Pt. positioning with epidural

BETSRN · Dec 20, 2003

Actually,Smilingblueyes, the squat bar is VERY useful when a woman has no leg power. You don;t have to use your back at all.

renerian, BSN, RN · Dec 20, 2003

I am glad I just had mine natural without all the "stuff". Painful but it was nice to get up fast and not bother with all the equipment/needles-the fetal monitor was necessary but a pain.

Hail to all you who work with pregnant/birthing moms. Not for me at all.

renerian

gypsyatheart · Dec 20, 2003

Originally posted by BETSRN
Actually,Smilingblueyes, the squat bar is VERY useful when a woman has no leg power. You don;t have to use your back at all.

Ditto, Bets! I LOVE the squat bar! It really does save the back, we use it probably 90% of the time, in a variety of ways. It does depend also if the pt has an epidural or not, in terms of pushing, but even w/epiduarl the sqaut bar is useful! Often, if their epidural is dense, I'll let 'em "labor down"...no point making it hard on mom, baby...and nurse. LOL Our epidurals are great now, however, because mom still has use of her legs and can move...what a difference from several years ago!

Deb, I agree, you definitely have to guard your back, no matter what area of nursing you work in! Once your back goes, forget it! :)

justjenny · Dec 21, 2003

I haven't done an OB clinical yet, but I have had two kids so...

My first was totally natural - no drugs. My second I had an epidural and I laid flat on my back. After awhile, another nurse came in and yelled at my nurse about raising my head up (as mentioned by another that the meds follow gravity and they didn't want it flowing "up" instead of "down") that actually scared me to death! I had visions of my chest suddenly becoming numb but I don't know if that is *actually* possible! (laboring moms can get crazy, eh?!)

I always look at the positive side of things.... my epidural "fell out" sometime during my labor. I suspected as much, but because I felt no pain I didn't complain. I feel very lucky because I was able to have pain control, but no real loss of feeling.... the contractions were *so stong* but did not hurt! I was up and walking very soon after because of the small dose of meds.... ?

As far as positioning, both were the "traditional" flat on yer back, legs in stirrups with absolutely no problem. Hey, whats worked for *so* many years must have some value....

Jenny

ADN graduate class of 2005

SmilingBluEyes · Dec 21, 2003

I know squat bars are great...in their place.

our epidurals must be too dense..

the squat bar is absolutely useless once they get em. useless I too, wind up letting them "labor down to at least plus 2-3 before I even start them pushing. The uterus does fine work on its own after all. who needs a squat bar in that case?

mitchsmom · Dec 21, 2003

I used a birthing ball with my third labor.

To back up, I had epidurals with #'s 1&2, with one I walked the halls a little bit then pretty much got stadol and epidural in quick succession and then laid there all night until I pushed him out semi-fowlers with me and a nurse, husband, or my mom taking turns holding other leg, I couldn't move my legs much to be in any other position and I only pushed about 30 mins anyway.

With #2 I was already 5cm and having to think about it so I don't remember walking, but I did get in the bath and loved it. I wanted to "try to go without an epidural this time" but I feel like I didn't get a lot of support from my nurse (I actually love her but instead of saying "if you're going to get it you have to do it now, it might get pretty bad later", etc... I wish she'd helped me get through it more)... anyway got out of the bath and got the epi and laid there until I had him semi-fowler's but using stirrups. *I* actually wanted the stirrups & I think they were the kind under my leg more than the under my feet kind like at the doc's - I know they changed whatever stirrups they used at first and then the second kind (or position) were better. Oh yeah, there were also some handgrips down by my hips that were GREAT!! I felt like they really helped me get leverage to help push effectively (pushed about 30 mins again).

