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.
We don't use fundal pressure very often, thank goodness, but in the cases where we have had to resort to that, we were one step away from disaster with no where else to go. I also hate it, but when it is warranted ( such as with shoulder dystocia), I have no problem doing it....Rarely, thank God...
Specializes in LTC, assisted living, med-surg, psych.
This thread takes me back to the 'bad old days' of childbearing, when they still gave enemas and pubic shaves to laboring women, did episiotomies whether we needed one or not, and strapped us into what I called the dead-bug position to give birth.......I'm glad my daughter can look forward to more humane treatment!! :)
Of course, her risk for a Cesarean is probably twice what mine was, she's apt to receive an epidural which may affect her ability to push her baby into the world on her own, and vacuum-assisted deliveries are so common nowadays at our hospital that it seems every other baby has the telltale funnel-headed look. But at least moms have more choices than they did back then, and maybe someday we'll get to where childbirth is seen as the natural and miraculous process it is, rather than a medical event which must be 'managed' like an illness. :)
We don't use fundal pressure very often, thank goodness, but in the cases where we have had to resort to that, we were one step away from disaster with no where else to go. I also hate it, but when it is warranted ( such as with shoulder dystocia), I have no problem doing it....Rarely, thank God...
I'm still a fairly new nurse, so maybe I'm wrong, but I thought fundal pressure was never appropriate in the second stage of labor. Suprapubic pressure, yes, when warranted, but never fundal pressure. Wouldn't fundal pressure compound a shoulder dystocia?
I just read that they don't give enemas anymore. Is this true? I myself love the idea of enemas...cuts out on the whole...soft serve ice cream thing that tends to happen.
And a final thought concerning stirrups...who ever invented them did not have the anatomy of the human foot in mind. To this day I have no idea how your heel of the foot is supossed to fit in it..on it....whatever. You know what I mean? I stick my whole foot through the hole but even thats uncomfortable. :chuckle
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No enemas here. the idea is not great cause you will just wind up feeling rotten after....and potentially week. It CAN cause electrolyte problems for some....
Specializes in LTC, assisted living, med-surg, psych.
I just read that they don't give enemas anymore. Is this true? I myself love the idea of enemas...cuts out on the whole...soft serve ice cream thing that tends to happen.
:chuckle
Oh, darlin', you just haven't lived until you've had a liter of soapsuds squirted up your hiney while coping with contractions three minutes apart......and then they want you to HOLD IT!!!!!
BTW, even after that ordeal I STILL did the soft-serve thing. :imbar
I know what foot pads are but we here have those tiny little stirrups for feet. You know the prehistoric things made of metal. No way they're used for legs. I knowwhat stirrups you use for legs and what you mean. (Saw them on ER :) )
That's the way to be a patient advocate. we all have to make sure some of these doctors out there realize that birth is NORMAL.... leave the woman to go with her own instints and they push these babies out with out much or any help..... We have a new group of Doc's comming to our Dept to deliver...and we heard they use stirups...well the stirupps on our dept are no more...they have gone missing....we don't use them any way so we made sure that they are no where to be found..... All of us in Labor and Delivery have to remember we are there for our patients first and fore most...... :)
i am reading this thread with interest as I am a nurse and midwife planning to move to USA later this year as L&D nurse. Please tell me that enemas are not mandatory! Also, fundal pressure in shoulder dystocia would only ansure the shoulders got REALLY impacted instead of maybe slightly.
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 
Mermaid4
281 Posts
We don't use fundal pressure very often, thank goodness, but in the cases where we have had to resort to that, we were one step away from disaster with no where else to go. I also hate it, but when it is warranted ( such as with shoulder dystocia), I have no problem doing it....Rarely, thank God...