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Stop! Is that Assessment Really Necessary?

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Specializes in Tele, OB, public health. Has 8 years experience.

While playing with my 3 year old daughter today, I had an opportunity to reflect on an issue that deserves more attention among nurses: Why do we do the interventions and assessments we do? Are they always necessary, or even appropriate?

Stop! Is that Assessment Really Necessary?

My daughter declared that her toy horse Jack had "died". She was very carefully checking him over and giving him "medicines" with her toy vet kit. I asked her if Jack was going to come back to life, to which she replied, "No mommy, Jack is dead" My immediate thought was why are we attempting to treat Jack at all if he is beyond help?

I immediately thought of an issue that had been annoying me at my current job. Recently I began working nights at a postpartum unit, after working days on a telemetry unit. One of the biggest challenges has been learning to group my cares and work around the patient's preferred schedules; after all, as my unit is low risk and my patients are generally young and healthy, they do not require the same frequency of a nurse's presence as the patients on a telemetry unit. Moreover, there is a lot of emphasis placed on our patients getting enough rest and sleeping according to their baby's schedule.

Sure there are exceptions: the fresh c-sections, the preeclampsia patients, the late preterm babies. But generally speaking, far less is needed from me on an average night than at my previous job. Still, many of the senior staff members insist on doing interventions and assessments that are completely unnecessary. There is a consensus on following "rules" because "we have always done it that way". To me, this means these nurses are not using critical thinking and are not individualizing their care plans based on what a particular patient actually requires.

A perfect example is the "order" that babies that weigh less than six pounds automatically require every four hour vital signs-even if their birth weight started out above six pounds. As this is my first OB job, I did not question this practice at first. But as I began to become more comfortable and knowledgeable, it began to trouble me.

Carrying out every four hour vital signs often meant that I was going into a room at 0400 and waking up mom and baby for no specific reason. Often these babies were term, AGA, low bilirubin level, had no body temperature issues, and all other systems had been WDL; sometimes these frequent vital sign checks were occurring at 0400 when the mom and baby were scheduled to discharge home later that morning.

After a while I began to ask "why?" Was this really necessary? Is it even an order?

I sat down and examined my order sets- there was no order for every four hour vital signs due to weight. I checked my facility's policies and procedures- it did not exist there either. Eventually, another nurse new to the unit began to question it and help me hunt for evidence of this order; there was none. On the night we were doing this, a charge nurse verified for us that there was no such order, as did the nurse educator early the next morning.

Apparently, in the past it had been a standing order- but several years had passed since this was the case. The unit educator agreed with that it was often unnecessary, and that it is up to us as nurses to use our judgment and decide when more assessments than are ordered are needed.

In my opinion, this is the crux of the matter. It is up to nurses to use our critical thinking skills and determine when more monitoring and assessments are needed, and when they are not needed. Additionally, we are supposed to be individualizing are patient's care plans- many of the order sets put in by the physicians state "at the nurses discretion".

Nurses who blindly follow "we have always done it that way" without carefully examining their patients are not using the full scope of their nursing role and are missing a crucial piece of nursing practice.

There seems to be a fear on my unit that without these unwritten rules, nurses will carelessly allow patients to go unmonitored and decline; perhaps this has been a problem on this unit in years past. My co-workers are not giving enough credit to themselves and each other when they do this- I do not know of one nurse who would not re-check a temperature on a baby with low temps, simply because it is only ordered every eight hours.

Furthermore, they are forgetting that as nurses we can always re check vital signs (and on our unit blood sugars on baby) if we feel it is warranted. We do not need an order for this- it is within our scope of practice. The physicians and other care providers we work with rely on us to use our thinking skills, monitor the patients, know when something is not WDL, and act accordingly.

Conversely, we should not forget that less is often more. How many times have nurses witnessed a 90 year old patient with a full code, despite actively dying, or the patient who demands every diagnostic test available despite there being no indication (except fear) for those tests?

Less is more; we do not need to endlessly assess and put our patients on edge or disturb a new mother and baby who are healthy and stable. We need to stop, think, use our nursing judgement and ask ourselves what a particular patient may or may not need.

Finally, we must always ask "why?" Why are we doing these assessments and interventions? Does this patient need something additional not ordered, or do they need less interruptions?

