OB's - Paramedics Checking Dilation

[spenac]

So should Paramedics be allowed to check active labor patients for level of dilation? Do any services allow this and if so how are protocols worded?

I see pro's and con's to this. But will hold my tongue till I see some others thoughts.

[AnthonyM83]

*blink blink*

It never occurred to me that any services out there don't. I thought that was standard training from the BLS level.

We did it just last shift and we were way more hesitant about it than the patient was. She was just in incredible pain and just wanted us to do what we needed and get her to a hospital. Most pregnant women know we need to do that and it's probably on their mind more than ours (is my baby going to be born in my living room floor?).

Not only are you checking for dilation, you're checking for crowning. You want to know what time frame you're working with and certainly don't want a baby to start emerging without you being ready...

[vs-eh?]

Considering the relative rarity of pre-hospital childbirth and the general unwillingness of paramedics to deliver pre-hospital (i.e. run for the hospital), it seems pointless.

Concentrate on properly assessing duration and frequency of contractions, getting a decent history, noting crowning, recognizing (potential) life threatening complications (placenta previa, abrupto, etc...), and be up on NRP. These are more improtant than assessing for cervical dilation.

Again, why add such non emergent physician procedures to an already under-educated system? I don't get it...

[spenac]

*blink blink*

It never occurred to me that any services out there don't. I thought that was standard training from the BLS level.

We did it just last shift and we were way more hesitant about it than the patient was. She was just in incredible pain and just wanted us to do what we needed and get her to a hospital. Most pregnant women know we need to do that and it's probably on their mind more than ours (is my baby going to be born in my living room floor?).

Not only are you checking for dilation, you're checking for crowning. You want to know what time frame you're working with and certainly don't want a baby to start emerging without you being ready...

So what are your protocols for this? Who provides the education?

[spenac]

Considering the relative rarity of pre-hospital childbirth and the general unwillingness of paramedics to deliver pre-hospital (i.e. run for the hospital), it seems pointless.

Concentrate on properly assessing duration and frequency of contractions, getting a decent history, noting crowning, recognizing (potential) life threatening complications (placenta previa, abrupto, etc...), and be up on NRP. These are more improtant than assessing for cervical dilation.

Again, why add such non emergent physician procedures to an already under-educated system? I don't get it...

I have delivered numerous times in the ambulance. 6 times this year. Took over 100 active labor the 90 miles to the hospital this year and delivered 3 more babies on the hospital bed before the doctor arrived. IMHO it could help us make a more informed call on whether to just set up and deliver vs just drive, also could help hospital decide whether to just wait till we get there or to activate a delivery team, yes small hospital. Already all active labor patients are naked patients and are visually checked but more info makes for better decisions.

[Connie31079]

We aren't allowed to check to see how far dialated a woman is, we're only allowed to check for crowning of the baby's head. No fingers (or other equipment for that matter) is allowed to be inserted vaginally to check to see how dialated our patient is.

Gotta ask all the other questions for sure, water broke? Lost your mucus plug (bloody show?), how far apart are the contractions, what # pregnancy is this for you, good pre-natal care, how fast did your other babies deliver? Stuff like that.....I wouldn't want to have to stick my fingers up there anyway.

[Leener77]

We were taught in EMT school that we aren't allowed to insert any fingers (unless the cord is prolapsed, in which case you insert your finges inside to release pressure off the cord from the baby's head) into the woman but to check for crowning. I, unfortunately, have never delivered a baby in the field so I don't have any experience in that area but I personally wouldn't mind checking for dilation. It would be another (although not absolutely necessary) tool to help questimate when delivery might be and how much time (if any) one may have to transport the PT to the hospital. But all the other questions need to be asked as well, as Connie mentioned above, which will also help to make that determination. You certainly can't go on dilation alone because you never know how long it will take to get from where ever they are to complete as it is totally different for each woman. Case in point.......It took at least 8 hrs for me to get from 1-5 cm (with my 3rd pregnancy)......but once I got to 5, I dilated from 5 to 10 in an hour......so like I said, each case is totally different especially if this is not a first time mom.

It is a skill that I wouldn't mind learning..........I think the thought of being able to deliver a baby is very exciting and learning anything having to do with that would be great......stricly in my opinion of course......cause I know it's not everyone's cup-a-tea...lol!

[Scaramedic]

:shock: :shock:

Not allowed except as already noted by Leener77.

Peace,

Marty

[DwayneEMTP]

Yeah, I was taught, I don't know about protocols, that nothing goes inside the vagina except to release tension on a prolapsed cord, or clear the front of the face of a baby born upside down.

What would knowing dilation change about your prehospital care? Having delivered so many babies I'm guessing you know that 5cm in one woman might mean 6 hours where it could men 10 minutes in the next...

I'm not criticizing your question, I just don't see where adding additional risk of infection to an already unsterile environment would pay any real dividends in this situation.

It's just too unreliable an indicator where time is concerned.

[Ridryder 911]

There are only two accepted times a (U.S. NHTSA) is allowed to insert the fingers into the vagina, as noted prolapsed cord and yes, to reinsert a prolapsed uterus.

Now, as a RN I am legally able to check for dilation. Now, with that said.. I don't.. why? I see O.B. nurses with years experience get it about 80% of the time, it is all subjective. The worst ones are non OB/Gyn physicians ... they are guess-a-mating.

Although, I find it ironic to be able to deliver and crich, intubate.. the old male stereotype role.. has bit us. Even though, I do doubt that most medics would be able to correctly determine dilation accurately due to low occurrence and experience.

R/r 911