New Moms at Risk, and a Wake Up Call to Nurses!
Posted by realityrounds on March 6, 2010
ABC News aired an interesting news segment concerning the increasing rates of maternal mortality, especially in California. The segment begins with a tragic story of a new mom who was scheduled for a repeat elective C-Section. She did not leave the hospital alive. This was a preventable death. 100%
The segment described how this new mom layed in bed for 30 hours, yes 30 HOURS!, after her surgery. Flame me if you want, but this sounds like a negligence of NURSING care, pure and simple. Basic nursing 101. Surgery patients need to be ambulated early and frequently to prevent blood clots, which is what this new mom died of. Sometimes I feel like (and correct me if I am wrong….cuz I know you will!) OB nurses neglect their postpartum moms. It is easy to do. These are young, healthy patients. However, a C-Section patient is also a surgical patient, and should be treated as such. Frequent assessments are warranted. Fresh C-Section moms often complain about ambulating. They are in pain, do not feel well, and walking is the last thing they want to do. This is where nurses need to step in. Help your patient ambulate! Educate you patients on how important it is for their health. Bolus them on their PCA (patient controlled analgesia) or give them a pain med, stabilize their incision, and help them to walk across the room!
The article also mentioned the relatively cheap intervention of SCDs (sequential compression devices). These are fancy stockings and inflatable cuffs that wrap around your leg and “squeeze” them to force the blood through out the veins. Now SCD’s are fine and dandy, and are slowly becoming the standard of care for C-Section patients (I did not have them when I had my Section 6 years ago), but they are nowhere near as effective as walking.
I do also believe that the amount of C-Sections in this country needs to be decreased. This is obvious. Until that happens (which I truly believe will happen), please nurses, take this story as a wake-up call. Be hypervigilant with your C-Section moms.
RR
atyourcervix said
I didn’t view the video of the story, but I wonder why she didn’t get out of bed for 30 hours post op? I have taken care of quite a few post op c/s moms who are on magnesium sulfate post op for preeclampsia (minimum 24 hrs post op), and are on strict bedrest for the preeclampsia/eclampsia seizure risk. BUT – we still get SCDs on them preop/post op, encourage movement and repositioning in the bed, and encourage cough/turn/deep breathing for good pulmonary hygiene as well.
Normal post op c/s moms: up out of bed at 6-7 hrs post op, after the risk for spinal fluid leakage from the spinal anesthesia has passed.
realityrounds said
The video did not state if she had other complications. It made it seem she was just in for a run of the mill repeat C-section. It did not seem from the video that she had preeclampsia. I was out of bed in 6 hours after my section. My nurse was sooo strict, but in hindsight, I am very thankful for it.
Have you always used SCDs for preeclampsia patients? If not, how was emboli prevented in these patients? Just curious.
atyourcervix said
As far as I remember, yes, we have always used either SCDs or TEDS
atyourcervix said
Hit enter too soon.
Yes, as far as I remember (8+ years of nursing), we have always used SCDs or TEDS for preeclamptic post ops. We started also using SCDs preop, intraop and post op for all c/sections about 4-5 years ago. I also find that if we have someone on bedrest, and it’s going to be more than just 12-24 hrs of bedrest, many of us L&D nurses will get an order for SCDs. I mean, it’s super easy to apply them. We keep a huge stock of them on our unit, plus we have several of the machines, and can easily order more machines from central supply if needed. It’s so simple, yet, so effective in reducing the risk of DVTs.
Anon for this One said
Going anon for this.
I’m a nurse (not OB). Exactly 24 hours after my C section, nobody answered my call. The nurse didn’t answer her pocket telephone, despite having left the telephone number on the dry erase board in my room. The baby was screaming, he wouldn’t latch, I had no milk, I was alone, I needed to make him a bottle. I capped my own IV, hooked my foley bag into the opening of my gown where it allows for nursing, made him a bottle, put him in the bed, climbed back into bed by myself (this sucks freshly post-op with your foley still in), and fed him. I didn’t see her again until 6:30am (about 5 hours later) when she came to do I&Os at the end of the shift. I burst into tears when the CNM made her rounds that morning.
I had my husband bring my white TEDs that I was wearing to work while pregnant so I could wear them while hospitalized. I’ll be damned if I was going to get a DVT.
realityrounds said
Your story is just sad, and it really makes me angry. What would have happened if you were not a nurse? You had knowledge to work around the system, even though it was a horrible situation. It is also a warning that nurses need to be allowed to nurse. We spend so much time doing non-nursing tasks. ugh
pinky said
yes, I feel that nurses have been put in a terrible position of either taking care of their patients properly or doing all their paperwork. Something has to give. I am horrified that Anon could not get anyones attention. What if the baby turned blue? Anon did you have a button to push to get someones attention? I am paranoid about everyone having their button just in case sh1t like blue babies or chest pain occur.
realityrounds said
To AYC, I think your hospital is in the minority as far as using SCD’s as a standard of care. My hospital also does this, but it is not a standard as far as I know. This is were nurses can make a huge difference in the health of patients. We need to get the word out!
RehabRN said
I didn’t have TEDs either, but I do recall being put right next to the nurses’ station and told, “You will get up and walk xx amount of laps per day down the hall. We don’t care how fast you do it. Just stop by and let us know you did it.”
I walked as soon as I could. It hurt like hell at first, but I got my meds and all was good, and my baby was not snowed, either.
L.R. said
I’m wondering, what’s an optimal nurse to patient ratio for postpartum? I’m delivering at a new hospital this time and I want to ask them that specific question because of a sorta bad experience at my previous hospital.
