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“Veal Chop” and Other Helpful Maternal Nursing Mnemonics

Pregnant women and new parents watch their newborns carefully. Everyone wants to be able to keep their infant safe, comfortable, and happy. Nurses have developed many mnemonics, such as “veal chop,” to help them identify signs of medical conditions in pregnant women and new mothers. Many parents can also benefit from learning these mnemonic devices to recognize symptoms.

A mnemonic is a trick or device for helping you remember something; mnemonics are often a pattern of letters. Nurses use mnemonics to remember important ideas and steps. Many of the mnemonics that nurses use, such as veal chop nursing, also apply to parents. Keep reading for a full breakdown of the most relevant maternity mnemonics every parent should know. 

VEAL CHOP, sometimes referred to as veal chop nursing, is a mnemonic used during delivery to remember fetal heart rate pattern changes. Rapid increases (acceleration) or decreases (deceleration) in a fetus’s heart rate can be a cause of concern.

VEAL CHOP allows nurses to understand what the infant is experiencing and if action is required. Broken down, VEAL CHOP works together with each letter in the first word correlating with the corresponding letter in the second word (V to C, E to H, and so on):

  • Variable — Cord compression
  • Early — Head compression
  • Accelerations — Okay
  • Late — Placental insufficiency 

Each stage of VEAL CHOP prompts a different reaction from the healthcare team. 

Variable decelerations in a heartbeat could be due to cord compression. When this occurs, the first step is to change the mother’s position to relieve potential cord compression. If this doesn’t alleviate the cord compression, the nurse may call for an amnioinfusion (reintroduction of fluids into uterine cavity), which, according to Cochrane Review, improves decelerations, five-minute Apgar scores, and mean umbilical artery pH; reduces the incidence of postpartum endometritis; and also reduces the rates of cesarean delivery. 

Early decelerations in heart rate tend to mirror contractions. And, in combination with head compression, this is an indication that the mom is ready for delivery. There is also a conflicting study that suggests that head compression causing fetal heart rate decelerations during labor is a myth.

Despite the scary idea of an infant’s accelerating heart rate, it’s actually a sign of a healthy and happy baby. No action is required.

If there are late decelerations, meaning that there is a gradual decrease in the fetal heart rate lasting for 30 or more seconds typically following a uterine contraction, it’s a possible sign of uteroplacental insufficiency. This is the most worrying type of decelerations. The nurse will have the mother turn to the left or right side or bring her knees to her chest to increase blood flow to the uterus and placenta. If symptoms don’t decrease, intravenous hydration, an oxygen mask, discontinuing uterotonics, or surgery (such as a C-section) may be needed. 

VEAL CHOP is a useful term for nurses to memorize to know how to act when the fetal heart rate rapidly changes. Many of these instances require fast action.

For healthcare professionals working in the labor and delivery unit, there’s more than just VEAL CHOP to remember. Other important maternal nursing mnemonics include: 

Postpartum depression affects more mothers than most people realize. In fact, many moms will not know they had postpartum depression until many years later. The nursing mnemonic BUBBLE HE is meant to help nurses monitor new moms for a variety of postpartum issues, including depression. New mothers can also use this mnemonic to recognize their own symptoms. 

Understanding there is a problem is the first step to getting help. There is no shame in asking for help; in fact, it takes courage to look out for yourself and address issues. 

BUBBLE HE stands for breast, uterus, bowel, bladder, lochia, episiotomy, Homans’ sign, and emotional status. 

  • Breast — Some new mothers experience cracked nipples that can become infected. It’s essential to examine mothers’ breasts regularly after birth and express some of the breast milk even if the baby is not feeding. 
  • Uterus — After giving birth, nurses will continuously check the mother’s cervix for firmness. A lack of firmness can be an early sign of an infection. 
  • Bowel — Nurses will check for regular bowel movements that can pass without pain.
  • Bladder — Women who just gave birth are encouraged to stay hydrated and pee frequently. The urine should be clear yellow, and the bladder shouldn’t be distended.
  • Lochia — Lochia is the vaginal discharge containing blood, mucous, and uterine tissue that a woman produces after birth. The lochia discharge should have have a natural pattern. For the first three to five days, it will be dark red with small blood clots not larger than a plum. Around days 4 to 10, it will become a more-watery light pink or brownish color. Eventually, from days 10 to 28, it will become a whitish-yellow color. Signs of clotting or an unpleasant smell can be a sign of an infection. 
  • Episiotomy — If the mother had an episiotomy, she may see mild edema (swelling) for a few days after birth. However, bruising, excessive swelling, or discharge from the incision is not normal. 
  • Homans’ sign — Pain in the calf or leg is known as Homans’ sign and can indicate thrombosis. If a new mom is experiencing discomfort behind the knee, she should consult her doctor. 
  • Emotional status — If a mother doesn’t seem to be bonding with her newborn or is displaying erratic behavior, it could be a cause for concern. Mothers can watch themselves for changes in their emotional status and seek help if they feel it’s needed. Women are especially vulnerable to postpartum depression during the time starting from delivery to six weeks afterward. 

