OB's - Paramedics Checking Dilation

[ERDoc]

It is in no way necessary. We don't even check for dilation in the ER. If they are not crowning they go to Labor and Delivery. Once a woman's water breaks you want to minimize the number of times you insert something into the vagina as you increase the risk of infection.

[chbare]

"Once a woman's water breaks you want to minimize the number of times you insert something into the vagina as you increase the risk of infection." The importance of this statement cannot be over-emphasized. The information you gain can be quite subjective as somebody stated in a prior post. In addition, somebody who is 90% effaced and 9cm dilated can labor for minutes to hours. You can gain a great amount of information with a non invasive patient assessment. I will let the OB docs do the secret handshake.

Take care,

chbare.

[Scaramedic]

Quick story:

We're bringing in an imminent delivery to OB. The RN stops us in the hallway and without a word to the patient reaches under the blanket and checks her dilation. She thens says "room 306" and walks off. The patient, my partner and myself are speechless, it was just so rude. So me being the funny guy said "Damn she could at least she could have bought you dinner first." To which the patient replied " or at least bought me a glass of wine to get me in the mood."

Peace,

Marty

[steph1030]

with ob pts we arent allowed to check unless crowning etc

if a limb/arm is visible, breech it is hands off

let the hospital handle it!it is up to them to handle any births not ours

our job is to get them where they need to be safely when called

[Leener77]

I absolutely agree that checking for dilation in the field is not necessary and (after thinking about it some more) really shouldn't be done simply because of increasing the risk of infection......especially if the water has broken. Also because pre-hospital births aren't done too often, the chance to 'practice' the skill would be few and far between. Labor is completely different from one person to the next and just because it happend one way for one, doesn't mean it will be that way for the next person.......ya just always have to be on your toes, and expect the unexpected when it comes to labor and child birth........it can be a wild and bumpy ride at times.....

And although it's something I think would be cool to learn (maybe in a different setting) I suppose it should be left to the professionals that do this on a daily basis........

[medic001918]

I agree, we should not check and there's no need. Checking for crowning in an active labor patient is significantly different from checking dilation as there's no need to insert fingers inside the patient. Inserting fingers is a last ditch effort for the presence of a prolapsed cord.

My wife is an OB nurse and she agreed with me that it's not needed for us to check for dilation.

I'd like to hear the protocol for those that say they do check, along with the educational background provided.

Shane

NREMT-P

[Dustdevil]

GO BIG OR GO HOME!!! :twisted:

I think either Anthony was attempting some EMT City style, "Go big or go home" humour, or else he was confusing dilation checks with visual checks for crowning.

While I agree that the male stereotype hurts us (many male nursing students report problems being allowed to fully participate in L&D rotations), I really don't see any need whatsoever for this in 99.9 percent of the systems out there. I worked one very rural, hospital based system where we had a grand total of three medics, and our drivers were RNs, that we would occasionally do a dilation check in order to decide whether or not to get a doctor out of bed ahead of us. It was something they wanted us to do and we got lots of regular practice at it in the hospital. So yes, I can envision a remote potential for this in EMS, but damn rare. Knowing what little I do about spenac's situation, this could possibly be something that would benefit them.

And who really cares anyhow. They're just Mexicans, right?

[spenac]

Thanks for all the input. I do agree that 99%+ services just need to get a visual and go. With my minimum transport of 90 miles and often times picking OB's an hour away from the station we end up with 2.5 hour transport times often. I do feel it could really help us better monitor what is happening instead of just peeking and waiting for something to be peeking back at us. If your service does allow dilation checks can you pm me the protocols. Thanks.

Now to educate those that do not do many OB's, to make sure you are not missing something when you look for crowning, gently open the vagina lips ( the labia ). You would be surprised how often at first look you think nothings happening, but when you open the labia you see hair(top of babys head) in the vaginal orifice where you should only see pink. You do not place fingers in vagina to do this.

While we are on the OB subject, lets say no dilation checks in the field for most, but what about episiotomies? To assist a tough delivery should they be allowed? Yes I realise that it is better most times to allow the baby to come out on its own, to even allow the perineum to tear. But at times I have had some women not tear and we assist stretching as much as possible but babys head sets stuck just inside and episiotomy could free the baby quicker helping avoid airway compromise of the baby.

[Leener77]

Perineal massage is an excellent way to stretch the vaginal opening allowing the baby's head to come out easier and to avoid tearing.....but that involves inserting the finger/fingers slightly into the vagina, so that's out (for most of us anyway). Episiotomy could be an option but there are times where there will still be tearing even with one.....like in a 4th degree tear. Usually a baby gets stuck or has a hard time coming out for other reasons.......not because of not having an episiotomy......like the head being stuck in the pelvis and shoulder dystocia. So I guess I don't really feel it would be a necessary nor a good idea to do one in the field.

Unless others out there with more experience that can suggest differently (considering I've never even delivered a baby in the field....lol)

[Just Plain Ruff]

as I pick myself up off the floor and dust myself off I exclaim Episiotomies inthe field. Holy crapola batman, do you think your medical director will allow you to basically cut the woman? I can't see a single benefit of a medic or (for dust's sake) GOD FORBID an emt doing this procedure.

But seriously, I can't imagine even thinking about doing an episiotomy. There is just too much that can go on with a sharp object down there. I don't want that anywhere near my liability insurance.