The hospital here has ongoing plans to use central monitoring (very common in US hospitals) so that the patients vital signs and EFM tracing are visible from a monitor bank at a desk and will probably be monitored by a "tech" rather than a nurse. Abnormalities will trigger a beep that will alert the tech to notify the nurse. This will allow them to cut back on staff and only go into the patients room when there is evidence of problems on the monitor. I am sure there will still be a written requirement to check in more frequently but, due to staff cutbacks, it is hard for them to get into the room often enough now. If women have epidurals, they will put up with the continuous EFM and lack of mobility (I can see the nurses going into the rooms and admonishing the mobile patients to lay still so they don't mess up the tracing).
The only real hope for our hospitalized patients is arriving at the hospital ready to deliver or midwives that choose to labor sit (about half of us). A few nurses support this, but when staffing cutbacks increase their workload it is easy to compromise.
There are some protocols about 1:1 nursing care for patients with inductions or PIH, but they are not followed. Things have changed completely from my early days as an OB nurse in the 1980's. One positive thing is the increasing requests for homebirths in this area!
Fran Wilson, CNM
Kennewick, WA
From: GA12L@aol.com
Reply-To: ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Subject: Re: Pain management/ shoulder dystocia
Date: Thu, 30 Mar 2006 05:49:37 -0600
In a message dated 29/03/2006 22:18:15 GMT Daylight Time, 530rose@msn.com writes:
Here in Kennewick, even women who specifically tell the staff that they don't want to be offered pain medication get an (at least) hourly question about whether they have changed their mind, and warnings that if they don't do it now it will be too late for an epidural. Docile epiduralized women demand so much less of the nursing staff...
Here, in the unit I work in, we don't ask women if they want pain relief. We believe that asking implies that they are not coping and if they think we think they're not coping, well it's a downward spiral. If they want pain relief they'll soon ask for it. How sad is it that the nursing staff where you are feel that an epiduralised woman demands much less.
It's the opposite here, women with epidurals are supposed to have one-to-one care as we can't leave a woman on a monitor unattended. However, the reality is that they are. There are job freezes here nationally and some hospitals are even talking about redundancies. Newly qualified midwives are not getting jobs either. We are stretched as it is and it's only a matter of time before a tragedy occurs.
I had a bad shoulder dystocia in the early hours of Tuesday morning and there were 2 other midwives in the room leaving one midwife to deal with whatever came along. The head was born at 01.30 the body by sweeping the posterior arm across the chest and face delivered at 01.43. My heart almost stopped. Baby weighed in at 11lbs 3 ounces. I told her if she had another baby to have a section! Babe has intact clavicles but has Erb's palsy, Apgars 4/1 and 9/5. I don't remember anything after I saw the head 'turtling' I just went into auto pilot. My hands ached after, I could have done with a cold glass of Chardonay.
Gail
