[Q.]

I have to agree with OBNurse Heather. Threats like yours are very unprofessional to say the least.

[jamistlc]

Originally posted by HazeK:
<STRONG>with a heavy motor blockage from an epidural, about 75% of our docs prefer a "passive 2nd stage" until +2 station....on dayshift, while they are so busy in the offices! About 25% are still "old school" & want us to push when pt is complete. Suggestion: When you can, avoid lying...or you'll get a reputation for it! Instead, I just don't check "heavy epi" patients after 8-9 cms until pt c/o strong pelvic pressure or I see small var decels w/ each contraction...usually are +1 or+2 by then!

Also, having done OB x 19 years in a unit w/ high epidural rate...must suggest you weigh each patient's need for an epi BEFORE 4 cms very carefully!!! You stated "up til now, I only lied about her being 4 cm so she could get her epidural.." I must suggest that in many cases giving an "early" epi is not in the patient's best interest! The pre-epi bolus is going to slow down her labor all by itself...then the heavy epi may slow it down even more! I HAVE given early blocks on very special occasions (PIH, "sh_tty tracings", very young teens who are frightend) but would suggest that active labor is NOT even well established until the pt is 4 cms! How about a nice HEAVY dose of narcotics instead? We often use Stadol 2mg+Phenergan 25 mg IVP for the "writhing, screaming" 2-3 cm patients!

hope this helps!

</STRONG>

Greetings All Nurses,

I have to agree with Hazel on all points! I am an advocate for "Natural Childbirth" and as such I think epi's only set the client up for a C-Section. But I have as a Doula suggested a analgesic like "Nubain". I like Nubain becuase it does not have the respitory depression like narcotic analgesics, as Nubain is a narcotic antagonist, in the same classification as Narcon, yet has analgesic properties. As a Natural Childbirth advoacte I want the client to take as many breaths as possible to evacuate built up lactic acid from the muscles, especially from these under used muscle groups, LOL. KEGAL, KEAGAL, KEGAL!

Originally posted by amberm72:
<STRONG>

HI Alisa--
It appears as if you could be under some scrutiny regarding your "practice" at work. Lying to phsicians is an absolute no-no and one you will be caught and punished harshly. It looks like you work at Pullman hospital on the WSU campus---I know who your manager is and will be contacting them soon. I hope you can clean up your act! </STRONG>

I have my thoughts on this post too. First of all this person is new to the board and may not know it's purpose or the ethics. Geezzz this was her first post, Welcome amberm72! I think we as a group need to ethically realize this is bullentin board's purpose is to share in safe place, information, strength, hopes, and dreams. It is not a place to "lurk" or gather information against other nurses. But amberm72 has a valid point it just her methods are in error! She IMHO should have PM'd (Private Messaged) Alisha rather than make a threat! There is two sides to this coin. We want autonomy as a Professional group, we must also except part of this is the ability to discapline our members! The only process I know of is the Board and that is not really what am talking about. What I am talking about is peer/professional review. Since I do not know of a method to address this type of issue, I think amberm72 is only saying what she knows to do. It is wrong (unethical) practice to lie to get an order! It is also unethical to use this forum for the purpose of catching nurses doing short cuts or similar things! So we as a group (call it the bullentin board nurses group) should form a committee for this issue and send our suggestion to the board of nursing in each of our states, so that we can do our own peer review without fear of loss of licensure, LOL


Peace,
Have a Blessed Day,
Jami




[ May 19, 2001: Message edited by: jamistlc ]

[amberm72]

So now that everyone thinks I'm a narc--there are some issues I should clarify. I know my sweet Alisa personally and have worked with her closely for awhile now. It's true that I am new to the board and stumbled on my dear friends board and I thought I would rib her a little and give her heck for saying that she lies to physicians. Alisa is a very ethical and loyal person and nurse and at no time would she ever compromise pt. care with lying etc... to get what she wanted. There is one nurse anesthetist in particular that refuses to give epidurals to women that are not a good 4 cms and complains when the doctors "make" her do it because the patient is out of control. It is my fault for falsely posting false information intentionally to give Alisa a bad time and therefore misleading all of you. To be honest, I didn't think that anyone would respond--boy was I wrong. I would never "narc" anyone out unless I thought someones life was at steak. My goal is to keep my own patients safe and practice nursing ethically while being a patient advocate--I don't want to have to worry about how my fellow nurses practice as well, I just want to be able to communicate and bounce ideas off my fellow co-workers and hopefully better the nursing practice as a whole. I hope this clarifies this issue for you all. Please forgive my for misleading you all. I will humbly leave my honest opinion from now on. Please respond--comments are welcome