We owe it our patients , and we owe it to ourselves; trust your judgement, use your brain and trust yourself. Our patients will thank us for it.

RN- Experience in TCU, LTC, ambulatory and a busy Tele Unit. Currently working in OB (finally!) The area I have wanted to be in since before nursing school. I am passionate about evidence-based practices MPH degree, 2020

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17 Comment(s)

As a postpartum nurse I agree with you one hundred percent. It still irks me that I have to wake Mom and baby up for one am vital signs. Why ?

Julius Seizure

Specializes in Pediatric Critical Care.

I see this issue in the pediatric ICU and step-down units as well. While a child may initially need hourly VS including blood pressures, once their condition has improved and their vitals are ordered q3 or q4, many of the nurses will continue to leave the blood pressure cuff on them all shift long, cycling automatically every hour. How annoying and uncomfortable must that be after several days?

In general, I think that we as heathcare providers often interrupt our patients rest too much. Even if the bedside nurse tries to cluster their care activities, it inevitable follows that the respiratory therapist, physical therapist, social worker, attending, fellow, resident, consulting doctors will all appear at different times, just as the patient was starting to relax and dose off. If they are stable enough, sometimes some undisturbed rest is the most therapeutic thing that we can give our patients!

dinah77, ADN

Specializes in Tele, OB, public health. Has 8 years experience.

I see this issue in the pediatric ICU and step-down units as well. While a child may initially need hourly VS including blood pressures, once their condition has improved and their vitals are ordered q3 or q4, many of the nurses will continue to leave the blood pressure cuff on them all shift long, cycling automatically every hour. How annoying and uncomfortable must that be after several days?

In general, I think that we as heathcare providers often interrupt our patients rest too much. Even if the bedside nurse tries to cluster their care activities, it inevitable follows that the respiratory therapist, physical therapist, social worker, attending, fellow, resident, consulting doctors will all appear at different times, just as the patient was starting to relax and dose off. If they are stable enough, sometimes some undisturbed rest is the most therapeutic thing that we can give our patients!

Yes, all of this! I know my pt's are not getting rest during the day either, as there is lab, docs for both mom and baby, hearing test personnel rounding, in addition to the day nurses......

Rest is sooooooo crucial. It really irks me that there is not more emphasis placed on rest, ESPECIALLY on OB, as these pts are not going to get any rest once they are home for a looooong time

ixchel

Specializes in critical care.

We recently changed our 0200 vitals requirement to nurse discretion, except patients who were admitted within 24 hours or are admitted with CVA. At first I didn't like it. I mean, how can these people survive without me knowing their vitals at 0200?! (I kid!) Plus we had a tech who would constantly give nurses a hard time if we needed vitals done. (She's no longer employed there, thankfully.) It makes the patients happier to not have to get up at 0200. And really, can you blame them? I hate waking people up. If I have IV meds due at 0000 or 0200, I'll tell them at 2200, ask if they have questions at that time, and then I'll let them know I'll try to work as quietly as possible when I come in if they are sleeping. Tired patients make for cranky and/or crazy patients. I don't like cranky or crazy patients who direct the cranky crazies at me, so I do my best to keep them well rested. :)

I think it's great you thought that one through, OP. As I was reading, I was thinking that being on tele before OB is helping you in that on tele units, we're sort of trained in orientation to ask, "why?" for every order. Sick patients require different thinking than healthy ones do, and I'm sure that while you're still orienting to OB, you still have that habit of thinking like you would on tele. Your patients are very grateful for the end result (sleep!), I'm sure!

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

This used to drive me batty when I worked on mother/baby. (What I do now tends to have a much quicker patient turnover so this is much less of an issue.)

What I used to do was have them call me. Whether she's a newly delivered mama or an antepartum she is more than likely going to be up in the middle of the night. Rather than wake her, I'd either strike a deal with her that whenever she's up to pee (or up with the baby) sometime betweeen 0300-0500 to just call me. That way she's only waking up once, I get what I need, and I'm not going back in there once she's just gotten settled back down. And if I didn't hear from her by around 0500 I'd go in if I had to, but that was rare. Babies like to be awake sometime between 03-05. But I was also usually the one asking to please be able to leave our long-term antes alone between 2300-0600 as long as they were afebrile (or asymptomatic for whatever other issue they'd been with us for).

gypsyd8

Specializes in TELE, CVU, ICU. Has 10+ years experience.

