When your patient is complete...

[violet_violet]

So at my new job, it seems like the RNs like to have their patient start pushing when they are complete... is that how it is at other hospitals too?

At my old unit, we like to wait for patient to have the urge to push before we do any pushing, we may do trial pushing to assess but usually we wait until they have the urge. We also let them labor down and not push just because they are 10cm...

What do you do? What are some of your techniques? How do you support your moms during pushing? I'm so used to having the MDs there with pushing, but at my new place, the RNs do most of the pushing with the patients... makes me a little nervous... help!

[babyktchr, BSN, RN]

An urge to push is always a good thing, but there are some providers who still hold on to the addage of pushing when complete. Sometimes you have to be more creative in how you present your case. I have often told providers they are 9 with hopes of buying more time. I am lucky to work with docs who believe it laboring down (especially with a great epidural). There is nothing more heinous than pushing for extended periods of time with someone that can't even feel pressure. Don't know about you all, but my back is just getting too old for all of this.

I think nursing just has to take a stand not only themselves but for the patient. It is not in anyone's best interest to push with no urge, except perhaps the provider, who doesn't even hang around for the 3 hours of constant pushing. We need to have dialogue and be on the same page when it comes to care.

[Elvish, BSN, DNP, RN, NP]

I am fortunate to work with docs (the private ones, anyway) who don't need to micromanage labors. And for the residents, the nurses are really good at saying, "She's a rim, Doc" and failing that, outright refuse to have the pt push before she's ready. Thankfully, the nurses are also pretty good at explaining to the residents why, and the residents for the most part listen.

[violet_violet]

I'm not used to having patients push with me.... How can I get used to it? I'm scared.

[serenity1]

We labor down until the patient feels the urge or pressure. Most of our docs want to walk in the room with the baby crowning, push three times and deliver the baby. It can be scary at times. I've had the doc tell me to start pushing at +2 and call back when crowning. Thankfully, we always have a doc in-house.

[passionflower, BSN, MSN, RN]

I remember making a comment about wishing we had a doc in house {the post was re: small/rural hospitals} and most commenters responded as if that wasn't necessary. I even remember one saying that most deliveries go routinely without any problems. Frankly I don't know how the OB's get away without at least an on-call doc being in house but I guess it's easier to jeopardize a patient and a nurse's license as long as the MD isn't inconvenienced.

[NJNursing, ASN, RN]

It all depends. If they are a multip, I may have them push at 10 cm. It also depends on the station. I like to wait until they are +2 to push. If they have no epidural or not a well functioning one, I will push at 10/100/+1. If they are a prime with a good epidural, I may do some test pushes. If they can push well, I will let them push. If not, I will labor down an hour and reassess. Many of our doctors trust us to push with the pts until nearly crowning. There are a few who will actually stay for however long it takes because they want their own pushing assessments. The more you do it, the more comfortable it will become. Have a senior nurse in with you to give you help and guidance for your first few times.