Stirrups?

[CEG]

Just curious how many use stirrups for delivery? I am a relatively new nurse and just started OB at a new hospital. I am surprised by the fact that everyone- epidural, no epidural, etc delivers in stirrups. I had not seen that anywhere else before. Just curious how other hospitals use stirrups and what percentage of moms? And medicated/unmedicated?

I usually have my moms push without them (unless the epidural has rendered them unable) and put them up when doc gets there but I would love to stop getting them out at all. I know research has shown stirrups use to lead to more perineal injury but I am curious what everyone else's practices are before I rock the boat.

[jenrninmi, MSN, RN]

We have ours up in stirrups unless it is a precip and we don't have time to break down the bed. Our docs believe it's for safety reasons.

[hoppermom3]

We have 1 OB-GYN who delivers in stirrups with the bed broke down. This looks terribly uncomfortable and unsafe to us. Moms feel as though their rear ends are just "hanging in the air". He also wants all the lights on bright.

Our family prac doc and our CNM both deliver with the bed intact, no stirrups. With both of these, usually the provider sits on the edge of the bed, the lights are very dim, and it is a calmer atmosphere. The only time we break down the bed for them is if they need to do a repair.

[lisamct]

We pretty much never use stirrups unless its an instrumental delivery. Most of our women deliver on all fours, left lateral or standing up so it wouldn't be an option even if we wanted to (which we dont!)

[Dayray, RN]

I only use stir-ups if the leg is just to numb and to heavy for me to help her with (very rare). I just think they look bad and hurt.

I do have to question some of the other things they are saying about posistion and breathing.

I have read things about open glotis pushing and it all makes sense BUT I tried it with epidurals and without. People just didnt push well with open glotis in fact the baby didnt move at all I really wanted it to work so i would have them use open glottis for an hour, there was little to no progress at the end of that hour and then we woudl use closed glotis and things moved right along

with respect to position: the people i work with are pretty educated and frequently have doulas. many of the doulas guid them threw pushing or patients have their own prefrances. squt bars and hand and knees are common. If the pateint has a preferance or if the doula is working with her i tend to just go with it and let them do whatt hey want usualy i find that progress on squat bars is poor and the pateint expends so much energy they tire quickly. hand and knees seems to work well but most pateints don't seem to like it. I have read the reports and honestly I dont care what posution people use BUT after they squt or use hand and knees and ask for help I have not found a postion that moves a baby faster then lithotomy with hands behind the knees and yes closed glottis pushing.

Ive seen allot of babies born in hands and knees and only a few in squating. belive me i try to help people do them and im really not sure why my personal experiances dont seem to reflect what the studies show.

I offten wonder what population these studies are done on. in the US people dont squat much in everyday life in other countries its pretty common maybe thats why We dont see the same results from it as studies show.

Thoughts? (please don't quote studies i have read them) please talk about what you ahve seen (more then once or twice).

[vandermom]

Most of our pt deliver with bed broke down and foot rests up. Not the traditional stirrups just foot rests. Most push until crowning before going into delivery position. Some family practice deliver without breaking the bed but not the OB's. Some doc are ok with allowing us to push the baby down however we can and others are actually right there the entire time and just don't allow enough time for the perineum to stretch. I quite often use a sheet pull when my pt isn't pushing effectively. This allows her to feel which muscles are the correct ones to use when pushing. Babies just don't come out the neck!!

[OzMW]

Lithotomy has been shown for some years now to be detrimental to women and fetus'! It should only be used for intruemntal birth (and then thats debatable!). Try getting woman off the bed....works alot better!

[OzMW]

We pretty much never use stirrups unless its an instrumental delivery. Most of our women deliver on all fours, left lateral or standing up so it wouldn't be an option even if we wanted to (which we dont!)

What she said...............:up:

[OzMW]

We have ours up in stirrups unless it is a precip and we don't have time to break down the bed. Our docs believe it's for safety reasons.

Have you asked them exactly what the 'safety reason' is? They are actually causing more harm potentialy!!!!!! :argue:

[HeartsOpenWide, RN]

I am still in nursing school, one year left for my BSN but I took an extra summer class doing a preceptorship in OB and am a doula and have taken a begining midwifery course which allows me to look for an apprentiship and eventually and become a Lm (but still going the CNM oute) and what I have noticed is that it depends on the provider not the hospital...and it seems to be the ones that use more interventions and have the additude of "I deliver babies" and not "I help women birth their babies" use stirups more

[HeartsOpenWide, RN]

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!

Laying in a lithotomy position does not straighten the birth canal, it causes her to push against gravity; it is the worst position for a woman to be in...were you saying your doctors or wack or that you agree with them? I I hope not the later..

[rnmomtobe2010]

Kinda hurts my feelings because I never got the chance to push..let alone sit straight up, pushing, while my feet were in stirrups... Never mind..I'll pass...

[nurseshepherd]

Laying in a lithotomy position does not straighten the birth canal, it causes her to push against gravity; it is the worst position for a woman to be in...were you saying your doctors or wack or that you agree with them? I I hope not the later..

The later for sure....we do everything we can to encourage moms to get in the position they find most comfortable while laboring but regardless of how great they are doing in a side-lying or squatting position, the docs insist on lithotomy and their rationale is it straightens the birth canal....we argue (professionally of course) and supply them with all kinds of research material to educate them, but to no avail, ignorance persists.