I am so glad I am not the only nurse who thinks sometimes less is more. I work ICU, and sometimes we have DNR patients being poked, prodded, and pestered when all they need is rest. I let them rest, and some horrified old timer says "DNR does not mean do not treat!" I am treating, by leaving them alone.

Common sense prevails!! Thank you for this article!! I can remember being in nursing school and my instructor asking me a question and I responded with, "common sense tells me..." and she bit back, saying, "there is NO SUCH THING as common sense in nursing!" In there lies the problem. We can call it critical thinking or whatever make us feel good....but please lets apply it. I am a rehab nurse in a brain injury unit and this type of thinking is much needed. I'll take it one step further....I find sometimes some nurses find validation in finding something that can be "reportable" to the physician which ultimately makes no difference to the patient's outcome. In order to find something reportable, they are poking and proding at their convenience, not taking into account the needs or discretions of the patient. So many times I find myself thinking...we need to put ourselves in their shoes.

dinah77, ADN

Specializes in Tele, OB, public health. Has 8 years experience.

I am soooo annoyed right now!!!

Just came back on to NOC, and I noticed one of my babies that I have been with for the past three days had a serum billirubin drawn on him today

His TCB was low, he does NOT look jaundiced in any way, so I was immediatly thinking what the heck?

Turns out the nurse working today "acidentally released" the order- so this baby was poked for NO reason, and guess what, the serum??? LOW

I should add that this is the SAME BABY who 2 days ago had to have his metabolic screen drawn TWICE simply because the HUC mislabeled the slip and the Lab tech did not notice

Like we don't do enough unecessary stuff already!!:banghead:

Thank you for this. I feel validated in my practice now as I often question the "culture" of my floor in this regard and do some things in my own way if I find the common assumption of how to do it to be ineffective or an inconvenience to my patient. I'm glad I'm not the only one to do this as it often seems I am in the small insular county in which I currently work.

I am going to touch on one of the biggest complaints of patients: undressing completely for ALL surgery. I can't tell you how many providers (doctors, nurses, techs, etc.) have defended this practice. When called out on this the two most common responses are infection control or incase something goes wrong (cardiac arrest).

Usually the "infection control" is just written to the procedure guidelines, no studies or research cited. As for the something goes wrong, a team in the ED can remove all clothing from a fully dressed patient (coat, boots, etc.) in less than 30 seconds.

It comes down to "this is how we have always done it."

Consider the the standard procedure for prepping a patient for all surgery, including outpatient: naked wearing only a gown, wheeled into the OR on a gurney. Consider what LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. Source: The Wall Street Journal

NOTE this was implemented in 1998!

Even the annual pelvic exam has been described as ritual:

The annual pelvic exam has long been a routine part of women's health care, but new guidelines say there's no good reason for it.

The recommendations, laid out by the American College of Physicians (ACP), advise against pelvic exams for women who aren't pregnant and have no symptoms of a potential problem.

The reason? There's no good evidence the screening exams benefit women, the ACP said.

"I think a lot of women will be relieved by this [recommendation], especially since it's based on scientific evidence," said Dr. Linda Humphrey, a member of the ACP's Clinical Practice Guidelines Committee, which devised the new advice after reviewing 32 studies on the benefits and harms of routine pelvic exams.

So how did pelvic exams become so routine in the absence of evidence? "In medicine, a lot of things have been done because we think they might help," Humphrey said.

"The reasoning behind why clinicians are doing it has never been very clear," said Dr. George Sawaya, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Instead, the pelvic exam is more like a "ritual" than an evidence-based practice, said Sawaya, who cowrote an editorial published with the new guidelines in the July 1 issue of the Annals of Internal Medicine. Source:

It is time to take the Voodoo out of healthcare. The Internet has taken the sacred knowledge away, now everybody has access to it. If a provider says something, they better be able to back it up with something other than "this is how we have always done it."

This is exactly why healthcare is in it's current state, and it is NOT getting any better. Healthcare has lost just about all it's credibility.

Credibility is like virginity; once you lose it, you can never get it back.

