Chapter 19: Nursing Care During Obstetric Procedures

Welcome to Last Minute Lecture.

This free chapter overview is designed to help students review and understand key concepts.

These summaries supplement not replaced the original textbook and may not be redistributed or resold.

For complete coverage, always consult the official text.

Welcome back to the Deep Dive.

Today we are pushing through the double doors of the hospital and walking straight onto the labor and delivery unit.

We are.

We're taking a very close look at Chapter 19 of maternal child nursing.

And the theme today is, well, it's about the reality of modern birth.

It is.

You know, we often talk about birth in these very soft physiological terms.

Ideally, the body knows exactly what to do.

The hormones flow, the uterus contracts, and the baby arrives.

But in the real world, and certainly in the textbook we're covering today, nature sometimes needs a nudge.

And sometimes it needs a full on shove.

Exactly.

We are covering the full spectrum of obstetric procedures.

We're going to talk about everything from breaking water to major abdominal surgery.

But the lens we are using, and this is critical for the nursing students or professionals listening, is the lens of the safety net.

The safety net.

I like that phrasing.

Because the doctor or the midwife might be the one holding the instrument.

Right.

Right.

But the nurse is the one ensuring everyone survives the experience intact.

Precisely.

Our mission today is to master the nursing responsibilities during these procedures.

When you intervene in a natural process,

you introduce risk.

That is just a fact of medicine.

You're changing the game.

You alter the physics of labor.

So the nurse's job is to be the one standing at the bedside, eyes glued to the monitor, spotting the subtle signs that say, hey, this intervention is going sideways long before it becomes a catastrophe.

So we have a clear roadmap for this deep dive.

We are going to travel sequentially, escalating from the least invasive to the most invasive.

That's the plan.

We'll start with amniotomy.

That's breaking the water.

Then we'll move into induction and augmentation, which gets us into some heavy -duty pharmacology.

Yep.

Pedosin.

Then we'll try to flip a breech baby with a procedure called version.

We'll look at assisted delivery with forceps and vacuums, the tools of the trade.

And finally, we will end in the operating room with cesarean birth.

And through all of this, we need to keep asking, why does this matter?

Right.

What's the, so what?

It matters because these are the moments where the risks spike.

We are talking about infection, hemorrhage, fetal distress.

This chapter is the difference between a safe outcome and a tragedy.

Heavy stakes.

Let's jump in.

Section one, amniotomy, artificial rupture of membranes, or AROM.

This seems like the bread and butter of L &D.

It is extremely common.

It's arguably the most common operative procedure in obstetrics.

Really?

More than anything else?

Well, just about.

The doctor or midwife artificially breaks the amniotic sac.

We do this for a few reasons.

Often it's to induce labor to just get the process started, or maybe labor has stalled and we need to augment it to speed it up.

Or sometimes it's strictly for monitoring, right?

Right.

If the external belts on the mom's belly aren't picking up the baby's heart rate reliably, or if we need to measure the exact strength of contractions, we need to place internal monitors.

And you can't do that through the bag.

You can't place those if the bag of waters is intact.

You have to break the seal.

But the text mentions a phrase that gave me pause.

Yeah.

Amniotomy implies a commitment to delivery.

That sounds serious.

It is serious.

I tell students this all the time.

You cannot unbreak the water.

No going back.

Once you rupture that membrane, the clock starts ticking.

You have removed the protective barrier between the sterile environment of the uterus and the non -sterile world outside.

So you're committed because of infection risk?

Because of the risk of infection.

We generally want the baby born within 24 hours of the water breaking.

So if you break the water and labor doesn't start, you're now on a countdown timer that might end in a C -section that you didn't plan for.

Let's visualize the tool here, because figure 19 .1 in the source material is quite specific.

It's called an amnihook.

Yes.

And if you've never seen one, imagine a long, rigid, disposable plastic rod.

It looks a lot like a crochet hook.

A crochet hook, okay.

The provider performs a vaginal exam to locate the cervix and feel the bulging bag of waters.

They slide this hook along their fingers, snag the membrane, and just nick it.

Pop,

fluid gushes out.

Then they typically use a finger to widen the hole to let it drain more freely.

It sounds so mechanical and simple, but the text warns about three major risks, the big three.

And this is where the nurse earns their keep.

Absolutely.

The first one is prolapse of the umbilical cord.

This is the number one immediate danger.

You have to understand the physics of the uterus to get this.

Think of the uterus as a balloon filled with water and the baby is a cork floating inside.

