There is a doctor that I work with....he likes to break the bed, use stirrups, vacuum and fundal pressure (ugh) on every single delivery. No matter if she's a primip or grand multip.
Well....hehe....good patient advocate that I am...I had one of his patients yesterday. She wasn't too fond of him (going to him by default, he was the closest OB, she lost her previous OB). She had a prior SVD with no comps.
Well well well, while Mr Stirrup man went looking for his infamous stirrups to add to the bed (we don't have them on most of our birthing beds, or in the rooms - they are RARELY used), I had her pushing. I mean, vigorously pushing. I wanted to get this baby to crowning+ before he came back in the room, carting his darn stirrups. Back in the room he comes - complaining that he couldn't find his darn stirrups, and no one knows what he was talking about (the type he wanted), and here I have the patient crowning with pushes. Bed is not broken - why bother? She can easily pass this baby out, not anticipating shoulder problems, etc. With his back turned to the patient while she's pushing, here comes the head....I tell him - "hey, no need for those stirrups here....and you wanna get some gloves on?" ..... while I'm starting to deliver the head. He quickly dons gloves, acting flustered because he has an unbroken bed, no stirrups, and god-forbid no vacuum or fundal pressure (cause I sure as heck am NOT doing it for him), and a normal delivery occurring right before his eyes!
In the end....no epis, no vaccum to this little one's head, no lacs even!
Hehe....score one for the nurse who advocated for her patient.
Afterwards....he complains to me "what if I needed forceps? or a vaccum? You're not going to be able to hold her legs up." Wanna bet buddy? I do it all the time for the other docs. And if we have an operative delivery like that, there is always a 2nd RN in the room.
:balloons: It was an excellent birth, and I hope I can help this doc see the light of a non-operative delivery, and how wonderful it can be.
The stirrups did not upset me as much as his routine use of FUNDAL PRESSURE. Stirrups are useful for extremely heavy people, when holding their legs for an hour or more can be taxing. I am not against their use in all cases. But fundal pressure in labor is NOT warranted, and in fact, is dangerous.
Yes, I know - all I can do is just document, document, document, when he does use it. And also try and get the patient pushing so much and having the head down so low that he has a 'precip' delivery.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
naturally all you can do is document. But like I said, the stirrups are not the big deal here, it's the fundal pressure. I have not worked with a physician in YEARS who did this practice. You are right, document the heck out of it......and hope for the best. And be sure if he asked YOU to do it, you do not. Good job!'
By the way, has the fundal pressure issue been brought up to your manager/director and the OB commitee???? I bet risk managers there would love to get hold of this one....
naturally all you can do is document. But like I said, the stirrups are not the big deal here, it's the fundal pressure. I have not worked with a physician in YEARS who did this practice. You are right, document the heck out of it......and hope for the best. And be sure if he asked YOU to do it, you do not. Good job!'
By the way, has the fundal pressure issue been brought up to your manager/director and the OB commitee???? I bet risk managers there would love to get hold of this one....
Yes, it's been brought up. We're with a temporary perinatal director right now, til we get a permanent one to replace the one who left in December.
I need to make a big stink again about the fundal pressure. It's just ridiculous, and has to stop.
I never understood why the stirrups are used in a delivery either. I also don't understand why a nurse has to hold up a pt's legs for birthing. I locked my arms around the back of my legs, clasped my hands over each wrist and out she came. :)
I never understood why the stirrups are used in a delivery either. I also don't understand why a nurse has to hold up a pt's legs for birthing. I locked my arms around the back of my legs clasped my hands over each wrist and out she came. :)[/quote']
Sometimes the docs will say-the nurse will help you hold your legs.... I instruct them to hold their thighs or knees, NOT me....I saw two co-workers permanently disabled with back injuries from holding legs...no more for me, I need to work for another 20 years!!!
Not to be a smart alec but how is someone not able to hold their own legs?
There are physical issues like weight and disability that can interfere, but beyond that some women are pushing for hours after HOURS of hard labor and just don't have that extra strength anymore. With the way my wrists have been screwed up from nursing, I don't know if I could do it for long :chuckle
There are physical issues like weight and disability that can interfere, but beyond that some women are pushing for hours after HOURS of hard labor and just don't have that extra strength anymore. With the way my wrists have been screwed up from nursing, I don't know if I could do it for long :chuckle
Exactly - some just can't reach due to that large baby in the way. And they are tired too. I don't have a problem with stirrups and think they are useful but not for everyone. Some docs have us break down the bed and some don't. I don't see a problem with that either. Every women is different. I would not have appreciated being made to move from my back unless the baby was in distress - I might have slapped anyone who tried while I was in transition and then pushing. There was a point for me where I just didn't want to be touched - I needed to focus . .and having my feet in stirrups and holding onto handles helped me focus my strength. Holding onto my slippery legs would have really made me mad.
Every woman knows her own body and will usually get in the correct, for her, position.
Now fundal massage . . that is a whole other story. I'm with Deb on this one.
Exactly - some just can't reach due to that large baby in the way. And they are tired too. I don't have a problem with stirrups and think they are useful but not for everyone. Some docs have us break down the bed and some don't. I don't see a problem with that either. Every women is different. I would not have appreciated being made to move from my back unless the baby was in distress - I might have slapped anyone who tried while I was in transition and then pushing. There was a point for me where I just didn't want to be touched - I needed to focus . .and having my feet in stirrups and holding onto handles helped me focus my strength. Holding onto my slippery legs would have really made me mad.
Every woman knows her own body and will usually get in the correct, for her, position.
Now fundal massage . . that is a whole other story. I'm with Deb on this one.
steph
Personally, I LOVE to use the squat bar as a foot rest. It's better than the foot plates. Tying the sheet around the bar as a pull makes it even more effective.
Dense epidural, out of control, frightened, handicapped, resting legs in between, leg cramps, multiple sclerosis, morbid obesity, knee surgery, arthritis, to name just a few of the things I have encountered.....
Bed is not broken - why bother? She can easily pass this baby out, not anticipating shoulder problems, etc. With his back turned to the patient while she's pushing, here comes the head....I tell him - "hey, no need for those stirrups here....and you wanna get some gloves on?" ..... while I'm starting to deliver the head. He quickly dons gloves, acting flustered because he has an unbroken bed, no stirrups, and god-forbid no vacuum or fundal pressure (cause I sure as heck am NOT doing it for him), and a 
RNLaborNurse4U
277 Posts
Yes, I know - all I can do is just document, document, document, when he does use it. And also try and get the patient pushing so much and having the head down so low that he has a 'precip' delivery.
Jen
L&D Nurse