Providers have been relegated to the role of advisor. People no longer have stockbrokers, they have financial advisors. They no longer have lawyers, but a team of legal advisors. This has happened when a profession has lost the trust of the people it serves. Healthcare is down there with congress, BUT ratings for individual providers are high.

That is because of people like the OP and others who speak up for the patient.

Finally, here is a doctor speaking about this very issue of credibility, protecting patients, and speaking up: Where Is The Physician Outrage?

This was an excellent topic. Thank you for starting the discussion.

dinah77, ADN

Specializes in Tele, OB, public health. Has 8 years experience.

I am going to touch on one of the biggest complaints of patients: undressing completely for ALL surgery. I can't tell you how many providers (doctors, nurses, techs, etc.) have defended this practice. When called out on this the two most common responses are infection control or incase something goes wrong (cardiac arrest).

Usually the "infection control" is just written to the procedure guidelines, no studies or research cited. As for the something goes wrong, a team in the ED can remove all clothing from a fully dressed patient (coat, boots, etc.) in less than 30 seconds.

It comes down to "this is how we have always done it."

Consider the the standard procedure for prepping a patient for all surgery, including outpatient: naked wearing only a gown, wheeled into the OR on a gurney. Consider what LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

NOTE this was implemented in 1998!

Even the annual pelvic exam has been described as ritual:

It is time to take the Voodoo out of healthcare. The Internet has taken the sacred knowledge away, now everybody has access to it. If a provider says something, they better be able to back it up with something other than "this is how we have always done it."

This is exactly why healthcare is in it's current state, and it is NOT getting any better. Healthcare has lost just about all it's credibility.

Credibility is like virginity; once you lose it, you can never get it back.

Providers have been relegated to the role of advisor. People no longer have stockbrokers, they have financial advisors. They no longer have lawyers, but a team of legal advisors. This has happened when a profession has lost the trust of the people it serves. Healthcare is down there with congress, BUT ratings for individual providers are high.

That is because of people like the OP and others who speak up for the patient.

Finally, here is a doctor speaking about this very issue of credibility, protecting patients, and speaking up: Where Is The Physician Outrage?

This was an excellent topic. Thank you for starting the discussion.

Excellent Points!!

I have never worked OR/PACU or anything related so I was not aware of the clothing issue with surgical patients

With all due respect to nurses with a lot of years under their belts, they are often the ones holding things back.

NOT ALWAYS; often it is a nervous newbie over vitaling and assessing our patients to death.

Seriously, and then people wonder why more and more people are looking at home birth or birth centers

Heck I tried to use a birth center- didn't work out for me, but with my next pregnancy I fully intend to try again- why? Because if my baby and I are stable I do not want to be bugged every few hours!!

dinah77,

Your point about the new nurses reminds me of that diaper commercial where the mother has the little girl slathered with hand sanitizer before holding her first born. Then with the second child she hands him to the greasy mechanic as she digs through her purse.

Here are a few more guidelines that I am sure most are unaware of:

The American Academy of Family Physicians' web site (Health Maintenance in School-aged Children: Part I. History, Physical Examination, Screening, and Immunizations):

Physical Examination

A full physical examination should be performed during any health maintenance visit, and is required in a well-child examination for insurance billing. However, one study has shown that physical examination in an asymptomatic, school-aged child will find a new abnormality in less than 4 percent of patients, and most of these abnormalities are not clinically significant.5 Few specific examination elements have been validated as having a positive or negative health effect. Because more than 1 million abused children are identified annually in the United States, physicians should remain alert for signs of abuse.
Screening Tests

Screening recommendations for school-aged children from the American Academy of Pediatrics (AAP) and the U.S. Preventive Services Task Force (USPSTF) are listed in Table 1.3.
[COLOR=#cc0000]The USPSTF recommends against scoliosis screening and testicular examination in asymptomatic patients because these tests have been found to be more harmful than beneficial in these patients.[/COLOR]

Here is the footnote for that reference: U.S. Preventive Services Task Force. Screening for testicular cancer. February 2004.Recommendation Summary - US Preventive Services Task Force

The log roll and DRE are no longer used in trauma. (Source: Log Roll and a Finger up Your Bum - Then You're Done:)

The studies done agree that although DRE can have a high specificity if you find something, its sensitivity is very, very low. DRE can be indicated in penetrating trauma to the lower GI area, suspected pelvic fractures, urethral disruption or spinal chord injury – although other clinical indicators will be just as sensitive.

