Bite your tongue!

  1. I posted this on the OBGYN board, but know that there are nurses out there that used to be in the OB dept that I would like to hear from as well.

    I just finished watching one of my favorite shows on t.v. - Maternity Ward on TLC.

    There was a mother-to-be on there that was a recovering heroin addict. She decided to quit the drug when she found out she was pregnant and takes that medicine to help her and her baby to not go through withdrawl. I cannot think of the name of the med to save my life.

    ANYWAY, when the dr. came in to check her, she asked the patient when the last time she used heroin was. The pt. responded "a while ago". Then the pt said that she used COCAINE just a week prior to coming in to deliver.

    SO, here is my question...how do you deal with pts like this? I know you have to be professional. I sure hope this is something they teach us in nsg school! Do you find yourself treating these drug addicted moms-to-be different in some way? Also, how do you "bite your tongue" when you know they are doing something that endangers their unborn child?
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  2. 10 Comments

  3. by   Q.
    I will leave this for shay. She always replies so eloquently on issues like this!
  4. by   babs_rn
    Frankly, if what somebody is doing is not only self-destructive but destructive to someone else, it would be negligent of me to "bite my tongue"!! You have to find a diplomatically blunt (lol - but it CAN be done) way to get the point across. Might not phase them in the least, but if you come across in a way that is firm and yet gentle, not judging but laying it out on the line that THIS is what can happen and THIS is what you're looking at having happen in the near future...you get the idea. In a way that says, I care, but I'm not stupid and you are worth more than that and so is your kid.

    Does this make any sense? I'm not going to give "warm fuzzies" and act like everything's alright when someone like that is destroying their future and the future of their children. Being a patient advocate is not about biting your tongue, but about speaking up. Maybe at the very least you plant a seed. My biggest soapbox is when people come in with drug/etoh/suicidal ideations...whatever. ...is to tell them something I bet they don't hear very much, if at all...."You are worth more than that".

    Just my little bit there..
    Babs
  5. by   fergus51
    I don't give warm fuzzies, but I don't assume a verbal lashing will do any good either. Most addicts know their behavior is harmful, and do it anyways. That's how string the addiction is. I try to be compassionate and tell them what they have in store and what resources they have access to if they choose to get clean.
  6. by   babs_rn
    Well, I wasn't implying a verbal lashing. As I said, "diplomatically blunt"...and build them up in a world that normally tears them down.

    b.
    Last edit by babs_rn on Apr 1, '02
  7. by   sharann
    Hi Proud2be,
    Was that mom-to-be by chance taking Methadone for withdrawl avoidance? This is the only one I've heard of. Anyhow, we do take care of many who behave in ways that are less than desirable. Unfortunately we can't judge them outwardly, but I think that we ARE only human and this makes it tough. You have the right idea. We have to be professional and "bite" our tongues, however, we CAN educate our pts. For example, you could say, "It's great that you are aware of the potential harm to your baby and yourself from drugs....etc.." We just have to treat them the best we can even if we hate what they are or DO.
  8. by   semstr
    Well in cases like this, the youthwelfare has to be informed by the treating doctor.
    They will come and talk with the ma-to-be and she will be "monitored" by them.
    As soon as they see danger for the child, the child will be taken to fosterparents and ma gets the change to go to a clinic to get clean and get het business together.
    Then, with help from youthwelfare and other socialsupports, she gets her child back, of course under strict supervision and she has the possibility to start all over again.

    Now, this is how it's supposed to go and sometimes it works.
    But in a lot of cases, the mother is too far gone and although help is there, she can't take it.
    A lot of the children are put up for adoption in the end, shich I think is the best for all.

    Take care, Renee
  9. by   fergus51
    Originally posted by babs_rn
    Well, I wasn't implying a verbal lashing. As I said, "diplomatically blunt"...and build them up in a world that normally tears them down.

    b.
    Didn't mean to imply that you did. Just saying what works or rather doesn't work for me,,,
  10. by   mattsmom81
    I have difficulty sympathizing with addicted Mothers. So often they hang onto the child (and indeed have even more babies) as a means of soaking the welfare system for more money---which they put into supporting their drug habit.

    Children of addicts deserve better and should be removed and placed in a healthy environment---foster care and adoption, IMO.
  11. by   RNforLongTime
    I watched that episode of Labor and Delivery last night and the heroin addict was taking Methadone! I was just flabbergasted when she said she had come cocaine a week or so ago and then ended up with a perfectly healthy infant.
  12. by   shay
    Originally posted by Susy K
    I will leave this for shay. She always replies so eloquently on issues like this!
    BAHAHAHA!! ME? ELOQUENT? Thanks for the compliment, Susy. Hee hee...I always see myself as more on the brash and tell-it-like-it-is side when it comes to issues like this....

    I did indeed reply, but did so on the OB nsg section. Here's what I had to say, if anyone's interested:

    You just DO. You just have to deal with it. There's nothing you can do about it except send the urine tox to the lab, notify social work, and pray the baby is breathing when it's born. I've taken care of so many crack moms that I've lost track. My first job was NICU, and my first delivery was a mom high on heroin during delivery. She was RAGING high. I actually had one patient who was a crack prostitute tell me she was going to keep having babies until CPS finally let her keep one....she'd already had 6 taken away from her immediately after birth....was in labor w/baby #7 when I had her as a patient. Did I want to smack her and tell her what a waste of oxygen she was? YES. Did I want to rip her ovaries, fallopian tubes, and uterus out immediately after she delivered so she could never again torture some poor innocent child with her toxic drug habit? YES. What did I do? I sent the tox, called social work and her CPS case worker, and prayed the baby would be breathing when it was born. That was it. I took care of her like any other labor patient. I comforted her in pain, got her relief when she needed it, and held her hand when the social worker came to take her to rehab....again.

    The only thing I do is encourage BIRTH CONTROL and try to steer them towards STERILIZATION and things like DEPO that they can't 'forget' to take when they're high.

    It sucks, but it's part of the job. Unfortunately.

    That's my 2 cents....

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