Okay, I'm with you.

A cork in a water balloon.

If the baby's head is wedged tight against the cervix, if the cork is in the bottle, then when you break the water, the fluid leaks out around the head, but the cork stays put, safe.

But if the head is high, if it's floating.

If the head is floating or at a high station, meaning it's not engaged in the pelvis, there is a gap.

When you break the bag, there's a massive gush of fluid.

A torrent.

And that current can watch the umbilical cord right past the baby's head and down into the vagina.

And then gravity takes over.

The baby's head comes crashing down.

And pinches the cord against the mother's pelvic bone.

It acts like a clamp.

You have just cut off the baby's oxygen supply.

It is an absolute emergency.

So as a nurse, preventing this is the priority.

Yes.

The text says clearly, amniotomy is deferred if the fetal presenting part is high or not cephalic.

If the head isn't down and engaged, you generally don't do it.

But let's say the procedure happens.

What is the nurse doing in that exact moment?

You are watching the fetal monitor.

Your eyes are glued to it.

Not cleaning up the fluid.

No.

You need a baseline heart rate for 20 to 30 minutes before the procedure so you know what the baby looks like when they are happy.

But for at least one full minute after the rupture, you are staring at that heart rate tracing.

And what are you looking for?

What's the red flag?

Bradycardia.

A significant drop in the heart rate or deep variable decelerations.

And what does that tell you?

That tells you the cord is being squeezed.

If you see that, you don't worry about cleaning up the water.

You hit the call bell.

You call for help immediately.

Okay.

Assuming the heart rate is fine, we move to assessment of the fluid itself.

We're documenting quantity, color, and odor.

Correct.

Normal amniotic fluid is clear, maybe straw colored, and has a mild earthy smell.

It shouldn't have a strong odor.

And if it's green?

Green means meconium.

The baby has passed stool inside the uterus.

Which is a sign of stress.

It can be.

It can happen when the baby is stressed or hypoxic.

The anal sphincter relaxes.

So green fluid is a yellow flag for the team.

We need to pay closer attention.

And if it smells bad?

If it has a strong foul odor, you are likely dealing with chorioamnionitis, an infection of the membranes.

Which is risk number two.

Infection.

Exactly.

Because we broke the seal.

Bacteria from the vagina can ascend into the uterus.

The nurse needs to be vigilant.

So temperature checks.

We check the mother's temperature every two hours after the water breaks.

But here is a clinical pearl the text hints at.

Often the baby gets sick before the mom does.

What does that look like on the monitor?

Fetal tachycardia.

The baby's heart rate will speed up, often over 160 beats per minute, before the mother ever spikes a fever on the thermometer.

So if that heart rate starts creeping up, you have to suspect infection.

The third risk was abruptio placenta.

This one surprised me.

Breaking water can cause the placenta to detach.

It's rare, but yes.

It happens with hydromneos when there is way too much fluid.

So the uterus is over -destended.

Right.

It's stretched tight like a drum.

If you rupture the membranes and a huge amount of fluid rushes out instantly, the uterus shrinks down rapidly.

Decompression.

Rapid decompression.

As the uterine wall shrinks, the attachment site of the placenta shrinks too.

If it happens too fast, the placenta can buckle and shear right off the wall.

That cuts off blood flow immediately.

Wow.

Okay.

So nursing care for amniotomy isn't just handing the doctor the hook.

Not at all.

It's FHR baseline.

Checking for cord prolapse signs, monitoring for infection, assessing that fluid.

It is basic comfort, right?

And keeping the patient dry.

Change those underpads frequently.

Lying in a warm, wet pool of fluid is basically creating a petri dish for bacteria.

Could hygiene reduce his infection risk?

All right.

Let's move to section two.

Induction and augmentation of labor.

We talked about the difference briefly.

Induction is starting from scratch.

Augmentation is giving a stalled labor a boost.

Correct.

And before we start any of this, we have to ask a fundamental question.

Is the body ready?

Right.

You can't just force it.

You cannot just force the cervix to open if it's not biologically prepared.

The text introduces the Bishop scoring system here.

Visualizing table 19 .1, it looks like a report card for the cervix.

It is exactly that.

It evaluates five factors to estimate if an induction will be successful.

If you try to induce a cervix that scores low, you are setting the patient up for a failed induction and likely a C -section.

Okay.

Let's run through the five factors.

We've got dilation, effacement, and station.

Those are the standard checks.

The ones everyone knows.