And in the latest version of ATLS, DRE is not mandatory anymore.

Ultrasound OR X-ray are the new standard method for diagnosing constipation especially in pediatric cases:

April 27, 2009 -- British pediatricians at a London children's hospital are using ultrasound to assess the severity of constipation in children. They have found that ultrasound is a good substitute for abdominal x-ray, with its radiation exposure, or a digital rectal examination, a procedure that children find unpleasant and disturbing.

(Source: US replaces x-ray for diagnosing childhood constipation)

Why are these long standing rituals being replaced? First and foremost they are not just uncomfortable, they feel like a sexual assault. (See National Institutes of Health, "Rectal exam mistaken for sodomy") Patients are demanding proof that these are necessary, and the evidence just does not support them.

Furthermore they do incredible psychological trauma to patients. Here are links that recognize that healthcare can retraumatize or be traumatic, and "trauma informed healthcare" can reduce the risk of this:

Making Hospitals Less Traumatizing I like this resource because it advocates "Provide a Post Discharge Safety Net".

Trauma-Informed Medical Care? Not at my doctor's office… (Some good links here!)

RETRAUMATIZING RAPE VICTIMS This is a great article!

Secondary Victimization of Rape Victims: Insights from Mental Health Professionals Who Treat Survivors of Violence This is an excellent research piece, and is something that I noticed in survivors of abuse from in, out, and both in and out of the healthcare system.

JAMA: Reducing the Trauma of Hospitalization

Then there is one of the best publications I have ever seen. It is theHandbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse put out by the Public Health Agency of Canada.

We are finally coming out of the dark ages of medicine.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

It's a fine line to walk, for sure. I do believe it's up to the nurse/midwife/doc/NP to have EXCELLENT assessment skills and pick up on the subtle changes that indicate something bad is about to go down. That way we know when to watch a little more closely and when to back off a bit.

I love being the one that dries off a pink, screaming baby and plops him right on his mom's chest for skin-to-skin immediately after birth. However, I've also been burned and had a perfectly fine baby crump before his 5-min apgar for no apparent reason (term low-risk birth and once we resused, never crumped again). So there's a fine line to walk, even for low-risk patients. IMO in a birth setting, there should never be fewer than two people at each birth besides the delivering provider; some things we know to be higher-risk, but sometimes you get the perfect pregnancy and the perfect labor, no problems with FHTs, and a baby that crashes and burns once placenta is out of circulation.

That's not to say we should overmedicalize birth, because we shouldn't. But it does mean everyone in the delivery room should have a thorough understanding of maternal and newborn physiology and be able to detect the subtlest changes.

Edited by ElvishDNP

MollyJ

Has 36 years experience.

I remember a true "aha!" moment when I was taught in my MSN program that policy should be written to reflect minimum standards not maximum.

It was an idea that rested uneasily on my consciousness and yet the advantages are so clear. Why create a hard to live up to policy that might create unnecessary work and a standard that was difficult if not impossible to live up to?

I will tell you one thing that can create this mania and that is litigation. The otherwise person who goes south "without our permission" can leave you with lots of self-doubt and then you get someone saying, "we should do vital signs on everyone all the time".

There will always necessarily be tension between doing too little versus doing too much and the best way to resolve it is nurses with enough time to see and individualize their patient's care.

I remember a true "aha!" moment when I was taught in my MSN program that policy should be written to reflect minimum standards not maximum.

I love this! I am going to use this.

As to unnecessary tests, it is NOT only the lawyers, it is GREED! CBS News, 60 Minutes did an expose titled, "The Cost of Admission"on Health Management Associates (HMA), the fourth largest for-profit hospital chain in the country with revenues of $5.8 billion in 2011.

HMA's pressure on ED MDs to admit more patients than necessary. HMA established preset quotas the MDs were pressured to meet or exceed. >20% in several cases. Good medicine keeps patients out of hospitals. Hospitals are where the bad bugs live. Decreasing admissions and reducing hospital stay is a huge modern medical emphasis. Everything about HMAs alleged efforts runs counter to that.

