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Re: New Series #1-Admission and NSVD of laboring patientsFrom: Betsy Hyde (elishyde@connix.com)Tue Dec 31 17:21:42 1996
We admit when in active labor, unless ROM with mec, or ROM with hx GBS. Do not do any routine labs. Do external fetal monitor strip until reactive tracing, then intermittant FH checks (if we can keep the nurses away from the monitor!) Internal monitoring used only if unable to obain an interpretable tracing. IUPCs only if question of dystocia. no *routine* ivs. No peripreps with betadine or anything other than water if there is a lot of stool. If not, no prep. No routine cord gases or routine placental pathology requests. There are many indications for the above, but I am referring to a normal woman with normal labor and normal-appearing child at birth. Re: midwives and doctors gowning and using eye covers at delivery....one of the docs at my hospital was fined several thousand dollars by OSHA for not having eye shields. I wear a waterproof gown, and mask...sometimes a full face shield and no mask. I don't wear anything over my glasses because they always fog up. The MD who was fined by OSHA had removed his face shield because his glasses were fogging up during surgery. I happen to like the use of a plastic baggie type underdrape, and it is the only drape I use. It contains the blood and fluids. Epidurals are a major expense, particularly if they increase the c/s rate as I believe that they do. Review of my statistics indicates that approx 1/3 of my patients have epidurals. My c/s rate among laboring women varies between 6-10%. Another major expense at my institution is Newborn Special Care Unit Admissions. A few years ago 1/3 of all babies went to NBSCU for observation or admission. This was largely due to inexperienced residents attending the births when peds were required (mec, prolonged rupture, etc). Now the nurse practitioners from the NBSCU are attending most of the births. I find their resuscitations are far more skilled, and their assessments result in far fewer admissions. I am sure this is a cost savings. PP we routinely get a CBC on day 1, but don't think this is necessary as a routine. I use ice x24 hours and then sitz baths if there is a perineal repair.
-- Betsy Hyde CNM Branford, CT Midwife in private OB/CNM practice Assistant Clinical Professor,Yale University
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