July 9, 2008

How inductions usually go on the unit I work on

*Not intended as medical advice. I'm really a 16 year old boy pretending to be an RN. :) *

As much as I have mixed feelings about scheduled inductions, and c-sections, they are pretty easy patients to admit. With an induction, they aren't laboring and uncomfortable yet so they can answer questions easier. There are several ways to induce labor, so I'll focus on what we do here with an induction using pitocin. This is the most common way it's done here. Usually, a pitocin induction goes something like this: at midnight, they arrive and after getting them acquainted with the room, I run through this database, full of questions that may not make any sense as to why I need to know, but I still have to ask. I joke with some patients that a labor nurse is the nosiest person you'll meet. We have to know your health history, any medications, herbal supplements you are taking, whether you have a birth plan, whether you have a car seat and have all the resources available to you. We have to make sure that if you have kids, that you actually have custody of them and that they weren't taken away from you. Even if you don't tell us, we'll eventually find out, just like if you are using drugs. Just own up to it, make it easier on us all. I also have to know if you have an advanced directive (living will or power of attorney for healthcare) We dont anticipate we'll really need it, but we are legally resposible for having it on the chart if you have one. And I think everyone should have one. I'll ask about your diet, if you feel safe at home, ask what you have with you and if you have any spiritual/cultural needs. After all of that, I'll do an assessment, which involves a cervical exam. In a perfect world, your cervix is favorable, or soft, thin and dilated. (If it isn't, I wish we could call the doc and either postpone the induction if its elective, or use a cervical ripening agent, like cervidil or cytotec. If I got to decide, it would be cervidil, but anyway... )I'll then start and IV for fluids, antibiotics if they are needed and for the pitocin, as this is the drug of choice for inductions at my hospital. Through the night, we don't expect that you'll make much (if any) change in your cervix. The goal is to get you contracting and ready for when the doc comes in in the a.m. to break your water, usually at about 7:30am. Some of the doctors may not do this if your cervix isn't ready, so they aren't setting the patient up for a c-section because their body wasn't ready to be induced, but with a medical induction, delivery is inevitable that day, regardless. And no, they don't come in at midnight to do this, at least not here. So I'll be in and out of your room every 15-30 minutes to increase the pitocin slowly, until you are having contractions 2-3 minutes apart. Then I'll only increase if they start to space out. It may be longer in between increases if the baby doesn't look especially happy. When a patient can get an epidural depends on the doc. With most, they are okay with it at anytime during the inductions as long as you are having regular contractions and are actually in pain. After your water is broken, things pick up pretty quickly. Contractions are more intense, you start to change your cervix and you are usually in good labor within an hour. Remember, I'm only generalizing here. Contractions on pitocin versus natural labor are more intense and closer together. That makes it more difficult for the mothers wanting to do it without pain medication, but it can be done. The stronger, more frequent contractions also increase the risk that the baby won't tolerate it. So, once you're on pitocin, we have to have continuous monitoring. That doesn't mean you can't move around, get up on the ball or in the rocking chair, you're just limited on how far the monitor cables can reach. Maybe at other hospitals, you can get up and move, I only know what we do here. Sometime in the hopefully near future, we'll have telemetry, so we can let patients walk in the hall and still have the baby on the monitor. I wish we used more methods of inducing more often, like using cervidil, or using a foley bulb. Some docs do use cytotec and cervidil, but none of them uses the foley bulb. I went to a conference and the midwife speaking. said he likes that the best. Speaking of conferences, I got info on a conference that I really want to go to. It's on emotionally charged issues in OB, like stillbirth, infant loss, the effects of that on the parents and children, postpartum depression, preterm labor and high risk pregnancies and how all of that affects the patient and the family. It sounds very interesting and worthwhile. So we'll see if work will pay for it.


Mrs. Spit said...

I wish all nurses had to go to those conferences. Maybe it would have eliminated the comment from the nurse that I had to settle down, I was hurting my baby. Now, I wasn't screaming, hysterical or otherwise. Just frightened.

Maybe it would have eliminated the nurse that came to discharge me and told me that she didn't need to check my car seat or tell me about shaken baby syndrome. Yeah, thanks. Like we didn't realize that we weren't going home with the baby who died.

Thanks, that was really useful information.

Nurse Lochia said...

I'm so sorry you had such insensitive nurses. I hope you reported their behavior to the director. There is absolutely no reason for anyone to treat someone this way, especially under the circumstances. I'm guessing work will let me go, and if I do I'll have to give a short talk to everyone else. And I agree, I think we should have more training on how to handle situations like this. Not only how we work with patients but how we handle it emotionally ourselves. Again, I'm so sorry you were treated so horribly.

Jody said...

Yes I apologize for the rude and thoughtless treatment you received. Talk about dull!!

Well we do use foley bulbs. And they seem to work pretty well. They're usually put in about 9pm or so and then we "tug" on em til they come out..OR they fall out when the pt. walks to the bathroom. I had 2 of these girls this am. Both lost their foleys when I tugged on em and then both had their Pit started.

Prisca: said...

We use the foley bulb (it is pretty helpful) and we have loads of cervidil inductions. I also wish we had telemetry! Great post!

Stellan Bracelets said...

I am praying that the conference will speak to the hearts of those who deal with stillbirths, infant loss, and other heartbreaking situations. I volunteer for NILMDTS, a non-profit organization that offers photography services to parents who won't be taking their babies home with them, and having been there myself, I have seen the best and the worst of comments/reactions/etc, I think there's a lot of room for improvement and education in this area.

God Bless you for the work that you do (and do well!).