Trick and tips

Fyreflie · Oct 24, 2012

Coupling and tripling contractions can be a sign of an OP baby (due to uneven pressure on the cervix from a funnily applied head maybe?) but I find Leopolds and assessment of pain (back labour being a huge indicator) more reliable than eyeballing the tracing.

Lots of babies with nuchal cords have persistent variables with contractions despite repositioning and/or more noticeably with pushing-but again, not always.

lovemyjoblandd · Oct 24, 2012

I know that there is never an "always". Just like to hear from other's experiences. Nurses never stop learning, and it seems everyday I'm catching something new. If one piece of advice can keep a patient from enduring something she wouldn't have had to because of my inexperience, then I will be a happy camper. I have scoured the internet looking for examples of fetal strips of abnormal labors such as breech, OP, etc. Cannot find a thing.

As for an OP baby, I know flip flopping mom from side to side can help the baby get turned, any other suggestions? How about helping baby descend (other than the obvious gravity and turning to the side with knee up or hands and knees)?

monkeybug · Oct 24, 2012

You can often visualize an OP baby by looking at the mother's belly. If you get her to lay flat and uncover her belly. An OP baby will often cause the abdomen to look like a "double bubble." There will be a dip around umbilicus. If you can then turn them over all the way on their side, almost on their babies, you can sometimes encourage a baby to turn.

Persistent variables can often indicate a nuchal cord (or true knot, or arm cord, or cord in baby's hand, etc.).

Wild extended accels can often be seen with breech babies. The contrations cause a bit more scalp stimulation on a breech baby, hence the accels.

At the facility where I last worked, it was common to "labor down" women when the baby wasn't well-engaged, especially primips. When they hit 10 cm, we would put them in High Fowlers, drop the foot of the bed down, and then "frog" their legs (knees out to the side, feet together) to help open the pelvis and let gravity pull the baby down a bit. I'd rather labor down someone for a half hour or so than start pushing from a zero station.

The longer you work in L&D the more things make sense to you, and the better your instincts become. I loved being able to tell a doctor "something just doesn't feel right, this is what I see." and have them take you seriously. I miss bedside L&D nursing (but I don't miss my evil nurse manager!).

Fyreflie · Oct 24, 2012

Monkeybug I love labouring down!! My last two jobs we always did--at this job everyone seems to think that if you sit a pt up with an epidural it will suddenly drop to no block :/

OP--I like the modified Sims with the top leg jack-knifed and then elevated in the soft stirrup-they end up with their lower shoulder well underneath or even behind them and their belly on the bed, lower leg straight. It's worked miracles for me!! I hate nothing more than a section for second stage arrest due to an OP or OT position--most of the time that is correctable in the first stage and if a pt has an epi and the nurse is in control of the position then unless you've tried every position you can, I feel like it's our responsibility when that happens.

Another one I like for rotation with an epi is the high fowlers/bed bottom down, frog legs and then leaning forward to "hang" belly (mimics leaning over the bed or sitting on the ball) with a tray table and pillows for support. I've had good luck with that same position for decels that won't resolve otherwise!

brillohead, ADN, RN · Oct 26, 2012

I'd rather labor down someone for a half hour or so than start pushing from a zero station.

Monkeybug I love labouring down!!

AMEN!

I wish this was standard operating procedure for every facility (assuming no fetal distress, etc.).

monkeybug · Oct 27, 2012

AMEN!
I wish this was standard operating procedure for every facility (assuming no fetal distress, etc.).

I learned very quickly when dealing with the residents (who will sit there gowned up the entire time the patient is pushing, driving me NUTS) the answer is always, "Oh, I just checked her, she's an anterior lip." They'll go away for maybe 30 minutes, and she'll get to labor down, and I will have 30 less minutes of being tortured by their presence. Now, our private doctors love laboring down and are very accepting if you ask to do it.

88nurse2010 · Nov 2, 2012

I like putting my mom's who I think have OP babies on their side, bottom leg straight, and top leg bent & up in the stirrup. Really opens up the pelvis. Knee chest also works sometimes. I like to keep the bottom of the bed level so mom's bottom is up in the air. I read somewhere once that this is better than having her back level. It allows baby's head to back away from the cervix a little.

NurseNora, BSN, RN · Nov 2, 2012

OP babies seem to have more earlies, earlier in labor, at a higher station tha others becauea of more pressure against the anterior fontinelle from the pubic bone.Before a baby with a nucchal cord starts having lots of varriables, you may see someyhing that Michelle Murray calls "Deltas". It's not an NICHD term, so don't chart it. You'll see a small rounded acceleration that then goes down into a small V shaped deceleration. Often it's not long enough or deep enough to classify as a varriable, but it's shaped like one. This may occur with contractions or with fetal movement between contractions. As labor progresses, you start to see the varriables develop. Look at the early parts of some strips of babies that were born with nucchal cords and see if you see any thing that might look like what I tried to describe.If you do an accoustic stim and get a varriable, you've likely got a cord.

lovemyjoblandd · Nov 14, 2012

Monkeybug, what are you doing now if not bedside. You seem very knowledgable ( I lurk these threads and have read many of your posts). It would be a shame if a nasty nm ran you off for good :/ Thanks for all the great tips guys! All makes perfect pathological sense. I always think that once someone else points it out and beat myself up for not putting things together

MamaMadge, ADN, BSN · Nov 17, 2012

I agree 100% with the side lying, head flat, top leg up for turning an OP/OT baby. As far as laboring down, FANTASTIC! The only thing I see occasionally is, if in high fowlers sometimes the cervix can become edematous. I like side-lying for laboring down as well! Keep them moving!!