Stirrups?

shortstuff31117 · Jul 21, 2008

I'm interested in others replies because I'm still new at this too.

Its pretty standard to use stirrups where I work, so that's what I'm used to, but would love different ideas.

Pretty much everyone where I work gets an epidural, and the docs like them in stirrups. If they can move their legs pretty good, I will go without the stirrups, but almost always when the docs walk in, they want the stirrups out. If they dont have an epidural, I'll pull the stirrups halfway out, sometimes, to give them something to rest their feet on.

JaneyW · Jul 22, 2008

AWHONN will be publishing their 2nd stage guideline update soon--watch the website for it and order it. I saw a lot of the content at the convention in June and stirrups are definitely on the outs. Perineal and lower extremity nerve damage from having the legs pulled up and back and apart. The recommended position for pushing was sitting upright with the feet flat on the bed. I have used it and it works well. You can always lay them back and get the legs up when the doc comes--they will probably ask you to do that anyway and wonder what you had been experimenting with. :-)

shortstuff31117 · Jul 22, 2008

I'm just trying to picture this LOL. Have them sitting straight up? and then their feet are on the bed while they push? Do you lower the foot of the bed or just leave it? I'll have to try it!

RN1989 · Jul 22, 2008

When I worked OB years ago it depended on the doc. Some wanted them and some didn't. A lot of times it depends on the local custom. It can be difficult to get some docs to change their habits even when hit in the face with evidence based practice.

CEG · Jul 22, 2008

AWHONN will be publishing their 2nd stage guideline update soon--watch the website for it and order it. I saw a lot of the content at the convention in June and stirrups are definitely on the outs. Perineal and lower extremity nerve damage from having the legs pulled up and back and apart. The recommended position for pushing was sitting upright with the feet flat on the bed. I have used it and it works well. You can always lay them back and get the legs up when the doc comes--they will probably ask you to do that anyway and wonder what you had been experimenting with. :-)

Can you explain this more? I am a member so I will check out the website but I am heading into work and might be able to put this to use...

Our docs honestly dash in in time to catch. There are many times when getting stirrups out would probably not happen due to time. Either way I would like to think I did some good.

rph3664 · Jul 22, 2008

I'm just trying to picture this LOL. Have them sitting straight up? and then their feet are on the bed while they push? Do you lower the foot of the bed or just leave it? I'll have to try it!

I think the person was talking about the patient squatting on the bed.

RNmama05 · Jul 22, 2008

Our OB residents use them, our midwives generally don't. I think it's about provider training and convenience more than anything- and fear of shoulder dystocia.

JaneyW · Jul 22, 2008

Squatting is also good, but this is not squatting. Sit them upright and have them lift their knees up so that their feet are flat on the bed. You can lower the foot of the bed if you like. They had some pics of women where the bed looked like a recliner chair with the back up, the foot down and them leaning forward over a tray table and pillow. This allows for good blood flow to the baby and it makes descent easier as well.

I went to two presentations about second stage that were quite eye opening. Both about positioning and strips. How we will ignore ugly strips because "they are pushing". They reminded us time and again that a lot of 2nd stage is our show with providers who come in and catch. As professionals we need to make sure we are being as safe as possible for our pts. Pay attention to baseline and variability. Labor down. Push every other UC when you have bad variables. Keep them upright or on their side for optimum blood flow. Don't do the old hold you breath and count to ten three times--let them do open glottis and don't push for more than 6-8 seconds three times a UC. Don't jam their legs back and open.

This may not be how we were taught or the culture in our facility, but this is the standard of care from our professional organization based on EBP. This is what the lead experts in our field are recommending. Experiment a bit. Read the research. You can use the research to advocate for your pts.

nurseshepherd · Jul 22, 2008

We still have doctors who fall out if the patient is sitting up at a 45 degree angle because it is bending the canal and they insist on having the bed almost flat to make the birth canal straighten out. Most of ours are up in stirrups, but one of the larger hospitals I worked at still puts women up in lithotomy and straps them in! :confused:

mom2michael, MSN, RN, NP · Jul 22, 2008

I despise stirrups because it makes the entire process look so clinical and it just boils my blood that childbirth has shifted to be clinical rather than natural. But that's my CNM desire coming out in me.

Anyway, glad to see some EBP coming to light. Can't wait to start trying this out. Our OB's will crap when they see it, but they are just there to catch anyway..

judy ann · Jul 22, 2008

Good grief! I've been out of OB for about 8 years, and hadn't used stirrups for several years before that. I had worked in several different hospitals, and with "young" and "old" docs as well as midwives. I guess that we are just more modern around here. Who'da thought?