OK, I just started a new job at a large and very good teaching hospital. I came from a small but very busy level one regional facility. My experience has been with low risk moms almost exclusively. That is one of the main reasons I changed jobs--I have a lot to learn.
Anyway, I have noticed that the moms are getting acoustic stim routinely--maybe two or three times during an NST that to me didn't look half bad. The nurse will use it, the residents grab it---even the students!! I was under the impression that it wasn't the best of practices. But then here I am at a higher level of care and different patients than I am used to. I will be searching for articles, but if anyone knows any off-hand, I would love to see them. I kept my mouth shut at work, but I would be glad to share research with them if there is any.
The reason I sometimes choose to give them a snack is that I have seen it work. Useualy I'll give them a popsicle or soemtimes a littel D5 LR. not to a patient with an aweful strip but to a patient with a strip that is just short of the mark for going home.
Same here. I'm talking about a baby with good variability who just hasn't had a true 15 by 15 accel yet. Obviously, we're not talking about patients with flat strips or decels.
OK, I just started a new job at a large and very good teaching hospital. I came from a small but very busy level one regional facility. My experience has been with low risk moms almost exclusively. That is one of the main reasons I changed jobs--I have a lot to learn.
Anyway, I have noticed that the moms are getting acoustic stim routinely--maybe two or three times during an NST that to me didn't look half bad. The nurse will use it, the residents grab it---even the students!! I was under the impression that it wasn't the best of practices. But then here I am at a higher level of care and different patients than I am used to. I will be searching for articles, but if anyone knows any off-hand, I would love to see them. I kept my mouth shut at work, but I would be glad to share research with them if there is any.
Thanks!
We were always taught that it should only be used in very special occasions. That it can be damaging and to NEVER use it on the belly. It is usually not necessary anyway.
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We were always taught that it should only be used in very special occasions. That it can be damaging and to NEVER use it on the belly. It is usually not necessary anyway.
I heard this in one of my conferences some time ago, too. And that evidence-based practices would not include the use of acoustic stim anymore. I just wish I could remember where....I have some research to do!!!!
I have also heard not to feed a mom, either. There is another rationale for this; should the baby be "bad" like the BPP of 4 we had the other day, and Lord Forbid, a csection needed, you don't want a lot of food in her tummy YOU just fed her. I usually just use very cold water or apple/OJ (if she is not diabetic).
Oh and the lady w/the BPP of 4 did fine-----she delivered lady partslly, but the baby definately had some serious decels in the final stages. The reason? A triple nuchal and bandolier cord!! (what a LONG cord). And at 38 weeks, the kid was barely over 5 lb. Seems the placenta was not quite up to snuff. So there ya go. The BPP was indicated and used----favorable, at least, in this situation. But in the next, a "4" might yield a baby whose apgars are 9/10 and no reason "why" it was so low. You always have to err on the side of caution, as everyone knows.
I'll agree with the point made about non-evidence based interventions being a problem in court. I don't worry too much about it in this case however because it won't really come into question if used appropriately. If a mom came in with giant late's and no veriablity and I choose to give her milk and cookies I'm sure I would hang in court. That is why I only use it in cases where it is appropriate. Sure there is a question about moms aspirating should they need a C/S but I'm not talking about those patients. For a baby that just appears a little sleepy some fluid and sugar often does the trick. So I guess the deciding factor is again judgment (something we are being allowed to exercise less and less in our field).
I'm kinda surprised to hear that the sounds from the digestive tract will wake a baby up. Can you post a source for that info? I had thought that the digestive tract was always moving and would have assumed that a baby who doesn't respond to position changes wouldn't notice a little extra noise in the digestive track. Guess I learned something new, I'll be interested to see that info in an evidence based study.
The reason I sometimes choose to give them a snack is that I have seen it work. Usually I'll give them a Popsicle or sometimes a little D5 LR. Not to a patient with an awful strip but to a patient with a strip that is just short of the mark for going home.
I will have to do some digging, but I will find the resource. I initially heard it from a Michelle Murray conference, so I will have to look back at some old conference materials.
RNnL&D
323 Posts
Same here. I'm talking about a baby with good variability who just hasn't had a true 15 by 15 accel yet. Obviously, we're not talking about patients with flat strips or decels.