transfer of active labor patient?

Been a few years but I was taught that if pt. is 4cm or greater you have to keep em.

I think unless you are transferring to a higher level of care where benefits of transfer outway risks you have to keep them. I believe this is true even if a unit is on divert.

Our transport teams won't transfer someone that is 4cm or greater in active labor...they have to deliver there.

I would rather see early labor patients transfered to a hospital that has enough staff than forced to deliver where there aren't enough nurses.

Here's what I think. If a patient cannot be adequately managed where she is, and the risks of transport (MVC, delivery complications) are outweighed by the benefits (high-risk center, available staff) then the patient should be transfered.

I work on a transport team. None of us really wants to put an active labor in the the ambulance, but sometimes thats the best thing. If a team is well-trained and equiped, the risks can be managed, but never really eliminated.

I would think twice about writing hard and fast guidelines (like dilation > 4cm). For example, if you have no NICU backup, is it better to put a preterm labor who's dilated 5cm's on the road, or wait and hope you can manage the premie? The circumstances should dictate the decisions, not a piece of paper. There are situations wherein no patient is too unstable to transport, but there are also times when it's better to take a "stay & play" approach.

Pete Fitzpatrick

RN, CCRN, CFRN, EMT-P

Here's what I think. If a patient cannot be adequately managed where she is, and the risks of transport (MVC, delivery complications) are outweighed by the benefits (high-risk center, available staff) then the patient should be transfered.

I work on a transport team. None of us really wants to put an active labor in the the ambualnce, but sometimes thats the best thing. If a team is well-trained and equiped, the risks can be managed, but never really eliminated.

I would think twice about writing hard and fast guidelines (like dilation > 4cm). For example, if you have no NICU backup, is it better to put a preterm labor who's dilated 5cm's on the road, or wait and hope you can manage the premie? The circumstances should dictate the decisions, not a piece of paper. There are situations wherein no patient is too unstable to transport, but there are also times when it's better to take a "stay & play" approach.

Pete Fitzpatrick

RN, CCRN, CFRN, EMT-P

Our state has an "anti-dumping" law which prohibits transfer of care if in active labor, although there is no dilation pinned to it. Our facility does not have a NICU attached to it, and we do have maternal and newborn transports. If we can help it, we don't keep anything under 36 weeks if in labor. That, of course, doesn't always happen.

I don't know if I agree with preterm transfer at 5cms, instead of keeping her and dealing with preemie. I think I would much rather deliver someone in the hospital than in the back of an ambulance, then have to deal with a postpartum mom AND a preemie. At least where I am, the only one that goes on a transport is a nurse and ambulance crew...and that is not enough backup for me in any situation.

I don't know how many times I have wished we could "divert" laboring patients...you know..when you turn around and there is one more standing there and you don't know what you are going to do with her? The only time we diverted patients is when our OR had a gas leak and couldn't do surgery. We don't divert at anytime...or with any staffing crunch...or with lack of beds. We have delivered in the doc's on call room.

Don't know what your answer would be, but it seems to me I would transfer stable, non-active people before I would transfer active ones....just me two cents.

Anti-dumping regs are federal laws. A pt. in active labour may be transferred for reasons of medical necessity. For example a pretermer may be transferred to a tertiary facility IF you have qualified staff to accompany her (I have taken OB Dr. w/ me before) and IF in the judgement of the transferring and recieving physicians it is safe and reasonable to do so and the biggest IF...the pt. gives her informed consent to it A primp at 4 cm w/ irreg uc's may well be a reasonable pt. to transfer to a tertiary facility 30 minutes away . A multip at 4 cm actively contracting who has a 1-2 hour ride to another facility probably would not be. I have never transferred a pt. due to inadequate staffing. In the case of poor staffing, we do things like cancel elective inductions and scheduled sections and make our pals from management come into staffing.

Actually a 33 week multip w/ twins and uc's was just sent out last week. She was 3-4cm and started on mag before transport to a facility about 30 min. away. She went w/ a nurse and a paramedic. The decision to transport depends on your facility's policy, pt. condition, and multiple other factors. I think you'd be sunk if a term pt. in active labour being transported due to poor staffing sufferred a complication. A facility can't make itself turn from primary to tertiary in an instant, but it is reasonable to make contingency plans in the event of inadequate staffing.

"I don't know if I agree with preterm transfer at 5cms, instead of keeping her and dealing with preemie. I think I would much rather deliver someone in the hospital than in the back of an ambulance, then have to deal with a postpartum mom AND a preemie. At least where I am, the only one that goes on a transport is a nurse and ambulance crew...and that is not enough backup for me in any situation."

BK,

The key is having a well-trained team with a dedicated transport nurse. In my mind it's just not good practice to take whatever available nurse and throw him on with whatever ambo rolls through the ED. Transport nursing is its own specialty, and not a place for amateurs. The case of the active labor transfer certainly highlights this.

Pete Fitzpatrick

RN, CCRN, CFRN, EMT-P

"I don't know if I agree with preterm transfer at 5cms, instead of keeping her and dealing with preemie. I think I would much rather deliver someone in the hospital than in the back of an ambulance, then have to deal with a postpartum mom AND a preemie. At least where I am, the only one that goes on a transport is a nurse and ambulance crew...and that is not enough backup for me in any situation."

BK,

The key is having a well-trained team with a dedicated transport nurse. In my mind it's just not good practice to take whatever available nurse and throw him on with whatever ambo rolls through the ED. Transport nursing is its own specialty, and not a place for amateurs. The case of the active labor transfer certainly highlights this.

Pete Fitzpatrick

RN, CCRN, CFRN, EMT-P

I couldn't agree with you more. Tranport nursing in my neck of the woods is a labor nurse in the back of an ambulance with an ambulance crew...that is it. Our nearest tertiary center is an hour plus drive away. We sometimes fly patients out but they have to meet certain criteria to fly and the weather has to be cooperative. When we have a bad baby, we wait in excess of 2 hours for a transport team to come for the baby. It really comes down to what is safest, and to be honest, the tertiary center will tell us to keep them at our facility and the neonatal team will be dispatched for the baby. We don't always get to choose who goes.

I wish it were better for us here in small community hospital heaven,...but we have what we have....and we do what we can. We do pretty well as far as getting folks out that need to go, but sometimes that just can't happen. As I said...as long as I have been in OB, we have only diverted one time, and that was for OR shut down. We have standing room only sometimes. Our staff though is really great and when the need arises, they rise to the challenge and come in and help out.

We have transported pretermers but only with a labor nurse, paramedic and/or doctor present. We have also had moms that we were sure would never make it to the tertiary care facility 45 minutes away. We would notify the NICU there and they would send their transport team AND their pediatrician to assume care of the baby at birth. More times than not, they were there before the birth.

I sure miss my OB days!

Vickie :balloons: