time with ext EFM. Some nurses take the monitors off completely during the placement and others doppler with hand held and others just leave them on tracing the maternal HR with a pulse ox on so you can prove the rate is maternal. I am looking for imput regarding awhonn's rec or some of your facilities practices/policies for this. Thanks again!

Can anyone tell me what awhonn's guidelines are for fetal monitoring during epidural planement? I can find info on fetal monitoring before and after epidural placement, but nothing consistant for during. We all know that during the placement the maternal position makes it difficult. I have been told conflicting things by my manager/educator and my co-workers and I are constantly being told different things by traverlers who come to help us! Thank you