With #3 I thought I waited at home a long time but I was only I think like 2cm when I arrived so I walked around alot, alternating with music in bed during intermittent monitoring, then when that got old (and labor too hard), I tried the bath again after loving it w/ #2... didn't like it too much this time - I think I was too far along to get comfortable in there, got out and sat on the ball at the foot of the bed with husband sitting facing me at foot of bed so in an ironic twist I was essentially sitting OB doc style at his crotch but it really worked for me and I think I liked the ball because it "gives" with your bottom and you can rock and sway around. The nurse would do counter pressure on my back and I could hold husband's hands and burrow into his stomach (body) during ctx. When it was time to be checked/monitored again I climbed in the bed and it went pretty fast after that so I didn't end up moving again although it was MUCH less painful out of bed throughout the whole thing. Laying down just did not feel good. I delivered in semi-fowlers once again although I started out side-lying and I think it would have finished that way if someone didn't ask me to turn over (I was pretty out of it by then in the thick of it). We also had a few moments of shoulder dystocia (evident after I was already on my back)-McRoberts/suprapubic pressure so I would have needed to be on my back for those anyway if he would had been stuck had I stayed in side-lying. Doc broke my water at the last minute and I think that's why he was stuck because he basically came flying down after that and I don't think he had a chance to get positioned properly - I didn't even want the water broken but I was worn down by the end. It wasn't too much of a nightmare dystocia, I felt him come out from under the bone with the suprapubic pressure and he was really bruised but otherwise fine. The nurse told me later she had been afraid they'd be resucitating him. I didn't really push that much, only a few times after I had the urge myself at that irresistable point (I guess you could say that I definitely "labored down") and then of course doc was like DON'T push (b/c of dystocia)!!!

Anyway, sorry to get on a tangent... you know how everyone is into their birth stories!!

nekhismom · Dec 25, 2003

I haven't started working yet, but when i had my son 2 years ago, I was on my back with legs in stirrups. I asked to walk, was told no, dr. doesn't allow it in active labor. I was only 5 cm dilated, but they considered this active. I did get to squat for about 5 minutes, but baby couldnt tolerate it. SO, back on my back I went. ON a side note, the squat bar made my shoulders so sore the next day i couldn't even lift my 7 lbs. 2 oz baby, and I thought I was going to die when I tried to wash my hair! LOL. I don't know if I didn't use it properly or what, but it was bad.

BETSRN · Dec 25, 2003

If you have a doc or go to a facility where they will not let you out of bed (in labor) then RUN to a new facility. That kind of philosophy is what leads to increase uswe of interventions and poor birth outcomes.

Betsy

BETSRN · Dec 25, 2003

I was talking about the squat bar being good wen the epidural IS too heavy. If you put up the bar and have the mom place her feet on it, it is a great tool for pushing. The bar will support her very heavy legs. You use the bar IN PLACE of the footplates or stirrups.Tie a towel around the bar and have her use that to pull on (instead of the bed handles). I realize if the epidurals are too dense then the patient cannot squat.

fourbirds4me · Dec 26, 2003

We do not even have squat bars for our beds and I have not seen the labor ball used since I've been here. Someone told me that our manager could not find squat bars to fit our beds. If anyone knows where they can be found I would be happy to pass the information on. I don't know the model but they are the wooden looking beds..... and my guess would be they are about 10+ years old.

BETSRN · Dec 28, 2003

Our beds have a wooden headboard and they are called Affinity beds. I think (not too sure though) that they are amde by Hill Rom. Ours are our original beds so they muct be at least 12 years old.

If there are two little holes on the base (by the heel end) of the footplates, that's where the squat bar fits in.

I would suggest asking your Bio-Med department about how to look into ordering a squat bar. Bio-Med should have all the manuafacturer's names of the equipment the hospital uses, as they ahve to be able to refer to the companies for repairs.

L&D_RN_OH · Jan 4, 2004

Positioning after the epidural is up to the CRNA or anesthesiologist. Some prefer low fowler's with a tilt, while another prefers semi fowler's. No one puts the bed completely flat. During labor, we alternate sides, and for pushing generally use semi fowler's with legs held up. That's what support people are for. Support. :chuckle If that's not working, we try side lying as well.

We also use the squat bar, birthing ball, toilet, Jacuzzi, sidelying, hands and knees. I have had some women in every position. I remember one in particular, who opted for pushing in some kind of cross country skiing pose. It worked for her. I wasn't too happy when she tried it standing on the bed, but...... :roll