Ep. 6: Early AROM: Helpful or Harmful?

Ep. 6: Early AROM: Helpful or Harmful?

If your unit implement early AROM due to the ACOG practice bulletin, you might wonder "Does early AROM actually help induced labor progress faster—or does it create more problems than it solves?" In this Birth Nurse Hotline episode, Jen and Heidi answer a listener question about early artificial rupture of membranes (AROM) during induction and walk through how they think about the research, physiology, and downstream effects of labor interventions. This is not a conversation about spontaneous labor (hands off!!). It’s a nuanced discussion about induction management, efficiency, labor progress, and how nurses apply evidence in real-world bedside care. We unpack what research on early AROM during induction shows, how physiology changes once membranes are ruptured, and why the “right answer” often depends on the bigger clinical picture...not just whether labor speeds up. We explore why intervention effects may not be equal across all patient populations, and what questions research still hasn’t fully answered. Evidence-based practice requires more than simply applying a study conclusion in isolation. ⏱️ TIMESTAMPS 00:00 – Intro + Birth Nurse Hotline question 02:00 – Framing the conversation: induction vs physiologic labor 04:00 – What research on early AROM actually shows 07:00 – Physiology changes after membrane rupture 10:00 – Labor efficiency vs downstream effects 13:00 – Pitocin, contractions, and intervention cascades 16:00 – Applying research in real bedside care 18:00 – Population differences and research gaps 20:00 – Final thoughts + key takeaways Articles in the peisode: Battarbee, A. N., Glover, A. V., & Stamilio, D. M. (2020). Association between early amniotomy in labour induction and severe maternal and neonatal morbidity.  Berry, M., Lamiman, K., Slan, M. N., Zhang, X., Arena Goncharov, D. D., Hwang, Y. P., Rogers, J. A., Pacheco, L. D., Saade, G. R., & Saad, A. F. (2024). Early vs delayed amniotomy following transcervical Foley balloon in the induction of labor: a randomized clinical trial. American journal of obstetrics and gynecology First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics & Gynecology  Halouani, A., Masmoudi, Y., Hamdaoui, R., Hammami, A., Triki, A., & Ben Amor, A. (2023). Early versus late amniotomy during induction of labor using oxytocin: A randomized controlled trial   🧬 Key Concepts * Early AROM in induction * Induction management * Labor physiology and interventions * Applying research at the bedside * Pitocin and labor progress * Intervention cascades in labor * Fetal positioning and membrane rupture * Clinical judgment in obstetric nursing * Population differences in intervention effects * Research gaps and unanswered questions

Ep. 5 The Surprising Way Nurses Impact Labor Outcomes

Can labor nurses actually influence birth outcomes? And if so… how? In this episode, Heidi surprises Jen with a research study about nurse influence on labor outcomes—and the findings are not what either of us expected. Together, we react in real time to what the research says about bedside nursing, labor progress, interventions, and the factors that may shape patient outcomes in labor and delivery. This conversation goes beyond the simplistic idea that “good nurses get better outcomes” and digs into the more complicated reality of systems, staffing, patient variability, physiology, communication, and bedside decision-making. Along the way, we talk about what nurses can influence, what we probably overestimate, and why conversations about outcomes in labor and delivery deserve more nuance than social media usually allows. If you’ve ever wondered how much impact bedside nurses really have—or felt pressure to personally “own” every outcome—this episode is for you. Why This Matters   Labor nurses spend more continuous time with patients than almost anyone else on the care team. But conversations about nursing influence on outcomes can quickly become oversimplified—either placing unrealistic responsibility on nurses or ignoring the ways bedside care truly matters. 👉 Understanding what research actually says about nurse influence helps support more realistic, evidence-based conversations about labor, teamwork, systems, and patient care.   ⏱️ TIMESTAMPS 00:00 – Intro + Heidi surprises Jen with the study 02:00 – First reactions to the research 05:00 – What the study actually found 08:00 – Nurse influence vs system influence 11:00 – The emotional weight nurses carry around outcomes 14:00 – What bedside nurses can influence Study Links: T.Tiwari, E. W.VanGompel, J. P.Selig, et al., “Personal Birth Experiences and Clinician Attitudes About Cesarean Birth: A Cross-Sectional Study With Female Labor and Delivery Unit Staff,” Birth (2026): 1–8, https://doi.org/10.1111/birt.70062 [https://doi.org/10.1111/birt.70062]. Edmonds, J. K., Yehezkel, R., Liao, X., & Simpson, K. R. (2017). Variation in cesarean birth rates by labor and delivery nurse staffing. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(5), 707–716. https://doi.org/10.1016/j.jogn.2017.03.009 [https://doi.org/10.1016/j.jogn.2017.03.009] Roberts, K., & Alba, B. (2025). Work Experience and Attitudes About Birth in Relation to Nurses' Cesarean Rates for Women With Low-Risk Pregnancies. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 54(4), 450–460. https://doi.org/10.1016/j.jogn.2025.04.004 [https://doi.org/10.1016/j.jogn.2025.04.004]

