“Patient has one hour to progress ‘adequately'”

by Apr 25, 2018Hospital birth1 comment

I came across this story from a nurse and I wanted to share with you.

First because it’s an amazing story illustrating how nurses can help birthing parents avoid a primary cesarean.

And second, because we can all use some good news.

Here’s her story shared with permission:

“So something that irks me to no end… when I take over a patient that is in labor with some ‘complications’ that could make it harder for her to have a vaginal delivery.

And the previous nurse was not actively managing the patient i.e not titrating the pitocin to get her contractions in a better pattern, repositioning the patient to get her out of that horrid contraction pattern, not restarting the augmentation in a timely fashion after a decel that recovered…

I assume care of patient and doc is giving patient 1 hour to progress “adequately” or she will be sectioned. 1 freaking hour.

But guess what? Challenge accepted!!

Got my orientee to actively manage this patient who was AROM and temp brewing with no cervical change.

Doc remains pessimistic, but I advocate for this patient while my orientee faithfully flips this patient from side to side and actively manages the pitocin with ‘on time’ increases.

Low and behold, patient progressed from 4-5 cm to 6-7 cm in that hour.

The second hour, the patient progressed to 8-9.

And not even 30 min later, the patient was complete and pushing with MD at bedside.

I was told that the patient that I acquired would be headed to the OR if no change was made by 8:30 pm.

At 10:28 pm a big baby boy made his way through some nasty fibroids and graced us with his presence via the vagina!!

Moral of the story: we as nurses need to know that we have more power than we believe we do when it comes to managing our patients.

Advocate for your patients verbally and with your care.

There was no reason that patient should have been delivered via cesarean.

But it almost happened to my primip due to lack of proper Nurse management.

And if she had delivered via cesarean, she probably would’ve been labeled CPD because the baby was big and she wouldn’t been able to have a subsequent vaginal delivery.”

I simply love stories like that!

We each play a role and there is SO MUCH that we can do individually, and as a team, to reduce the cesarean rate!

As this story mentions VBAC after cesarean for CPD, I want to share with you a recent study on VBAC after cesarean for arrest of descent. The video is at the end of this article.

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1 Comment

  1. In Serbia, we are also given one hour only. I was told the same thing by my doctor, and since I wasn’t progressing that fast, I was pushed into a cesarian. I was told my insisting on having a vaginal delivery was putting my child’s life at risk.
    I wasn’t strong enough to stand up for myself and my child.
    But anyway, hospitals in Serbia don’t even want to consider VBACs. The only option, I guess, is birthing at home.


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Jen Kamel

As an internationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the US, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.

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