But the other two are cervical consistency and cervical position.

What do those mean?

These are tactile assessments.

You feel for them during a vaginal exam.

For consistency, does the cervix feel firm like the tip of your nose?

That's unripe.

Or does it feel soft like your lips or stick of butter?

That's ripe.

A soft cervix stretches.

A firm one resists.

And position?

What about that?

Early in pregnancy, the cervix is posterior.

It's actually pointing back towards the tailbone.

As labor gets closer, it moves anterior pointing forward, lining up with the birth canal.

An anterior cervix scores higher.

So we add up the points from all five.

What's the magic number?

What's the passing grade?

Generally, a score greater than eight is what we want.

That's just the likelihood of a vaginal birth is similar to spontaneous labor.

And if it's low, say a four or a five.

If the score is low, we can't just start contractions.

We have to do cervical ripening.

Ripening, making it softer.

The tech says we can do this with chemicals or with mechanical tools.

Let's start with the drugs,

prostaglandins.

Right.

We use drugs like prepadil or cervadil.

These are prostaglandins that break down the collagen in the cervix, making it softer and more yielding.

Or we use mesoprostol, also known as cytotech.

And the techs had a specific note about cytotech being an ulcer drug, that seems on.

Yes.

And this is important for nurses to know.

Mesoprostol is FDA approved to prevent gastric ulcers.

Using it for cervical ripening is an off -label use.

But it's common practice.

It's very effective and very inexpensive.

So it is widely used.

The risk, though, is that it's a pill.

Once you put it in, you can't take it out.

And the main risk with all these ripening agents is tachycystally.

Too many contractions.

The uterus goes into overdrive.

We'll get to why that's so bad in a moment.

But first,

the mechanical methods, the Foley catheter.

How does that work?

This is pure physics.

You insert a Foley catheter, just like for a bladder, through the cervix and inflate the balloon with about 30 to 50 milliliters of water.

And it just sits there.

It sits there.

The pressure of the balloon resting on the internal side of the cervix stimulates the release of local prostaglandins and, you know, it physically stretches the cervix open.

And then there's laminaria, which I have to say sounds like something from a biology class.

It is.

It's dried sterile seaweed.

You insert these thin sticks into the cervix.

They absorb water from the cervical mucus and expand, swelling up like a sponge.

As they swell, they gently force the cervix open.

It's slow and gentle.

OK, so the cervix is ripened.

The bishop's gore is up.

Now comes the main event for induction,

oxytocin, or as most people know it,

the most common drug in obstetrics and also one of the most dangerous.

It is classified as a high alert medication for a reason.

Why is that?

It has a narrow therapeutic index, meaning the difference between a safe dose and a dangerous dose is very, very small.

The text describes a very specific IV setup for pedosin, not just plugged into the arm.

It's a piggyback.

This is a critical safety protocol.

You never, ever just free flow pedosin.

Oxytocin is always diluted in fluid and run as a secondary line on an IV pump.

And this is the key.

It connects to the primary 5V line at the proximal port.

The port closest to the patient.

Why does that matter so much?

Imagine an emergency.

The baby's heart rate crashes.

You need to stop the contractions instantly.

You hit stop on the pedosin pump.

If the pedosin was connected way back at the IV bag, there is still six feet of tubing filled with the drug that is going to flow into the patient by gravity.

So even though you turn it off, she's still getting the drug for another few minutes.

Exactly.

Which could be catastrophic.

By connecting it at the proximal port literally inches from the vein, when you stop the pump, the drug stops entering the body immediately.

There is no residual in the line.

That makes perfect sense.

So we are running the pedosin, titrating the dose up slowly.

What is the nurse watching for?

We mentioned tachycystally earlier.

Let's define it.

Tachycystally, or hyperstimulation, is defined as having more than five contractions in a 10 minute window averaged over 30 minutes.

Or contractions that last longer than two minutes.

Or if the uterus doesn't relax for at least 30 seconds between them, the resting time is crucial.

Why is that lack of relaxation so dangerous?

I would think more contractions equals faster, baby.

That's a common misconception.

You have to understand placental physiology.

The placenta only refills with fresh oxygenated blood when the uterus is relaxed.

Ah, so between contractions.

Right.

During a contraction, the muscle squeezes the blood vessel shut.

Flow stops.

The baby is essentially holding its breath.

So if you have contraction, contraction, contractions with no break.

The baby never gets a breath.

They run out of oxygen reserves and go hypoxic.

So the nurse sees this on the monitor.

