Questions about moms in labor

amber1142 · Jun 27, 2005

Is it proper for a nurse to tell a patient who has gone to the hospital in labor to "go home and come back when you can't talk through your labor discomfort"
What is that all about. If you are in labor, in this case every 3-5 minutes documented but do NOT need pain meds just yet, this does not sound proper to me, especially since what is the point of "controlled labor"
That is my rant----happended to my daughter who did agree to go home but had to come back after 3 hours when she absolutely needed pain med control and did deliver 11 hours later
Oh and by the way-----the nurse discharged the patient, never seen by the MD----but supposedly did talk with the MD
Also only 1-2 cm at that particular time

I would think it depends on protocol (either hospital or physician/midwife), whether the woman has had children before, and probably some other factors. I don't know that a nurse should make that call independently.

I don't think it's inherently improper. Very early labor is not always a cause for hospitalization and could be considered a waste of resources.

SmilingBluEyes · Jun 27, 2005

It may not be worded well, but it's a good rule of thumb, particularly for first-time moms. What they MEAN to say is, when the contractions are strong enough for you to have to work/concentrate to breathe through them, it's likely active labor, versus prodromal (early) labor when contractions are weaker and not changing your cervix.

The wording was a bit callous and insensitive, but I get what they were driving at.

I advise them to take a warm bath, eat a light meal and drink plenty of water. I also advise them to use relaxation breathing techniques to see if they help with the discomfort. In active labor, none of the above will make the contractions "go away" or labor "stop". I then tell them:

" Please call me or come back when the contractions have a regular pattern of at least 3-5 minutes apart and you have to concentrate to breathe and stay relaxed through them. Active labor contractions worsen, not diminish or get better, with drinking water, taking a warm bath or using relaxation techniques. They continue to pick up in frequency and strength as minutes and hours go by".

That usually provides the patients a guideline as to whether or not they are in active labor, or having early labor contractions. We know the patient is having contractions, and no one disputes that. The difference between active labor and early labor is, usually, the contractions come much closer together and get harder and harder to breath through.

None of the above applies to PRETERM LABOR, I must caution. If you are earlier than 35-36 weeks and having more than 4-6 contractions an hour, and they do not stop, you need to go to the hospital for evaluation and to have labor stopped, if possible. Preterm labor is another matter altogether.

Oh, and often, yes----- a patient is seen by a nurse in L/D but not actually seen by the doctor. The nurse by law, however, must contact the doctor/midwife and tell that person the patient is there, her history and the current complaint (what brings the patient there) and also the patient and fetal conditions. Both must be stable to be discharged home and this is documented. The doctors where I work review all the charts/fetal heart monitor strips of "rule-out" patients we have seen.

Also, while I have the practioner on the phone, I also always ask for a "sleeper" or some pain meds (commonly morphine) for uncomfortable early labor patients who are being discharged home. The sleeper/med helps them relax but does not stop active labor from progressing, when the time comes. Most patients are a lot happier if we do at least make an effort to sympathize and make them more comfortable if they are told the disappointing news, "it's not time yet". We are adhering to EMTALA guidelines following the above practices.

Good luck and I hope I have helped you some.

bagladyrn, RN · Jun 27, 2005

Is it proper for a nurse to tell a patient who has gone to the hospital in labor to "go home and come back when you can't talk through your labor discomfort"
What is that all about. If you are in labor, in this case every 3-5 minutes documented but do NOT need pain meds just yet, this does not sound proper to me, especially since what is the point of "controlled labor"
That is my rant----happended to my daughter who did agree to go home but had to come back after 3 hours when she absolutely needed pain med control and did deliver 11 hours later
Oh and by the way-----the nurse discharged the patient, never seen by the MD----but supposedly did talk with the MD
Also only 1-2 cm at that particular time

As the above posters said, this really is not inappropriate. The "when you can't talk through" is just a way to give a first time mom an idea of what intense contractions are like as most of them have no real reference point for pain in labor. And yes it is usual for the nurse to discharge a pt. to home after speaking to the provider by phone with her assessment. MDs do not come in to the hospital to assess labor on every patient and few hospitals have a provider in house at all times. Assessing the patient for active labor/ labor progress is one of the duties of the labor nurse.

By the way - congratulations on your new grandchild.

tntrn, ASN, RN · Jun 27, 2005

What they said :)

r_janice · Jun 27, 2005

Im not yet a nurse but I think it is NOT proper.

I actually had this happen to me when I was having my daughter. I went to the hospital Saturday nite at about 930p, with contractions and much pain. The nurses were very rude to me and told me to "go home until the contractions are so bad I cant walk, talk, or breathe during it." :angryfire After a sleepless night and no food, (it was weird I couldnt eat a thing for about 36 hrs before i had my baby) I was right back at the ER in labor with the daughter. Thank god the nasty nurses were done their shift.

I had the best nurse and doc when I delivered my daughter. :balloons: The two of them were great. :)

I understand that my contractions werent THAT close together so there was no way of saying how long it would be before I popped. But they could have said something other than "Go home until the pain is unbearable", which is basically what they said. They could have said it in a nicer way that made sense because all it did was piss me off!! Im in pain and all I get is a go home til it hurts even more. There were two nurses, you would think that at least one of them would explain to me the difference between pre labor and active labor.

Dayray, RN · Jun 28, 2005

Well mabey it was the way it was said to you?

