[tlmhospice]

I am a former OB nurse (like 10 years ago) and have questions. I have a friend who is 39 weeks, dilated to 4 the last time her dr checked her (last week), and is continuing to have steady contractions today q 5 min. She has been sent home time after time due to her dr refusal to do anything for her even with hx of pitocin needed. She recently had her weekly visit with this dr and he didn't even check her cervix for progress. She has no SROM, but the baby seemed to engage over the last 2 days. Is it normal now for moms to get sent home at this point? What could the hesitation be with her doc? He is quite an a**, terrible bedside manner, but I dont want to believe he is just that stubborn about AROM. Any answers would be appreciated!!

TLM

[Dayray]

It's difficult to say without knowing all the facts. Some doctors don't like to induce and there could be other factors we don't know about.

I had a patient a few weeks back that was dilated to 4 at 37 weeks it was her 4th pregnancy and she would have contx Q 5 min then they would go away. She made it all the way to 39 weeks and had a very nice fast (but not too fast) delivery. the doc said she didn't induce because she wasn't sure of the patients dates and wanted to give the baby extra time just in case it was only 35 weeks instead of the 37 we were calling it.

I wouldn't be too angry with the doc, they may be concerned about dates or could just be one of the few doctors that are reluctant to induce. Most doctors induce at the drop of the hat so it makes the ones that don't seem strange but inductions aren't always a good thing.

Spontaneous labor has allot of benefits induction only becomes reasonable if the benefits of spontaneous labor are outweighed by risks or problems.

[tlmhospice]

Wow, after reading some of the posts on here, I find myself sounding impatient and almost disrespectful to you OBers by us wanting induction. Sorry for that!!
Unfortunately, the situation on this end is a bit more complicated than just wanting induction for convience. Ok, a little bit of instant gratification I suppose! My friend is giving her baby up for adoption, and the birth parents are in from out of state, but that really is only a minor consideration. Her doctor has never once taken a fundal height on her, has absolutely refused to answer any further questions, and I quote, "You are only allowed 3 questions per visit with me," and in general, I don't feel he has taken care of her. I understand what was said about the dates, but that is one thing this dr INSISTS that he is right on the head about. It really blew me away when he didn't check her cervix for progress last time. Maybe I am way behind on the times here!!! Afterall, I only went from OB to hospice!!

She went on to the hospital today and is now again on her way home. I look forward to seeing her tonight at TaeKwonDo class (instructor's wife, not student until after baby ) to shed some new light on her whole situation thanks to reading on here. Thanks to all, as I had almost forgotten how understaffed and overworked us nurses are!! Thanks for the vent as well!!

tlm

[moondancer]

I think the key here is...."is she in active labor?". It doesn't seem so. You can walk around and be 3, 4 or 5 cm dilated but unless the cervix is changing, active labor is not happenning. Even w/ctx at q 5min...which is not active labor(that would be u/c's q1-2min apart 60-90 sec long and mom unable to walk or talk w/them...she would have to "breathe" to get through them).
So, if mom is doing fine...she is not post dates, there is no reason to induce. Needing pit in the past means nothing. I went to 42 wks w/my 1st, needed pit, but that has not been the case w/any of my last pregnancies!
Her doc may be an a**, but, he should be thanked for not jumping the gun and trying to induce a healthy woman w/a healthy fetus! I know how frustrating it is at this stage of the pregnancy, just help her to be patient and her body will kick in...look at it this way...she's almost halfway there, so when she does go into *true* labor, it'll go that much quicker. I do hate all the prodromal stuff, though...it is so tiring!
Good luck to your friend.

[L&D_RN_OH]

Originally posted by moondancer
I think the key here is...."is she in active labor?". It doesn't seem so. You can walk around and be 3, 4 or 5 cm dilated but unless the cervix is changing, active labor is not happenning.

Exactly. If the cervix isn't changing, and obviously, if she's being sent home from the hosp, it's not, then she's not in active labor. And w/o a medical indication, there really is no reason to induce. I'm actually kind of surprised. It's usually the a**es that want to induce. I'm sorry for her that she has to tolerate that kind of relationship with her doc.

[NurseMegA]

I actually sent a patient home once at 6 cm. She wasn't really in active labor yet. She didn't want pain medication and wanted to labor at home. She came back several hours later @ 8 cm and delivered almost 2 hours later.

I agree with the other posters. If her cervix isn't changing she isn't in active labor. There is no reason to induce her yet. Even if the doctor is a a$$ he is doing the right thing as far as not inducing her yet.

[Dayray]

Yes the doctor does sound like a jerk. Not because he won't induce but because he limits her to 3 questions and just sounds insensitive.

As for the comment about understaffed and overworked, while that may be true it's not the reason that I say induction isn't indicated. I personally (regardless of staffing) would rather have an induction and delivery then to triage 3 or 4 women home so it's not that OB nurses don't want to deliver. In fact for most that I know delivery is there favorite part.

In this situation (based on the facts you have provided) it sounds like a judgment call, I mean an induction isn't completely out of line but its not imperative. The doc could justify it either way but inductions are many times very hard on mom and baby not to mention that they carry a certain amount of risk so if I were an OB (god forbid) I would be less inclined to induce unless there were strong indications to do so.

My opinion is just an opinion but it's based on having seen allot of really hard inductions and having seen a few baby's be induced too early when dates were off just a little. I have real sympathy for patients that are having a hard pregnancy but induction isn't always a good solution to that.

[BETSRN]

It depends on the doc but we often send them home if they are not in any actuve labor pattern. They can walk around several cm's dilated for days and weeks. We ahd a lady walking around who was 9cm and not in labor. It took us HOURS to finally kick her into labor. leave nature alone and let it happen on its own.
Betsy

[mother/babyRN]

If she is 39 weeks and not changing her cervix, then there is no reason to do so..If she is overdue than do so....Early labor sucks but I agree, we need more info...Depends upon how high the baby is...If the baby is high, one wouldn't want to rupture membranes in the case of a prolapse......And her idea of steady 5 minute contractions may not be strong, although fatigue may make her feel that way...If her cervix isn't changing and she isn't having long contractions, there isn't any reason to keep her on a stretcher when she could be better off in bed or the bathtub....

[mother/babyRN]

By the way, in any case when a doc (or nurse) but usually a doc ( how is that for my prejudice showing)is a jerk or just not answering your questions, do what my dad is fond of doing and I have found also works for me....Remind him or her that he or she actually works for you and you would appreciate answers to the questions you have..If your friend is so uncomfortable, have the husband have this conversation...Don't ask, tell the doc that you have some questions and inform him that you aren't leaving until they are answered. Ask what parameters he or she is using and when those parameters will change....Mention that you are concerned with health issues and will make notes of what he or she says ( that usually wakes them up really quick when a potential lawsuit language leaves your lips)...Come in a couple of times on the night shift..That sometimes earns an admission simply because they get sick of being called. Have the conversation that You WILL ask questions and expect them to be answered...He ( or she) works for YOU afterall..This is your baby...This is YOUR experience...Go for it and be assertive....If you don't get your questions answered, ask the doc who the chief is so the questions you have WILL be answered. If he IS the chief tell him good, he is just the one you need to speak with....Good luck to your friend and Happy baby...