Contractions are back to back.

The baby's heart is dropping.

What is the protocol?

The text lists a specific intervention drill.

We call it the stop and turn drill.

It's a sequence every L and D nurse knows by heart.

Step one, reduce or s -stop the oxytocin infusion.

Off the tap.

Immediately.

Step two, turn the woman onto her side, usually the left side.

This relieves pressure on the vena cava and maximizes blood flow to the placenta.

Step three.

Oxygen.

We give eight to 10 liters via a tight non -rebreather face mask.

We want to supersaturate the mom's blood so whatever flow gets to the baby is as rich in oxygen as possible.

And step four.

Fluid bolus.

Open up that primary high V line wide open to boost blood volume and improve placental perfusion.

And if the uterus still won't relax after all that, then we have to use a tocolytic drug.

Usually tribuline.

It's a shot that relaxes smooth muscle.

It essentially paralyzes the uterus temporarily to stop the contractions and give the baby a break.

One last side effect of oxytocin mentioned in the text is water intoxication.

Yes.

This is a tricky one.

Oxytocin is chemically similar to antidiuretic hormone ADH.

Which makes you hold onto water.

Exactly.

If you run high doses of piosin for a long time, the mom's body starts retaining fluid.

It dilutes the blood, leading to hyponatremia low sodium.

And the signs of that would be?

The nurse needs to watch for headache, blurred vision, and confusion.

It can lead to seizures if not caught early.

Okay.

Let's switch gears.

We've tried to induce, but what if the baby isn't even pointing the right way?

What if the baby is breach or transverse?

Then we might attempt section three version, specifically external cephalic version or ECV.

Which is a fancy way of saying turning the baby from the outside.

That's exactly what it is.

It's basically trying to manually turn the baby from the outside of the abdomen.

I'm looking at your 19 .4.

It looks intense.

The doctor has both hands digging into the mom's belly.

It is intense.

It's not a massage.

It's a manipulation.

The doctor pushes on the baby's head and bottom, trying to encourage a forward or backward roll into the head down position.

The text says this is done after 37 weeks.

Why wait?

Why not do it when the baby is smaller and has more room to spin?

Two big reasons.

First, if you do it too early, the baby is small enough to just flip right back to breach.

It's a waste of effort.

That makes sense.

Second, and more importantly, the procedure has risks.

You could entangle the cord or shear the placenta.

If a complication happens during the version, you need to be able to deliver the baby immediately.

By emergency C -section.

Right.

You want the baby to be term 37 weeks to ensure they are ready for birth if something goes wrong.

What are the nurse's responsibilities here?

Safety.

Again, it always comes back to safety.

We start with a non -stress test, an NST, to prove the baby is healthy and reactive before we even touch them.

Then we usually administer a tocolytic like that tributyline we mentioned to relax the uterus.

You can't turn a baby if the uterus is tense or contracting against you.

And there's a note about ROGAM.

Crucial.

If the mother is RH negative, the manipulation could cause a microscopic mixing of fetal and maternal blood.

Which could sensitize her immune system.

Exactly.

So we check the blood type and give ROGAM if needed to prevent that immune response for future pregnancies.

Okay.

Let's move to section four.

Operative vaginal birth.

This is when the baby is coming down the canal but needs help getting out.

We're talking forceps and vacuums.

Right.

We use these to shorten the second stage of labor, the pushing stage.

What are the reasons for that?

Maybe the mom is just exhausted and can't push anymore.

Maybe she has a heart condition and shouldn't push hard to avoid the Valsalva maneuver.

Or maybe the baby is in distress and needs to be out in three minutes, not 30.

Let's look at the tools.

Forceps in figure 19 .5 look intimidating.

They are.

They are large curved metal blades.

Think of them like salad tongs that lock together.

Salad tongs.

They slide in on either side of the baby's head, cradling the cheeks and jaw.

The physician applies traction pulling while the mother pushes.

And the vacuum extractor.

It's a suction cup.

It attaches to the occiput, the crown of the baby's head.

The provider uses a hand pump to create section and there's a gauge with a green zone to ensure you don't use too much pressure.

Are there prerequisites?

Can you just grab these tools whenever?

Absolutely not.

The text is very strict on this.

First, the cervix must be fully dilated 10 centimeters.

You can't pull baby through a closed door.

You'll tear the cervix.

Second, membranes have to be ruptured.

And third, and this is a big nursing rule, the bladder must be empty.

Why the bladder?

A full bladder takes up valuable space in the pelvis.