A new mother’s body and mind will go through changes, and it’s crucial to understand how the mom is coping. Many of the symptoms outlined in BUBBLE HE are physical. However, physical pain and infections can take an emotional toll on new parents. BUBBLE HE provides a good plan for looking after and taking care of new mothers after delivery. 

HELLP syndrome is a nursing mnemonic used to diagnose a life-threatening variant of preeclampsia. The disorder is characterized by rapidly deteriorating liver function and thrombocytopenia. Patients with HELLP syndrome who present with frank hepatic failure should be screened for acute fatty liver of pregnancy. 

Postpartum preeclampsia occurs when a mother has exceptionally high amounts of protein in her urine and high blood pressure shortly after birth. While postpartum preeclampsia is a rare condition, it can be potentially dangerous. Catching this condition as soon as possible is a mom’s best chance for avoiding further complications. 

HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. 

Hemolysis is when the body breaks down red blood cells too quickly. This can lead to anemia, which can lead to further medical complications. Elevated lactate dehydrogenase and/or schistocytes (fragmented blood cells) on a peripheral blood smear could be signs of hemolysis.  

Elevated liver enzymes can be a sign that the liver has been compromised and can’t function properly. 

Platelets help with clotting, meaning a low platelet count can put someone at risk for excessive bleeding. This, in conjunction with hemolysis, is particularly concerning. 

While postpartum preeclampsia is a less common condition, recognizing the signs early on is essential for a new mother’s safety.

LARA CROFT is one of the most important nursing mnemonics. This mnemonic device is used to analyze the causes of abdominal pain during pregnancy. While abdominal pain is common and can be normal, there are times when it’s a sign of a more significant problem. 

LARA CROFT stands for labor, abruptio placenta, rupture, abortion, cholestasis, rectus sheath hematoma, ovarian tumor, fibroids, and torsion of the uterus. 

Abdominal pain could be the first sign of labor. 

This is when the placenta prematurely separates from the uterus, causing abdominal pain and bleeding. This is very dangerous if left untreated. 

A ruptured ectopic pregnancy typically causes internal bleeding and intense abdominal pains. A rupture of the uterus is also very painful and is a critical emergency. This condition is quite rare, occurring in 1 out of 15,000 to 20,000 deliveries for patients with no prior uterine surgery.

Also known as miscarriage, this is when the body spontaneously ejects the fetus. 

When bile from the liver doesn’t escape, it’s called cholestasis. While very uncomfortable but not as dangerous for the expecting mother, it can be hazardous for the baby and cause complications such as stillbirth or preterm birth. 

Rectus sheath is a rare hematoma that causes tearing within the rectus. 

Fibroids are benign tumors that originate in the uterus and are made of smooth muscle fibers (myometrium). Luckily, fibroids very seldom pose a risk to the mother or the baby depending on their size and location. 

This occurs when there is a rotation of more than 45 degrees around the long axis of the uterus. 

It’s essential to understand when it’s appropriate to ignore or to address abdominal discomfort. Having this knowledge on hand can make an expectant mother feel in control of her pregnancy and the symptoms she’s experiencing. 

VEAL CHOP, BUBBLE HE, HELLP syndrome, and LARA CROFT are some of the helpful nursing mnemonics that healthcare teams use to care for new mothers and babies. 

With any medical condition, knowledge is power. Knowing some basic nursing mnemonics can help new and expectant mothers recognize symptoms that need special attention versus regular pregnancy discomforts. 

https://www.ncbi.nlm.nih.gov/books/NBK546627/

https://www.ncbi.nlm.nih.gov/books/NBK539820/

https://my.clevelandclinic.org/health/articles/9682-pregnancy-physical-changes-after-delivery

https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/symptoms-causes/syc-20363257

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