HMA had a well thought out plan on how they had control over emergency physicians. That control, was exerted with corporate wide computer software called Pro-MED which was installed in every emergency room. HMA says it was designed and approved by medical experts to improve the quality of patient care. But doctors, nurses, emergency room directors and hospital administrators told us that HMA customized the program to automatically order an extensive battery of tests -- many of them unnecessary -- as soon as a patient walked into the emergency room.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

This is a problem that affects all areas of nursing, but I think it is especially important in obstetrics, because in this field, over-assessing our patients often means (speaking of moms here) exposing/touching their most intimate areas and putting them in vulnerable positions (lithotomy, anyone?). We can't pretend that inserting our fingers into a woman's vagina carries the same weight, emotionally, as accessing a vein or doing an echo or whatever.

We also stand to cause long term harm to patients with some of our over-assessments. Overzealous blood sugar protocols lead to unnecessary formula supplementation, potentially damaging what might be a fragile nursing relationship and setting the mom up for major problems, once we usher her out of the hospital with her bag of formula goodies and an internalized doubt about her ability to provide adequate breastmilk for her baby.

Universal CEFM increases c/s rates without improving neonatal m&m, leading to increased maternal m&m throughout her reproductive life span.

Removing babies from mom's chest in the first few minutes after birth, in order to "assess" them in the warmer, decreases the newborn's ability to transition and leads to greater instances of hypothermia, hypoglycemia, TTN, etc... and all the resultant interventions.

Great article. We like to feel that our careful assessments and thoughtful interventions are critical in the health of our patients- and they are. But sometimes these assessments and interventions are not only unhelpful, but actively harmful.

dinah77, ADN

Specializes in Tele, OB, public health. Has 8 years experience.

This is a problem that affects all areas of nursing, but I think it is especially important in obstetrics, because in this field, over-assessing our patients often means (speaking of moms here) exposing/touching their most intimate areas and putting them in vulnerable positions (lithotomy, anyone?). We can't pretend that inserting our fingers into a woman's vagina carries the same weight, emotionally, as accessing a vein or doing an echo or whatever.

We also stand to cause long term harm to patients with some of our over-assessments. Overzealous blood sugar protocols lead to unnecessary formula supplementation, potentially damaging what might be a fragile nursing relationship and setting the mom up for major problems, once we usher her out of the hospital with her bag of formula goodies and an internalized doubt about her ability to provide adequate breastmilk for her baby.

Universal CEFM increases c/s rates without improving neonatal m&m, leading to increased maternal m&m throughout her reproductive life span.

Removing babies from mom's chest in the first few minutes after birth, in order to "assess" them in the warmer, decreases the newborn's ability to transition and leads to greater instances of hypothermia, hypoglycemia, TTN, etc... and all the resultant interventions.

Great article. We like to feel that our careful assessments and thoughtful interventions are critical in the health of our patients- and they are. But sometimes these assessments and interventions are not only unhelpful, but actively harmful.

Oh my gosh, all of this!

The thing with blood sugars, I have too many colleagues that become so by the book for this it makes me wanna scream

Or weight loss in newborns- I have come into a shift to find a healthy, eating lots, low bilirubin, term babe who was a c-section started on supplementation with formula by a previous shift simply because the baby is 8-9% weight loss. They do not seem to give any weight to the factors listed above, they are only stubbornly looking at that old school 10% weight loss guide.

I cannot wait until the idea and scale devolped by the Penn State team is the standard. That one actually takes into account how the baby was delivered, hours of age, breastfed or not, etc

Here it is for anyone who has not seen it

https://www.newbornweight.org/

Of course, we cannot use it in an official capacity but I do think it is useful for putting things in perspective

I do also wonder about cervical checks

I attempted to have a birth center birth for my daughter. I labored for 2 days @ home before hitting a wall of exhaustion.

My midwife was very good about sparse cervical checks, instead relying on other indicators.

When I gave in and went to the hospital after 2 days of no ROM or much progression past 5cm, I evenutally came down with a fever and dx of chorio after 16 hours of being there.

There is a small part of me that always wonders if my subsequent infection was r/t the number of people and frequency with which someone was poking around in my vagina

For the record, I did not have AROM until 68 hours in, and eventually delivered after 73 hours of labor.

At least I only had to push for 30 mins :up: