StBRN

Thanks May Baby:nurse:

Hi, I am a Canadian nurse hoping to work in the U.S. in 2006. Right now, though I am studying for a perinatal certification exam. One of the topics is regarding paralysis and FAS in pregnancy. I cannot find any info about women who are paralysed and are pregnant, or about women with fetal alcohol syndrome who are pregnant. Or any info about management in labour, except that women with paralysis may require a forceps delivery (or c/s, I guess). Does anyone know anything more about these topics

I have noticed that almost nobody mentioned that some pts. in prodromal labour will refuse pain meds, all the while wanting to stay in hospital when not in active labour. For example, one night in triage, this woman (primip) came in with her husband in what appeared to be early labour (irregular cxns). 1cm/thick/-2 with membranes intact. Quite uncomfortable, but refusing all analgesia. Her husband, the spokesperson (seemingly) was very angry with me that after 4 hours and no cervical change, I was sending them home. As I explained, if the woman wants no pain meds then she is perfectly able to continue this stage of labour at home. I will say that I was as soothing as I could possibly be while teaching about early labour, and tried to remain understanding. In any case, this man was telling me that the baby would not be "safe" at home because his wife was in labour and that this was ridiculous and he wanted to speak to the doctor, etc. Well, anyway I sent them home after AGAIN asking the woman to consider analgesia (which she refused). The husband, needless to say, was very unhappy with me. (I had already spoken to the doc and told the husband and wife this as well as what the doc had said - I was not going to wake him up again to repeat his orders directly to the husband!!!). As it turned out, they came back about 5 hours later (around 1030) and the woman delivered late in the evening. I am glad for her, and she even got to deliver on LDRP (I work on high risk L&D). I think her husband was more upset than her about the whole situation. Unfortunately, this is a fairly common occurence where I work (busy hospital with avg. 450 deliveries/month now). Thanks for listening!

I wanted to add something to my question: If the MW then intervenes and the FHR still has decels, at what point does she have to head to the hospital? I mean, a lot of babies will still have some decels (especially variable - although how can you tell with a doptone? What if they're late?) Again, just curious.

Hi, I have a nagging question that I wonder if anyone could shed some light on. Here goes - if a midwife is to do a homebirth, does she follow different regulations for fetal monitoring than those of the ACOG (SOGC in Canada)? That is, does she not have to start continuously monitoring and providing the usual interventions (IV, O2, repositioning, etc) for nonreassuring FHR? I mean, most babies have variable decels in the 2nd stage of labour. So if the MW hears them, does she not have to intervene? Obviously the risk for physical and neurologic sequelae is low (especially if low risk pregnancy), but do midwife patients have to sign a waiver that they won't sue if something does go wrong? Is their insurance sky-high like OBGYN's?