#7025
Tonia
Member

As a Labor and Delivery Nurse, I used critical thinking daily when monitoring laboring women and assessing the fetal heart and fetal heart surveillance strips. I remember caring for a couple who were in for their second child and wanted an unmedicated birth, typically women do not require continuous monitoring of the fetal heart in this situation but intermittent monitoring instead, which was Q15 mins. As she progressed I noticed the baseline fetal heart rate was beginning to rise more and more which lead me to question if the mother was developing a temperature, as it turns out she was developing a low grade fever, at this point she was given Tylenol for the fever but I felt given the fever and elevated FHR and that this was a second pregnancy ( they tend to go quicker) that a vaginal exam was called for at this time to assess progress, it was during this time I noted green amniotic fluid which signals meconium and is a higher risk delivery then they had planned and that the patient was also almost 7-8cm dilated which meant the transition phase would be soon to start and things would go fast. At that time I notified the Charge Nurse of the situation, the On Call OB as well as the NICU who were going to need to be there for the delivery, Everything happened very quickly and fell together in a coordinated way and a healthy baby boy was delivered. The vaginal exam was not necessary at the time I decided to do it, however given all the information in front of me I used my critical thinking to assess each aspect of the situation, all the data in front of me from the maternal temp to the FHR and my knowledge from previous situations to move forward. Had I not done so then it could have been a hurried situation, stressful and increased the chances of issues with meconium aspiration.