OB's - Paramedics Checking Dilation

[katbemeEMT-B]

Obviously somebody hasn't done many OB calls. Nothing hot and nothing sexual about a vagina covered with all sorts of pre-birth goo(hows that for a medical term).

Best descriptive medical term yet. I'll have to remember that for my classes.

Hey, question, are most of your patients full-term or do you have many pre-term? Just curious. I can totally identify with the lack of prenatal care thing. We get moms that come through class with less then three month to go and haven't been to see a doctor yet. The first thing we do, set them up with our favorite OBs. They usually end up being illegals and don't want anyone to know.

[spenac]

Spenac, where the heck to you work? 6 live births in the ambulance this year? I know medics with 20yrs in the field (in busy systems) who haven't delivered any babies. Holy guacamole...

On the border. Minimum 90 miles to the hospital. Many OB's show up in remote areas that take more than an hour to get to, then that takes us 2-3 hours to get them to the hospital. Most are illegals, that get into the country illegally or even legally with a day pass then go hide out at a friends house till they go into labor. I actually went 2 years transported 300+ active labors with no deliverys. Last 2 years only about 200 active labors and 9 or 10 deliverys in ambulance.

We used to put stork stickers on back window but got to a point you could not see out. So on new ambulance we don't do it.

[spenac]

Best descriptive medical term yet. I'll have to remember that for my classes.

Hey, question, are most of your patients full-term or do you have many pre-term? Just curious. I can totally identify with the lack of prenatal care thing. We get moms that come through class with less then three month to go and haven't been to see a doctor yet. The first thing we do, set them up with our favorite OBs. They usually end up being illegals and don't want anyone to know.

We get lots of no prenatal care OB's. Large number of pre term OB's, but don't break down our charts beyond OB, so not sure of numbers. Thankfully we get most of those to the hospital. I have delivered a couple of preterm over the past few years, sadly to young and did not survive. Thankfully most of the time we are able to bolus them and slow or stop contractions. If all else fails we go to terbutaline to try and stop pre-term contractions.

[sledogg1]

In 18 - 19 yrs doing this and delivered 5 , I have never inserted fingers for a dilation check. Believe me you know, if she not a crowing don't go a measuring!!!!!!!!!! With ambulance chasing lawyers out there, you don't have a leg to stand on. Yes, we are trained in school and rotations but really..........do u want to go there.

[Dustdevil]

With ambulance chasing lawyers out there, you don't have a leg to stand on. Yes, we are trained in school and rotations but really..........do u want to go there.

Wait... do your policies/protocols/whatever address this? If so, what do they say specifically? Why would they train you to do this if they didn't intend you to do it? If they do intend you to do this, are you not practising negligently by not doing so? Talk about not having a leg to stand on! I'm confused.

[sledogg1]

Hay Dust, long time no chat.....................as Connie mentioned earlier our policy/protocal does not include this, look but don't manual dilate. Trained in class and rotation as the EMT-P, ACP scope but not allowed on the rig like catherazion....... in breech though allowed to if head does not deliver 2-3 min place gloved hand -figers in a v position over baby's face and push vagina away.

[spenac]

In Texas these procedures are up to the service's medical director. The medical director can make written protocols for pretty much anything that they are willing to allow. Our medical director educates us in and allows many procedures other services would never consider. Our medical director understands we are the only medical care for at minimum 90 minutes and often longer.

[TheWritingParamedic]

I don't see the point in checking for dilation since labour is not an emergency until 'something' is popping out of mom. By something I mean body parts or fluids or anything that you check for and go, "Oh my god." Truly, what purpose would it serve aside from telling the hospital, "We have a 26 y.o. female in active labour dilated 2 centimeters." Erm...no, thanks, I'm good. It takes 8 to 10 cm before the baby can enter the birth canal anyway, so... I can see the good and bad points of allowing us to do it. My medical director see no point in us checking for dilations since "babies were delivering themselves long before midwives learned to check dilation." Make sense to me.

[Ridryder 911]

It is these type of situation, I believe that Scope of Practice should be ended with the "..as Medical Director deems necessary"....

There may be areas, that was described were more detailed assessment would be necessary, where as in other areas should never be considered. Of course it goes with saying additional education and clinical exposure would be needed.

That is the great thing about medicine, it is an science mixed with art, to practice. There are areas dependent upon so many variables that it should never be cooked book.

R/r 911

[Dustdevil]

I don't see the point in checking for dilation since labour is not an emergency until 'something' is popping out of mom.

Not always true. In seriously premature labour, this information can be invaluable to the crew and the receiving facility in deciding what to prepare for, and the possibility of diversion. When you have over an hour of transport, things can and do change very rapidly. Labour-like pains in a preemie mom that is not dialating is a very comforting thing that will allow you to transport without panic, and the hospital to wait without panic. Labour pains in a preemie mom who is rapidly dilating is extremely worrisome. You are going to want to have your ducks in a row, and so is the receiving facility. After a one to two hour transport in labour is not when you want your very first eval done! Especially on these young moms with zero prenatal care and a very limited ability to relate their prenatal history because they speak no English.

Think outside of the box, people. Not every EMS system is like Turd Watch, with cookbook medics working 5 minutes from three different Level 1 hospitals. There are some extremely remote and unique systems out here -- including mine -- where your standard urban cookbook won't get you past the first ten minutes of three hours of patient care. And I find it a little amusing that many of the same people who always whine about limited protocols, limited, pay, and limited respect will turn around and try to draw concrete boundaries around our practices.