After my c-section (not planned, I was in labor) they put the SCDs on me but they were woefully understaffed and no one was ever around to help me getting up and around. It was so hard because it hurt so badly and I had all these IVs and was bleeding pretty heavily too. I just wanted someone to help me steady myself so I wouldn’t collapse on the floor alone! My husband stayed as much as possible, our 2 year old in tow, but there were a couple times when they were gone and the baby was screaming in her bassinet and I could not leverage her out safely from my bed and I felt like I was going to pop a staple and was just so scared…and no one answered the call button. They also didn’t have me get out of bed until they took out the cath and other stuff, like 20 hours after surgery. Reading this…that scares me.
atyourcervix said
Optimal nurse-patient ratio in postpartum is one nurse to 4 couplets (mother & baby unit). That’s optimal – not necessarily what staffing dictates. I have heard postpartum nurses having as many as 8-10 postpartum couplets on night shift.
Pattie, RN said
I am sure you didn’t mean to imply that the NURSE should use the bolus function on a PCA, did you?? Recomending such to a pt, fine—doing it yourself—not fine.
realityrounds said
You are right, that is not what I meant. Is that what it sounds like? I meant, get the patient’s pain under control before ambulating. Simple nursing 101.
Allison said
Hmm. On our PCAs there is the patient controlled dose button and an optional clinician bolus option that can be used by nurses as needed per orders to get pain controlled or to premedicate for movement. This is acessed by code or key. We always have orders before using this. That is how I read this.
maha said
That story makes me really sad. I feel so bad for that woman and her family. I’m wondering though, how much pre-op teaching she got regarding the importance of ambulating? And like other commenters asked, what was the staffing ratio?
Sarah said
My hospital uses the SCD’s for everyone the second they step in the door until they are ambulating freely. Standing order, but I doubt that anyone would crucify one for using SCD’s on a pt without one!
My c-sections girls are up 5h post up, unless there is a clinical reason to remain in bed. This story is sad – I tell my c-section ladies they will be sick of me by the time my shift is over, but its for their own health and safety.
Our maternal fetal medicine folks have been prescribing fragmin post op, specifically for women over a certain BMI – sorry that I can’t remember the exact number at this hour.
emjaybee said
I know they are probably a good thing, but I hated those damn boots. I could not sleep properly at all while I had them on, they were loud and extremely uncomfortable. I ended up pulling them off myself when the nurse failed to come do it when she said she would. I didn’t mind walking nearly as much, frankly. /rant
Lisa said
I have had two c-sections. I was allowed up 10 to 12 hours after the first one to shower and use the restroom as needed. With the second baby, I was kept in bed at least 18 hours (c-section at 1, up the next morning). I did have those annoying compression things on my legs though. Despite being bed bound, I provided ALL care (diapers, nursing, cleaning) for my sons once we got into our room as I was so drugged I didn’t think of calling for help.
At no time was I asked to walk and this was at a world class teaching hospital.
realityrounds said
Holy Crap!
I also had a C-Section. My mean (ha, she was great!), nurse made me get out of bed 6 hours post-op. She was so insistent. It was 5am, but she was all “get up!” “Freshen up in the bathroom!” “Sit in this chair until breakfast!” Thank God for her.
Anon said
Wow. Just, wow. For my c/s I still had a Foley’s and had not moved from the bed for over 24 hours. I had NO IDEA that this would be a problem. The emergency bell pulling out of the wall, and consequently yelling for help, and having my husband show up ( before any nurse came ) after going home and eating and showering was the icing on the cake.
Anon said
I went back and looked at my chart and it says that I was on “bedrest”. Some quick math revealed that from closing up the c/s to first time out of bed was near 30 hours 30 min. The operation was “uneventful” and my condition was “satisfactory”.
RR: “The segment described how this new mom layed in bed for 30 hours, yes 30 HOURS!, after her surgery. Flame me if you want, but this sounds like a negligence of NURSING care, pure and simple. Basic nursing 101. Surgery patients need to be ambulated early and frequently to prevent blood clots, which is what this new mom died of.”
Is this for real? Are there studies?
realityrounds said
It is very real that ambulating quickly after surgery prevents not only blood clots, but also pneumonia. I do not have any research to link, but if you googled it, you would find loads of research.
I will warn that every patient situation is different. Some post-ops are too unstable to ambulate, like AYC noted. At the minimum, non-ambulatory patients should have SCDs placed.
Cloud said
Huh. I live in California. I gave birth (twice!) at the hospital that I think has the highest number of births per year here (or maybe it is second highest? I can’t remember- anyway, a very large hospital).
Anyway, my second birth was a C-section because the baby was breech (undiagnosed until I was in labor!) and on the large side. After wards, I had the cuff that squeezed my legs to circulate blood. And my nurses got me up and moving as soon as I stopped puking from the anesthesia. I’m not sure how much they would have forced the issue if I hadn’t been willing, though.
Since my C-section was unplanned, and in fact a big surprise given my previous vaginal birth, I had almost no pre-op education about having a C-section. But I thought they did a pretty good job helping me out after the fact.
Mama to Monkeys said
I have had two cesareans. The first one was unplanned, and I had no idea that blood clots were an issue. I am pretty sure I was up and around (with help, of course) within 6 hours. The second c/s was just as unplanned as the first, however this time I knew to get up and moving asap. I had a spinal and was therefore flat on my back for three hours. After that was over and we got the pain controlled with some Tordol (PCA only for a c/s is ridiculous imho which is what they started me with) I was up and around to the point where the nurses were surprised. There was no way in HELL I was going to get a DVT due to my own pain or exhaustion. I’m pretty sure that I was up about 5 hours post op the second time.
Shelly said
I don’t think poor nursing care is exclusive to C sections. I recently had a vag birth at the hospital I work at (and they knew it!)I had a post partum hemorrhage and neither my fundus or tear were checked past the first 4 hours. I went back and looked at my chart- but both assessments were charged as if they did it.