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
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.
Wow, I'm amazed that she was able to hold that baby in at a +3 station for 15 minutes while her doc got there. Usually in this situation I end up delievering the baby :chuckle The nurse probably shouldn't have left the room if she was really +3. Glad everything turned out great.
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.
I had a patient come to triage c/o contractions for 1 hour. She was so stoic, I thought she was probably in early labor. When I got FHT way down, practically in her pubic hair, I said, Uh, I'm going to check your cervix before we do anything else. She was complete and +3. I called out for the doc who was a few rooms down following another delivery. They said she was taking that pt to the OR for a D&C. I said, no, she needs to come now. The pt delivered in triage a few minutes after the doc ran down the hall.
I arrived at the hospital with my third, walked all the way up to L&D, used the bathroom (saying "I would feel a lot better if I could have a bm :chuckle ), was obviously complete when the midwife checked, and delivered my daughter about 3 minutes after starting to push.
With my fourth, we didn't make it to the hospital, before he slid out with no pushing.
I tell people all of the time to come back when pain gets to where you cannot walk or talk thru them. It is a reference point for them..as opposed to coming in smiling, full makeup on and an entourage bigger than the preidents. Contractions ever 3-4 mins doesn't mean much if the cervix is closed. Everyones pain tolerance is different also. I find family members have a harder time with being sent home than the actual patient sometimes.
Don't mind me....I shouldn't be replying..I am cranky. Just wanted to express that I say the very thing you described....but as a reference. I am not mean or berating about it. Sometimes those first time mommies have that horrible prodromal labor that last weeks. I feel for them.
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.
Yes, I had one before...this was w/ #2, my ds. I was induced w/ my dd...contrax were so much worse w/ her. I think she wasn't 'done' yet, but the docs insisted on induction. I was 2 1/2 weeks late, and something was said about calcium deposits on the placenta? Anyway, thanks for your reply, you make great points :)
Yes, I had one before...this was w/ #2, my ds. I was induced w/ my dd...contrax were so much worse w/ her. I think she wasn't 'done' yet, but the docs insisted on induction. I was 2 1/2 weeks late, and something was said about calcium deposits on the placenta? Anyway, thanks for your reply, you make great points :)
If you had calcium deposits on the placenta then she was "overdone".
I tell people all of the time to come back when pain gets to where you cannot walk or talk thru them. It is a reference point for them..as opposed to coming in smiling, full makeup on and an entourage bigger than the preidents. Contractions ever 3-4 mins doesn't mean much if the cervix is closed. Everyones pain tolerance is different also. I find family members have a harder time with being sent home than the actual patient sometimes.
Don't mind me....I shouldn't be replying..I am cranky. Just wanted to express that I say the very thing you described....but as a reference. I am not mean or berating about it. Sometimes those first time mommies have that horrible prodromal labor that last weeks. I feel for them.
This is often where doulas step in as a valuable service to help save the sanity of an L&D nurse. :) We will go to the mothers home, reassure her, etc so she's not so antsy. I use phone contact as well to talk with the mother about how she's feeling and what she can do in early labor to get her mind off things and not be focused too early.
I totally agree with BK about contraction length. All the time, I hear about contractions being 5 minutes apart and lasting a minute long. But if she's not working with them (and we're talking average primips here), she's often going to show up way too early to L&D and either be sent home, or put on the clock.
I was 37 weeks pregnant with my first child, and was having non-painful, close, but somewhat irregular contractions (5 minutes here, 2 minutes here, then 3 minutes, etc). I called the doc on call, and when he found out I was 37 weeks, he said, rather rudely, "37 weeks..come on the hospital so I can send you back home." Yup--my son was born less than 3 hours later!!
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.
:balloons: (((((((Deb)))))))) You sound like a darn good ob nurse -- one I would have loved to have when I was pregnant with my three girls. I LOVE reading your ob/gyn comments all the time. Your comments are professionally put, thoughtful, sensitive to the need being presented, compassionate, caring, and they just plain ol' bring a smile to my face when I read what a great ob nurse you are. Don't mean to make you blush or anything, but I've read numerous comments on this forum from you, and I'm super impressed all the time. If the Lord blesses me with enough money to build and run my own health center one day, I'd want nurses just like you to work for me. :icon_hug:
Specializes in obstetrics(high risk antepartum, L/D,etc.
((((((((((((Deb))))))))))) I also find your posts really good. Thanks for making all us L&D nurses look good!!
I usually will teach patients (and SO) to palpate contractions. I use the old "cheek, nose, forehead" comparison. I have even taught this over the phone. It is a really good way to #1. help the patient come to the hospital at a more appropriate time, and #2. It keeps them busy. I also prefer to send them "to the shower", telling them to let that warm water run on the sore spot on her back. I have had moms come back for their next baby and tell me that they will always remember my teaching and pass the info on to others. Everone benefits!
So far as "does the RN make the decision to send the patient home". In so many words, yes. What I tell the MD/ CMW on the phone is what they use to make that decision. Often I have been asked "What do you think?" This is one of the tricky things that make OB nurses unique. :yelclap: :yelclap:
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
wow Judy and Renee, I am blown away by your compliments. THANK YOU from the bottom of my heart.
I needed that today.....just had a kinda rough day in OB. I have my days when I wonder if I even BELONG In OB. (we all have challenging days right?). I really thank you, it meant a lot to hear all this.
We tell pt's all of the time to come back when their contractions are stronger. They may have regular and in fact, painful contractions, but only a very early stage of dilitation or none at all. Honestly these ladies will be more comfortable at home and they are often told to go home. Sometimes we send sleeping meds like Ambien or pain meds like Percocet or Darvocet with them. I think many times, they are really disappointed that they are in pain, but not in labour. I feel awful for a lot of them, but there is very little we can do. Many times, they will ask for things like artificial rupture of membranes or pitocin augmentation. The truth of the matter is, esp. w/ a first baby, their cervix isn't very responsive to these interventions if it is thick and only 1 cm and they may end up as a c.section if the physician or midwife gives in to their wishes. Occasionally, we do therapeautic rest with patients and we keep them and give them meds for pain or sleep and sometimes an IV for hydration. We are more likely to keep pt's like this if they live far from the hospital, are multiparous, or have visited us numerous times. Prodromal labour doesn't mean it's painless. This is one area of teaching that I find physician's offices to be quite deficient. MY advice to first time moms is to please take classes, please try comfort measures like warm showers and positioning before deciding they will not work w/o trying them, and please realize that many times, we can't eliminate your discomfort in early or prodromal labour. If we work together, often times we can signifigantly reduce your pain. We will try our darndest to help, but only time will solve this problem. Truly, I think some patients are totally wiped out from prodromal labour and can't even recieve all of the info. we give them. Best of luck to your daughter!
NurseforPreggers
195 Posts
:chuckle
Wow, I'm amazed that she was able to hold that baby in at a +3 station for 15 minutes while her doc got there. Usually in this situation I end up delievering the baby :chuckle The nurse probably shouldn't have left the room if she was really +3. Glad everything turned out great.