It just gets in the way.

Also, if you use metal forceps around a full bladder, you risk traumatic injury to the organ.

So the nurse has to catheterize the patient?

Often, yes.

We do a straight cath right before the procedure to make sure it's completely empty.

Now let's talk about the aftermath.

We've used these tools.

What trauma are we looking for in the mom?

For the mother, we look for lacerations and hematomas.

A hematoma is a collection of blood under the tissue.

The skin might look fine, but underneath, a vessel has burst.

How does the nurse spot that?

What's the key sign?

Pain.

Severe, unrelenting pain.

If the mom has an epidural and should be numb, but she's complaining of severe deep pressure or rectal pain, you have to suspect a hematoma.

It requires immediate attention.

And for the baby, what are the risks there?

With forceps, we look at the face.

The blades press on the facial nerve, so you're looking for facial asymmetry.

When the baby cries, one side of the face moves, but the other stays flat or droops.

It usually resolves, but it needs to be documented.

And with the vacuum, the text uses a specific term, the chignon.

The chignon, yes.

This is a classic parent panic moment.

The suction cup sucks fluid into the scalp, creating a circular swelling, a distinct bump right on top of the head.

It looks like a deformity.

It looks like the baby is wearing a fluid -filled hat.

It can be really alarming for parents.

And this is where the nurse steps in with education.

Yes, you have to be proactive.

You have to reassure the parents.

This is not a brain injury.

It is just fluid in the skin.

It's called a chignon, and it'll disappear in a few days.

Managing that anxiety is a huge part of the care.

Section five, episiotomy,

the surgical cut to the perineum.

The text notes that this used to be routine, but now it's restrictive.

Why the change?

For a long, long time, the belief was that a clean surgical cut heals better than a jagged natural tear.

So doctors cut almost everyone.

Seemed logical at the time.

It did, but the research eventually showed that routine episiotomies actually increased the risk of severe tears, specifically third and fourth degree tears that extend into the anal sphincter.

So by cutting, you actually made it easier for the tissue to rip further.

Exactly.

You created a path of least resistance right toward the rectum.

So now we only do it if absolutely necessary, like if the baby is stuck or we need room for forceps.

There are two types described in figure 19 .8, median and medial lateral.

Right.

A median cut is straight down from the vagina towards the rectum.

It heals easily and it hurts less.

But because it points straight at the rectum, if it tears further, it goes right into the sphincter.

That's a high risk for long -term incontinence issues.

And medial lateral.

That's a cut at a 45 degree angle off to the side.

It avoids the sphincter, so it's safer for the rectum.

But the trade -off is?

It cuts through thicker muscle belly, it bleeds more, it is much more painful, and the healing is tougher.

So what is the primary nursing intervention for episiotomy care?

Ice.

For the first 12 to 24 hours, ice packs are non -negotiable.

Why ice first?

The cold causes vasoconstriction, shrinking the blood vessels, which reduces swelling and numbs the pain.

After 24 hours, we switch to heat, like a sitz bath, to promote blood flow and healing.

But day one is all about the ice.

We have arrived at the final section, section 6, cesarean birth.

The text notes the rate is high, almost 32%.

It is.

And because it is so common, we sometimes forget that it is major abdominal surgery.

But physiologically, it carries all the risks of any surgery, hemorrhage, infection, anesthesia complications, and organ injury.

Let's walk through the pre -op preparation, because there's a checklist the nurse must follow.

NPO status is standard.

But why are we giving antacids like Bicitra?

Bicitra sodium citrate.

It's a liquid that tastes very sour, but it's really important.

We give it to neutralize stomach acid.

Why?

Because of the risk of aspiration.

If the patient vomits while under anesthesia and breathes that vomit into her lungs, the stomach acid can destroy lung tissue.

A chemical pneumonia.

A chemical pneumonia that can be fatal.

By neutralizing the acid first, we dramatically reduce the damage if aspiration happens.

And the hair removal.

The text specifies clippers, not razors.

Never a razor.

A razor blade creates microscopic nicks in the skin.

Those micro abrasions are open doors for bacteria.

We want to prevent surgical site infections, so we use electric clippers to trim the hair without ever touching the skin.

One positioning detail caught my eye.

The wedge.

This is a vital safety measure.

You never lay a pregnant woman flat on her back, even on an OR table.

The heavy uterus, remember there's a baby and fluid and a placenta in there, will crush the vena cava and aorta against her spine.

Cutting off blood flow.

Right.

