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Old 06-07-2011, 10:43 AM   #31
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Re: Water breaking ?

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I think there is some confusion here regarding a non-stress-test versus a contraction stress test. A non-stress test (NST) can indeed be performed by a CNM, CPM, or OB at an office visit with a handheld doppler. You do not need a tocodynamometer or to even know if the mother is having contractions to perform a NST.

So what is a NST? Continuous auscultation of the fetal heart for 20 minutes. During that time, the mother reports when she feels fetal movement. The practitioner is listening to the fetal heart rate (FHR) to first establish a baseline, then to hear at least 2 instances of an elevation of the (FHR) at least 15 points above baseline, for at least 15 seconds' duration.

As an aside to ~apurkeyp~, a trained ear can most certainly detect non-reassuring FHR patterns compared to the mother's contraction pattern without SEEING it on a strip. You simply listen to the FHR while observing/feeling the mother's contractions. A wise midwife will transfer her client to the next level of care when appropriate.

An as another aside, will everyone please leave defining a CPM's scope of practice to NARM and women who are actually midwives?
Great post!!

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Old 06-07-2011, 04:17 PM   #32
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Re: Water breaking ?

Quote:
Originally Posted by greenhands View Post
I think there is some confusion here regarding a non-stress-test versus a contraction stress test. A non-stress test (NST) can indeed be performed by a CNM, CPM, or OB at an office visit with a handheld doppler. You do not need a tocodynamometer or to even know if the mother is having contractions to perform a NST.

So what is a NST? Continuous auscultation of the fetal heart for 20 minutes. During that time, the mother reports when she feels fetal movement. The practitioner is listening to the fetal heart rate (FHR) to first establish a baseline, then to hear at least 2 instances of an elevation of the (FHR) at least 15 points above baseline, for at least 15 seconds' duration.

As an aside to ~apurkeyp~, a trained ear can most certainly detect non-reassuring FHR patterns compared to the mother's contraction pattern without SEEING it on a strip. You simply listen to the FHR while observing/feeling the mother's contractions. A wise midwife will transfer her client to the next level of care when appropriate.

An as another aside, will everyone please leave defining a CPM's scope of practice to NARM and women who are actually midwives?

You are 100% right. I guess the reason it was mentioned that a CPM didn't do an NST is because when most people hear "NST" they think the monitor you are placed on with the two belts - one for fetal heart tones, and one for contractions - in that sense - no midwives I've ever encountered or spoke to, do that. Most often, it is never thought of that an NST can mean simply listening to heart tones and monitoring movement and accelerations. Excellent information!

But you are right - I completely see what you are talking about! great information! Thank you!
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Old 06-07-2011, 04:31 PM   #33
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Re: Water breaking ?

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You are 100% right. I guess the reason it was mentioned that a CPM didn't do an NST is because when most people hear "NST" they think the monitor you are placed on with the two belts - one for fetal heart tones, and one for contractions - in that sense - no midwives I've ever encountered or spoke to, do that. Most often, it is never thought of that an NST can mean simply listening to heart tones and monitoring movement and accelerations. Excellent information!

But you are right - I completely see what you are talking about! great information! Thank you!
correct! since i went post-dates with my newbie (41w3d), my MW (CPM) did an NST for me, and also wrote me a referral for an AFI ultrasound.
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Old 06-07-2011, 05:30 PM   #34
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Re: Water breaking ?

I highly advise having a discussion about this with your care provider sooner than later. I found out at 31 weeks that my OB was totally unwilling to work with me in the event of prom and I had to find someone new.

I think a pp mentioned, and my midwife advised taking vitamins E and C to prevent water breaking in the first place.
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Old 06-07-2011, 06:33 PM   #35
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Re: Water breaking ?

"Most often, it is never thought of that an NST can mean simply listening to heart tones and monitoring movement and accelerations."

never thought of by whom? that IS the definition. you can look in any obstetrics or midwifery textbook and it will tell you the same thing.
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Old 06-07-2011, 06:41 PM   #36
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Re: Water breaking ?

The only reasons to go to the hospital right away are a) if you have fast labors (breaking my water sends me directly into transition from wherever I'm dilated... happened with both kiddos... if my water broke, I'd be on my way to the hospital within seconds) or b) suspected prolapsed cord, or c) signs of infection. My sister had a prolapsed cord with her 3rd baby... just knowing how scary that was would make me go straight to the hospital personally, even if I didn't have precipitous labors.
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Old 06-07-2011, 06:55 PM   #37
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Re: Water breaking ?

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Originally Posted by greenhands View Post
"Most often, it is never thought of that an NST can mean simply listening to heart tones and monitoring movement and accelerations."

never thought of by whom? that IS the definition. you can look in any obstetrics or midwifery textbook and it will tell you the same thing.
Oh I do not doubt that is the definition. I'm certainly not trying to argue with you - I completely see what you mean and thought you had an excellent point and agree with you.

What I meant is that for most people, (not in the medical profession or similar) - mothers, or soon to be mom's associate an NST with being strapped with two monitors - one for FHT and one to monitor contractions, if any. This is all I meant

See what I'm saying?
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Old 06-13-2011, 02:09 PM   #38
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Re: Water breaking ?

My water broke at home both times. First time I went to the hospital soon after and waited forever. Second time I stayed home until contractions were 3-5 minutes apart...
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