The OP baby..a question

amber1142 · Jul 29, 2005

. My charge RN says she was just gently pushing the baby's head to rotate. Is this safe? What is the best wasy to rotate an OP baby? Tricks of the trade? Thank you in advance for all your imput.

I can't imagine that would be in an R.N.'s scope of practice, but I could be wrong. On the other hand, I'm at a teaching hospital, and there is such a long line of residents waiting to learn procedures that the nurses don't even do cervical checks.

SmilingBluEyes · Jul 29, 2005

Can't say I have manually rotated a baby's head ever. If position changes and pushing on mom's side did not do it, that is when I would call a doctor. This is out of my scope beyond those things I have already tried.

BETSRN · Jul 29, 2005

I can't imagine that would be in an R.N.'s scope of practice, but I could be wrong. On the other hand, I'm at a teaching hospital, and there is such a long line of residents waiting to learn procedures that the nurses don't even do cervical checks.

Not being able to be autonomous (and do exams, labor management,etc.,) is exactly why I do NOT work at a big teaching hospital with interns and residents.

We probably do a LOT of things that are not really in our "scope of practice" but that's a pretty gray area.

If you ever want to actively participate in your patient's labor, go to a different facility where you can really learn something and actively participate.

SmilingBluEyes · Jul 29, 2005

so do you manually rotate babies' heads then Betsy? Just curious.

amber1142 · Jul 29, 2005

If you ever want to actively participate in your patient's labor, go to a different facility where you can really learn something and actively participate.

I can appreciate what you're saying, but I am learning a great deal about high risk obstetrics which is what our unit is. I love listening in during rounds; I love hearing the fourth years give the interns tips; I love it when the attending quizzes the residents on some complicated scenario.

Our patients are very sick: We have pre-eclamptics, hypertensives, diabetics, renal failures, seizures, vent-dependent, pre-term labor, and tons of teenagers. We routinely deliver 26-34-week preemies. We have to use our assessment skills and judgment to keep a mom from seizing. We have to know our drugs. We have to be prepared to scrub for sections on a walk-in mom with no prenatal care. My nursing skills are being honed in a way that pleases me. Delivering babies is only a small part of what we do, though there is ample opportunity to hold the hand and coach a frightened young woman.

I understand what you are saying. There may come a time when I want more independence in the management of laboring women, but I think that's when I'll be ready to move into midwifery.

**RosesrReder, BSN, MSN, RN** · Jul 30, 2005

Just wanted to say hi to you and welcome you to the family. :icon_hug:

Best wishes to you. :)

RNnL&D · Jul 30, 2005

Can't say I've manually rotated a baby's head, although I have rotated Mom, as in from side to side and all fours to try to rotate an OP baby.

BETSRN · Jul 30, 2005

so do you manually rotate babies' heads then Betsy? Just curious.

Sorry, I wasn't clear on that, was I? No, I have never rotated a baby's head, but I would put downward pressure on a head and certainly support the head it if was crowning and I didn't have a practationer in the room. It is unlikely I would get that far without a doc or CNM unless someone precips.

I have seen one of our midwives put her two fingers on the top of the baby's head and keep some pressure there, effectively rotating the baby around. I saw her do that with an OP and it turned right around. The patient also was lying on her side at the same time: nice manuever that time! It worked.

What I meant by my comment (unclear as it was) about doing things outside the scope of practice is that often, depending on the type of facility we work in what is outside the scope of practice in one facility is certainly within the scope of practice in another. We do vag exams, put on scalp electrodes and r/o labor checks at our place without a practitioner in house and at other places, nurses cannot do those things. A colleague of mine has gone to a hospital where she puts in IUPC's as well.

So, I think scope of practice varies from place to place.

amber1142 · Jul 30, 2005

So, I think scope of practice varies from place to place.

I believe that "scope of practice" is a legal issue; it's what your state board of nursing allows you to do legally as a nurse. That is separate from a job description which may well vary, as you say, from hospital to hospital.