Blood can't get back to the heart.

The mother's blood pressure tanks.

We call it supine hypotension.

And if mom's pressure drops, the baby's oxygen supply drops.

So the wedge just tilts her.

We place a foam wedge under one hip to tilt her just enough to side.

It shifts the weight off the vessels and keeps the blood flowing.

Simple, but life -saving.

Now let's clarify the incisions.

Figure 19 .2 and 19 .9 show that the skin incision and the uterine incision are not always the same.

This is a critical distinction for the nurse and the patient to understand.

The skin incision is what you see.

Usually it's a fan -in -style bikini cut.

It's horizontal, low, and cosmetic.

But the uterine incision is what determines her

Correct.

The uterus is usually cut with a low transverse incision.

This is horizontal, in the lower, thinner part of the uterus.

It forms a strong scar.

If a woman has the scar, she can attempt a vaginal birth, a VVAC, with her next pregnancy.

But there is also the classic incision.

The classic incision is a vertical cut in the upper, muscular part of the uterus.

We only use this in dire emergencies or for certain fetal positions, like a transverse lie.

This scar is weak.

The muscle fibers don't knit together as strongly.

So she has a classic scar.

Once a classic, always a cesarean.

It's a saying.

She cannot labor again, because the risk of the uterus rupturing along that scar during contractions is far too high.

And you can't tell which one she has just by looking at her belly.

No.

She could have a perfect bikini cut on the skin, but a classic cut on the uterus.

You have to read the operative report to know for sure.

The text also touches on the emotional side, the feeling of failure or missing out.

This is a huge part of the nurse's role in the OR.

The room is cold, bright, and filled with beeping machines.

The woman is strapped down.

She might feel like her body failed her.

So what can the nurse do?

The nurse needs to be the anchor.

Sit by her head.

Explain the sensations.

You'll feel pressure now.

You'll feel some tugging now.

Keep the focus on the baby and validate her feelings.

Be her human connection in a very technical environment.

And post -op.

What are the priorities?

It's a mix of postpartum and post -surgical care.

We check vital signs, lochia, which is the vaginal bleeding, and the fundus.

But checking the fundus on a fresh incision is very painful.

So how do we do it gently?

We use the walking fingers technique.

You support the incision with one hand to hold it steady.

Then gently walk the fingers of the other hand from the side toward the center to feel for Don't just push down hard.

And we have to watch the pain meds.

Yes.

Often, duromorph, which is a long -acting morphine, is put in the epidural or spinal.

It gives 24 hours of pain relief, which is great, but it can cause respiratory depression.

So we have to count breaths.

We have to count breaths.

It also causes intense itching pruritus.

Patients will scratch their noses raw.

The nurse needs to know this is a side effect, not an allergy, and manage it.

Finally, the splinting technique.

This is essential patient education.

Coughing with a fresh abdominal incision feels like your insides are ripping out.

It's terrifying.

I can't even imagine.

We teach the patient to hold a pillow firmly against her incision when she coughs, sneezes, or even gets out of bed.

That counter pressure supports the muscles and reduces the pain significantly.

Expert, we have covered a massive amount of ground.

From the simple scars.

If you had to distill this for the learner, the nurse standing at the bedside tomorrow, what is the core takeaway?

The core takeaway is vigilance.

Technology, whether it's piticin, forceps, or the scalpel, is just a tool.

But the nurse's assessment is the safety net.

It's the human element.

It is.

Whether you are watching for cord prolapse after breaking water or watching for tachycystole during induction, your job is to predict the complication before it happens.

Let's run the highlight reel one last time.

Let's do it.

Number one, amniotomy.

Check the station first.

Watch the FHR immediately after the break for cord prolapse.

Two,

induction.

The bishop's score tells you if the cervix is ready.

Piticin is dangerous.

Use the proximal port and memorize the stop and turn drill.

Three,

operative delivery.

Empty the bladder first.

Watch for hematomas in mom and nerve injury in baby.

And four, C -section.

It's major surgery.

Wedge the hip to prevent hypotension.

Know the incision type for future pregnancies.

And what's the one thing that applies to all of them?

Never forget to explain the why to your patient.

Why we are turning her, why we are checking the monitor.

An informed patient is a calm patient.

That wraps up our deep dive into extetric procedures.

It's a lot of responsibility, but that's the job.

It is.

Stay curious.

Thanks for listening.

Go review those diagrams, especially the bishop's score and the incisions.

It really helps to see it visually.

Until next time.