Still as others have said this is a good rule of thumb. Especialy with someone not wanting pain meds. Just last night I told a natural child birth pateint to go home because we would end up doing things to her if she did'nt. I do explain things very thouraly though and I always acknowlage that they are in pain. Still if the contx are'nt that strong, your cervix has'nt changed and you dont want meds, you need to go home.

I sent a lady home last night with percocet and ambien she came back 6 hours later (after sleeping) 5 cm and had a baby. Thats the best thing I could have done for her. She got some rest and woke up in hard labor, got back in plenty of time to get to the hospital.

I supose it's in how it is said. Offten people feel embarrased and confused when they go home. I hope that I have'nt come off so gruff to pateints. I do try to make them feel okay before I send them home but I would agree with the thinking behind what your daughter was told.

allnurses Guide · Jun 28, 2005

Agree with the L&D nurses here.

If your cervix isn't changing, you aren't technically "in labor". We also send women home with the same instructions.

If you aren't "in labor", it sounds harsh, but you are taking up a bed that a mom in labor needs. The hospital I took neonatal resuscitation at yesterday had to close to L&D and send the moms in early labor to other hospitals. One all the way to Sacramento.

steph

r_janice · Jun 28, 2005

I do agree that it is a good idea to send the patient home if they are NOT in active labor. But at the same time the nurse should explain the reasons why the patient is being sent home. I was simply told "Go home and dont come back until the pain is so bad you cnat walk, talk or breath." Now I was a first time mom and I didnt know anything about labor and delivery, all I knew was that I was having a baby :chuckle I think Dayray is right; it was the way the nurses said what they said. I, today at this moment and time, agree that it was right for them to send me home. That day when they said it, I wanted to power sock them both in the mouth. I was in pain they said go home til it gets worse!! Im glad I understand why they did it now, but I probably would have understood then too if they would have explained it better. :rolleyes:

Kaseyrn2b · Jun 28, 2005

Just curious...but do rns always do cervix checks when pts come in? I ask b/c my contrax never really got to the level of pain you are talking about. I went to my OB for a labor check, though I was certain he'd send me home. It just felt like strong menstrual cramps...turns out I was 5-6 cm..I had an epidural when I was 8 cm, but mostly b/c the nurse kept telling me it was my last chance... I must be in more pain than I am letting on etc,...not that I am complaining AT ALL, my little man was 9 lbs w/ a HUGE noggin :chuckle ...he popped out about 15 mins after. I am strongly considering going into OB nursing, but I wonder if it will take me some time to get used to how much pain pts normally feel...

NurseforPreggers · Jun 28, 2005

Just curious...but do rns always do cervix checks when pts come in? I ask b/c my contrax never really got to the level of pain you are talking about. I went to my OB for a labor check, though I was certain he'd send me home. It just felt like strong menstrual cramps...turns out I was 5-6 cm..I had an epidural when I was 8 cm, but mostly b/c the nurse kept telling me it was my last chance... I must be in more pain than I am letting on etc,...not that I am complaining AT ALL, my little man was 9 lbs w/ a HUGE noggin :chuckle ...he popped out about 15 mins after. I am strongly considering going into OB nursing, but I wonder if it will take me some time to get used to how much pain pts normally feel...

At my facility RNs always perform cervical checks on R/O labor patients as long as the patient is not preterm or bleeding. Sounds like you had a wonderful birth experience with minimal pain. Every now and then someone breaks all the "rules". What number child was this for you? This happens much more often with mother's who have had prior deliveries rather than with primips.

One thing you said about not knowing if you will get used to knowing how much pain pt's normally feel .... I don't have any children, I have never been through labor. That does not make me any less of a labor nurse. Pain is a very subjective phenomenon. Some women will be screaming and crying at 1 cm, while other mom's appear quite comfortable at 7,8,9 cms.

I had a patient WALK in a few days ago complete. Literally WALK. I've never seen anything like it in my life. Instead of taking her to a labor room, I took her to triage. Everyone laughed at me when they realized she was complete :chuckle But sometimes you just never know.

BabyRN2Be · Jun 28, 2005

I had a patient WALK in a few days ago complete. Literally WALK. I've never seen anything like it in my life. Instead of taking her to a labor room, I took her to triage. Everyone laughed at me when they realized she was complete :chuckle But sometimes you just never know.

This happened to my cousin. She went in to see her doc earlier in the day and the doc's nurse told her she would go that night. Lisa shrugged it off and wouldn't let it become part of her "wishful thinking." She went home and she started to have contractions. They started to get worse and worse through the evening, but didn't want to go in just to be told to "go home."

Since this was Lisa's 3rd baby (in as many years), I told her not to mess around with anything. Although she wasn't in any real distress, she decided to go in at her husband's behest. They drove to the hospital, he walked her up to L&D leaving the car in an admission spot (but this was in the middle of the night). He knew something was going on...

Lisa thought that this was all for nothing. That she was going to be told that she was 3-4cm, and that the baby would come later that morning. They walked in to L&D, the nurse told her to put on a gown. She got back into bed, she was checked, and she was found to be complete and +3. She said, "No way... they aren't even THAT painful!" The nurse quickly ran out of the room, begging Lisa not to push, got the midwife on standby, and called her doc at 12:15AM. They just let her labor down while the doc got there. Doc arrived at 12:29AM, told her to push, and out came little Matthew at 12:31AM.

She told me that was a little too close for them, and she was glad they went because they live in rural NH. They didn't want an unintentional home delivery, which would have happened if they had waited any longer.

BTW, precipitous labors tend to run in our family. When it's my turn, I'm not taken any chances. I like my car's upholestery.