SmilingBluEyes · Jul 30, 2005

Sorry, I wasn't clear on that, was I? No, I have never rotated a baby's head, but I would put downward pressure on a head and certainly support the head it if was crowning and I didn't have a practationer in the room. It is unlikely I would get that far without a doc or CNM unless someone precips.
I have seen one of our midwives put her two fingers on the top of the baby's head and keep some pressure there, effectively rotating the baby around. I saw her do that with an OP and it turned right around. The patient also was lying on her side at the same time: nice manuever that time! It worked.
What I meant by my comment (unclear as it was) about doing things outside the scope of practice is that often, depending on the type of facility we work in what is outside the scope of practice in one facility is certainly within the scope of practice in another. We do vag exams, put on scalp electrodes and r/o labor checks at our place without a practitioner in house and at other places, nurses cannot do those things. A colleague of mine has gone to a hospital where she puts in IUPC's as well.
So, I think scope of practice varies from place to place.

I Don't know about scope varying from place to place, but by state, yes. But I DO get what you mean as what nurses' roles are in different place. There is a big teaching hospital near me where I will not work for the reasons you state. Too many residents having to learn "this or that" for nurses to do much but paperwork and vital signs. YUCK---that is certainly not for me, either, Betsy. You and I sound like we practice similarly-----it seems often in LDRP settings like ours, doctors really rely on us MUCH more to be their true "eyes and ears" and use our judgement----- and we do a lot of things, that in other places, only residents/attendings will do (because they are always around and always someone needing to learn).

We also place our own internal monitors/IUPC's, do sterile speculum exams and rule out patients w/o attendings/residents in the house (we just have to report by phone on the patient before we discharge them). We have standing orders that cover doing a lot of things based upon the situation and nursing judgement .With a phone call to the doctor, giving report, the labor and delivery situation is literally ours to run as our judgement allows, particularly at night.

I like that role a lot---the independence and trust of our physicians is great. I am truly a lower-intervention person, myself, and I like that I have some leeway to do that, in low-risk situations too. NOT EVERYONE in MY care automatically gets internal monitors, etc, esp. if she is seeking a more natural experience....I wish I had in my care more people electing natural labor/delivery. I love working with midwives, as well....ah but I do digress.

So---like you---- That is why I chose to work in a smaller community hospital minus all the doctors and students having to learn things----not putting them down, we all have to learn. But that whole experimental environment is not for me, surely....

Anyhow, thanks for clearing things up a bit Betsy! Now, I see what you were saying.

wannabemw · Aug 1, 2005

This is my first post although I have been "lurking" for months. I am a fairly new RN in L&D with about 6 months experience, 2 on my own. The other night I had a mama G2 P1 , came in in labor at 4/80/-2 at 11pm. she progressed well, no interventions got to 9 by 2 am. Baby was dirrect OP. She stayed at 9 with a very thick anterior lip for the next 2 hours. I changed her postions Q 20 min. Side to side. She is having an overwhelming urge to push for these last 2 hours and breathing through her contx. Finally, as im getting anxious that the MD is going to choose c/s ... my charge nurse helps me out. She goes in checks the patient, puts both hands (2 fingers each hand) inside and manually rotates the baby from OP to OA and she has the baby in 10 min. (she still had the thick anterior lip). So I guess my question is, what are other RN's experiences with manual rotation of a OP baby. My charge RN says she was just gently pushing the baby's head to rotate. Is this safe? What is the best wasy to rotate an OP baby? Tricks of the trade? Thank you in advance for all your imput.

This technique is a MW trick for turning the babe. I just read about it in

"Heart & Hands, A Midwife's guide to Pregnancy & Birth" by Elizabeth Davis. As far best way to turn the babe? Must have been... mom had a safe & happy delivery! (Sure wish I had known about this when I had my 1st OB baby & ended up w/forceps delivery!) BTW, I had a friend delivery 1wk ago that was OP & her DOULA (whom is also an Inspiring LMW) read about this technique & just had to share w/me (I have such great friends!).

Thanks for sharing! Glad to know there r still some nurses out their that believe in holistic ways!:wink2:

Congrats on becoming a new RN! :yelclap: I can't wait to be you!

~MJ

*and no, the DOULA didn't attempt it, she just wanted to know what she would do if she were the MW. The baby turned at delivery (after a loooong 40hr labor) due to the OP.