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When are they in trouble? (Decels)


Hi again ladies! It's been awhile since I posted. I am in my 2nd week of L&D, and today had a class on strips, etc. One thing that concerns me is knowing when there's trouble vs maybe a normal variable decel. We learned today that the late decels are normally gradual (vs spontaneous or sudden) and start after the contraction starts. In the class, we saw easy to read ones. On the floor, I've seen some that I wouldn't have thought were bad, but there's doing a c/s because of them.

So is it just experience, or a bit more instinct? What tips do you guys have for me here?

Also, anything else that signals something is wrong? All I've had so far are pretty normal, uncomplicated deliveries. In fact, the ones I had last week (4 deliveries) were all WAY too easy (say maybe 5 pushes and out). I have a great preceptor, and she lets them labor down rather than push forever. And we've been going over strips a bit. But because I was charge on the gyn floor which had ob overflow, the educator and NM think I'll be ok with 8 wk orientation. I can take 12 if I need to. I'd just like to master this part asap, since it is fundamental.

Thanks so much guys! I'm sure I'll have tons more questions later!


Specializes in Perinatal, Education. Has 9 years experience.

Take as many strip classes as you can. You will find that they will all say basically the same thing, but there will be differences of opinion. You will also read research that says that EFM does nothing to improve outcomes anyway so why do we stress over the strip so much!

A lot of comfort will just have to come from experience. I have been doing L&D for two years now and I still am clueless sometimes even thought I am confident in my strip reading skills. ALWAYS ask your co-workers if you are hesitant about anything. It isn't uncommon for us to have a strip out with several of us looking at it and trying to figure out how concerned we should be. This can be especially frustrating at 3am!!

Plus, a variable may not mean much or it could mean a lot depending on the stage of labor, dilatation and what the strip has looked like until then. Give yourself time and DEFINITELY listen to your gut.

Take your time. Take many classes and don't expect to become even remotely comfortable with a normal labor for at least a year. You'll do fine. Always confer with your nurse peers. Even those really seasoned nurses(I am talking about the 30 year veterans) will always be sure to confr with others. L&D is critical care. Things can change in an instant. Don't worry, As you get more and more experience, you'll be more and more comfortable. However, no matter how much experience one has, one shuld never become complacent! Good luck. I hope you love L&D as much as I do!

Thank you so much. That really does help. I'm not sure where to find more classes, but I'll look (this one I was told: you're going to a strip class on Monday), so I went! I just am scared and don't want to do anything to harm a patient or miss anything.

I've heard it takes a couple of years to get comfy on L&D. Yikes! It requires a lot of judgement I have not yet acquired skills in.

I do appreciate the advice!


Specializes in OB.

I am also new to L&D (about 9 months now) and I still have a hard time with this. I do as everyone else does, have your co-workers review the strip with you. And when in doubt, call the cnm or md to come review the strip, that is thier job.

Does your unit do strip review? Ours does about every 3-6 months. One of our senior nurses or managers will hold an informal discusssion about strips they "randomly" pull. We go over what was done, what should have been done and outcome. No names of pt's or nurses invovled.

Good Luck! I love L&D!

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