Hospital Routines and Procedures

 

Fetal Monitoring

The babyís heart rate is often a good indicator of well-being, so it is monitored during labor and birth. There are two options for monitoring. (For more detailed information, see monitoring page.)

Intermittent Auscultation. A caregiver uses a fetal stethoscope or a Doppler device to listen to the babyís heart beat, at least every 30 minutes.

Electronic Fetal Monitor. Elastic straps around the motherís belly hold in place 2 devices which measure the babyís heart rate and relative strength of contractions. Provides continuous data, printed as graphs for the nurse to review on a regular basis. Typically, there are also monitors at the nurseís station, with other caregivers keeping an eye on the monitors in all the rooms.

  • Routine in many hospitals is to put on the monitor when the mother arrives at the hospital, in order to establish a 20 minute baseline measurement for her. If everything looks fine, the monitor can then be removed, and mother can be monitored intermittently. In many cases, however, the monitor is used throughout much of labor.
  • Indications: Necessary with pitocin and with epidurals. May be helpful for high risk mothers. (controversial)
  • Advantages: Continuous data, record of labor, caregiverís preference.
  • Disadvantages: Limits mobility, may make labor feel more like a mechanized, medicalized process. May lead to an over-diagnosis of fetal distress, and resultant excess of cesarean sections. (controversial).

 

Monitoring Momís Vital Signs

  • Blood Pressure: Checked every 30 minutes during active labor, every 15-30 minutes during second stage and post-partum.
    • What are they looking for? B.P. often decreases with epidural. Significant drop may indicate bleeding, shock, or supine hypertension. B.P. can rise rapidly with PIH, pre-eclampsia, eclampsia, fluid overload.
    • If youíre in bed, they often use an automatic B.P. monitor. However, if youíre moving around, they can use a regular cuff.
  • Heart rate
    • Normal resting rate for adults is 60-100 beats per minute. During labor, itís not unusual for it to reach 100-130 at times.
  • Temperature
    • An elevated temperature could indicate infection. (An elevated temperature can be a side effect of epidural.)
    • Babyís heart rate may increase in response to maternal fever (heart rate change may be detected before fever becomes measurable). Baby may have a fever at birth.
    • Significant maternal may be treated with I.V. fluids or antibiotics. If baby has a fever, may be tested for infection, and treated for infection (even if it turns out the fever was due to epidural effects, and not to infection.)
  • Respiration rate may be checked, especially if anesthesia or narcotics used
  • Fluid intake and urine output.

 

Vaginal Exams

  • Done by nurse or caregiver.
  • Determine the effacement and dilation of your cervix, and the station, presentation, and position of the baby.
  • Usually done upon arrival at the hospital, then done again whenever there seems to have been a significant change in intensity and frequency of contractions, or when mother feels the urge to push.
  • There is a risk of infection, especially after membranes are ruptured, so exams should be minimized. Should be limited to times when results of exam will affect decision-making or actions taken. (e.g. when pain medications are being considered, or when determining if itís time to begin pushing.)

 

I.V. (Intravenous Catheter)

  • A needle is inserted into a vein (generally in the back of the hand, or inside forearm). A catheter (thin plastic tube) is inserted through the needle, then the needle is removed, and the catheter is taped in place.
  • Fluids (e.g. glucose: sugar water) are run through the catheter for hydration. Medications can be added, such as Pitocin, antibiotics, and narcotics.
  • Indications: Necessary with pitocin, epidural, c-section, some high-risk labor
  • Advantages: Allows for rapid infusion of fluids and medications.
    • Necessary for hydration if the hospital has a policy of no fluids by mouth. (Thereís little scientific support for this policy in normal labor)
  • Risks / Disadvantages
    • Pain of insertion. Annoyance / discomfort due to presence of catheter.
    • Mobility is limited. I.V. fluids can be hung on a pole that you can push around as you walk about the hospital, but many people find this frustrating, and may choose not to move around as much after I.V.
      • Lack of mobility may lead to increased pain, and slowed labor
    • May make you feel like a sick patient, make others treat you as one.
    • Glucose does not meet your full nutritional needs during labor, thus prolonged I.V. use may lead to fatigue, discomfort, and slowed labor.
    • Bladder may fill more quickly. If mother is not urinating frequently, the full bladder can cause pain and slow labor progress.
    • The sugar in I.V. fluids can lead to hypoglycemia in the newborn.
    • The sugar in I.V. fluids may increase the perception of pain by the laboring woman. One study (Morley, 1984) showed that glucose infusions decrease the threshold for pain perception, and decrease the maximum amount of pain that is tolerable.
    • May cause phlebitis, over-hydration, or infection.
  • Alternatives.
    • For hydration: drinking fluids. Eating ice chips or popsicles.
      • If thereís concern about dehydration, urine output can be monitored. Volume and color are indications of fluid level. Some physicians monitor ketones in urine to assess hydration.
    • For medications: intramuscular shots may be an option with several medications. Otherwise, a ďhep lockĒ may be an option. This is similar to an I.V. needle, and is inserted into the skin to allow for quick access for medication. However, fluids are not run through it.

  

Compiled by Janelle Durham. Sources: Outline from Birth Educator Training, Birth Education NW / Seattle Midwifery School. Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler (2001 edition). Methods of Childbirth, by Constance Bean, 1990.

 

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