Ep 4: Questioning Attitude? Or Questioning WITH Attitude? The Skill Nurses Need More Of

What happens when nurses stop asking questions? In this episode, Jen and Heidi explore the concept of questioning attitude—a term often used in other high-risk industries, but is not well applied in labor and delivery nursing. We talk about why a questioning attitude is not the same thing as negativity, conflict, or “being difficult,” and why curiosity and critical thinking are essential for safe bedside care. From protocols and routines to unit culture and hierarchy, we unpack the subtle ways nurses can be conditioned to stop questioning things that deserve a second look. This conversation is all about building the confidence to stay curious, think critically, and engage more deeply with the “why” behind clinical decisions. Because good nursing is not just about following directions—it’s about understanding what’s happening, recognizing when something doesn’t fit, and being willing to ask questions when it matters.   🔥 Why This Matters Healthcare is complex, fast-paced, and highly protocol-driven—but patients do not always fit neatly into algorithms or routines. When nurses lose the ability (or psychological safety) to question what they’re seeing, important concerns can be missed and critical thinking can erode over time. 👉 A questioning attitude supports safer care, stronger clinical judgment, and more thoughtful bedside practice.   ⏱️ TIMESTAMPS 00:00 – Intro + what is “questioning attitude”? 02:30 – Why high-risk industries teach questioning culture 05:00 – Nursing hierarchy and psychological safety 08:00 – The difference between curiosity and conflict 11:00 – Protocols, routines, and critical thinking 14:00 – Real-world bedside examples 16:30 – Final takeaways + staying curious in practice

Ep. 3: Evidence Based “Icks”: The Things That Make Us Pause

Every specialty has its “icks”—and labor and delivery research culture definitely has a few. In this episode, Jen and Heidi talk through some of their biggest research and evidence-based practice “icks” in perinatal nursing: from oversimplified interpretations of studies to rigid protocol thinking, black-and-white social media takes, and the pressure to treat research like a mic drop instead of a tool. We unpack the difference between understanding research vs weaponizing it, why nuance matters in labor and delivery, and how evidence can lose meaning when it gets separated from physiology, context, and clinical judgment. This conversation is thoughtful, probably a little too relatable for anyone who has ever rolled their eyes during an “evidence-based” debate online. 🔥 Why This Matters Research is incredibly important—but how we interpret and apply it matters just as much. When evidence gets oversimplified, stripped of context, or used to shut down discussion, nurses can lose the ability to think critically and adapt care to the patient in front of them. 👉 Evidence-based practice supports clinical and critical thinking– it can’t replace it.   ⏱️ TIMESTAMPS 00:00 – Intro + defining “research icks” 02:30 – Oversimplifying studies 05:00 – Social media evidence culture 08:00 – Protocols vs thinking critically 11:00 – Losing context and nuance 14:00 – Why physiology still matters 16:00 – Final thoughts + biggest takeaways

Ep. 2: Evidence-Based Practice: When You Know Something Isn’t Right

What do you do when you know something isn’t right—but you aren’t sure if you have the right words to back it up? In Part 2 of our evidence-based practice series, Jen and Heidi move beyond definitions and into the real-world application of evidence-based care at the bedside. If you’ve ever felt stuck trying to explain a clinical concern without the perfect study, guideline, or wording, this episode is for you. We explore why nurses often feel pressure to “prove” things before acting, how physiology and pattern recognition fit into evidence-based practice, and why clear thinking matters more than memorizing research citations. We also revisit the funnel vs stool metaphor from Episode 1 and introduce a practical framework for applying evidence in real time: 👉 Recognize → Interpret → Act This episode is all about helping labor and delivery nurses feel more confident using evidence, not just searching for it. Why This Matters Many nurses can recognize that something feels wrong before they can fully explain why. That gap between instinct and explanation can create hesitation, second-guessing, and difficulty advocating at the bedside. But most bedside decisions are not made with a journal article in your hand. 👉 Understanding how to apply evidence in real time helps turn pattern recognition into clear clinical thinking.   TIMESTAMPS 00:00 – Intro + callback to Episode 1 01:45 – The “science words” question 04:30 – Why nurses feel pressure to prove concerns 07:00 – Evidence vs memorizing studies 09:00 – Recognize → Interpret → Act framework 11:30 – Physiology, pattern recognition, and bedside judgment 13:00 – Final takeaway + applying evidence in real time