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Re: VBACFrom: Kaycnm@aol.comMon Oct 30 11:45:01 2000
In a message dated 10/29/00 3:53:28 PM Eastern Standard Time, jkulkin@mindspring.com writes: << Intermittent monitoring by auscultation is standard accepted management for normal pregnancy and is how we practiced for years. Kay, join in if you will. >> But it is a constant conflict with the nurses. They are so unfamiliar with it, that they will put the mom back on the monitor to "see how she's doing" any chance they get. So if there is another patient to see, or if I go get something to eat, or go to the bathroom, I come back to the woman in bed with the monitor on. The concept is not understood by them, that is, the measure of reassuring FHTs with intermittent monitoring. I have even had nurses be so personally uncomfortable with the woman being off the monitor that she completely abandons my patient. I will realize that she has not listened for an hour. This happens mostly when I have a very new nurse, (remember I work in a very large 42 bed L&D unit with lots of turn-over) who has never seen intermittent monitoring and is afraid of confrontation. I think they must figure that since I'm in with the patient and I look like a nurse, I will take heart tones. And, often, I will, as I explain to the nurse that they need to be done q 1/2 hour. I have had lots of discussions about this policy and thankfully, there is a copy of the protocols attached to each chart. I take the nurse to the chart and read the appropriate sentence to her. Many times the nurses (especially at night) have told me they were unaware that such protocols existed and furthermore, don't believe that they are actually allowed to follow this protocol. Then we get the charge nurse involved and then we get the head nurse involved and then everyone is getting a bit snippy. Certain shifts are worse than others. (night) Of course, many nurses are wonderful. Some love the idea, and seem to get great pleasure taking care of these women. They rise to the challenge and often make suggestions about using the shower, birth ball, or some more effective pushing position. Of course, the women love it. Who doesn't love getting continuous attention in active labor. I remember very clearly the nurse who stayed over her shift to hold my hand in labor, 28 years ago. Her interest in my labor and birth touched me deeply. Many women remember their nurses with affection and gifts. Some nurses have special talents for making the laboring woman feel like a queen. My patients labor epidural rate is about 35% (it is 90% in this hospital). I believe many women need more pain relief if they are strapped into a bed for labor. If women are open-minded about drugs and an epidural, that is, if they have come into labor thinking they will get them only if they need them, then many will not ask for drugs if they can walk, shower, sit in a rocker, or hang over the bed. But, they will not do these things unless they have a very unusual nurse or they have a midwife. ^~^~^~^~^~^~^~^~^~~ Kay Johnson, CNM Atlanta, Georgia ~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~~^~^~ "Life is too important to be taken seriously." Oscar Wilde ~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^~^
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