[AlisaL&D]

Well this issue of lying is becoming blown out of proportion. I should explain myself better. I certainly understand the risk of giving an early epidural with inadequate fetal descent which could result in acynclitic descent, and also the risk of placing one with a poor contraction pattern. Having said that, in the past, I have worked in a facility where things are not "black and white" and the "gray" areas of nursing face us each day. I resent making a woman wait until four centimeters because that is that physician's or CRNA's "magic number", especially on an induction that we will augment anyway. We have CRNAs that refuse an epidural, despite the doctors orders until they are at least 4cms, despite a low station, gross rupture or a woman that is bearing down on a cervix causing edema because she is screaming out of control. You may bash me but I occasionally will tell them they are 4 cms in order to get the epidural, but to the doctor I let them know the situation. I have also worked with physicians that are so poorly trained and barely functional that if I don't manage the case for them, they will screw it up....for example, "a physician that will come into a room where fetal tones are stuck in the 60's, the mother is screaming, and his priority of care centers on asking me when the woman last voided and what her most recent BP was. I want to tell him to put a sterile glove on, do some scalp stim, and shut up. I do agree that a labor will face the lowest risk of additive complications if allowed to progress naturally, but many women need an epidural early in order to cope, plain and simple. To this end, I advocate for them, and my outcomes are positive. Enough said.

[amberm72]

Hey!

Perfectly said my friend!! Any facility would be very fortunate to have you on their staff!! You are a wonderful nurse and friend for that matter--and I hope that I can incorporate all that I have learned from you into my nursing practice. I love ya and please keep tickling the brains of those that have been L&D nurses forever and those that are just getting their toes wet! I know you will continue to enlighten us all!

Ambor! (and Tuckie)!

[Q.]

Somehow this discussion turned into the twilight zone somewhere - both of you gals lost me in your deep, intertwined discussion...of....something.

My eye is even twitching.

[canoehead]

Well you guys really know how to stir up a storm. Truthfully, if there are any night folks out there, we pretty much manage the labors ourselves. I know when I call a doc in the middle of the night I'd better have a good idea of what is needed, or may end up with a Tylenol order. So, we all know what has worked for us in the past, and read the journals, and pretty much call with info we think is pertinent. We have a lot of influence there.

That said, having managed the labor to 1+ stn, and the doc says don't call til she's fully, what do you do when he says " I'm on my way, don't let her push" (!) knowing the guy has just been sound asleep and lives a half hour away. Any thoughts?

[P]

WOW - just read this thread - brings up a lot of issues doesn’t it?

So here is my 2 cents

As we are learning more about the second stage of labor, we have discovered that often there is a latent phase, usually soon after 10 cm when the body slows contractions and the women takes a rest. Many do not immediately even feel like pushing - epidural or not. This phase can last up to 30 min.

Your nurses who suggest the squat position are right on target - it opens the pelvis and assists with decent. If the epidural is a "heavy" one, this is the time to slow it down so the woman can feel her contractions to coordinate the pushing, or GET into the squat. THIS IS NOT TO SAY LET IT COMPLETELY WEAR OFF!!!

Women with epidurals need active coaching to coordinate their pushing efforts. I find it usually takes about 30 min or so to really get a woman into coordinated effective pushing.

Hopefully the count down clock starts when the woman really starts to push effectively - not when she hits 10 CM.


As for lying.

As noted above, this is not professionally acceptable.

Besides being dishonest about a patient's true condition, it is a return to the old subservient doctor nursey games. As a professional RN, you do not need to lie - tell it how it is, that the person is pushing well, the head is descending, and you anticipate a vaginal delivery -

Innercity Nurse Midwife with 14 years as a labor&delivery nurse