Another OB Problem

  1. I sware I've got to stop working at this hospital, or I will see the inside of a court room.

    A G2P1, with 1st baby delivered by c-section, presented to L&D and had been ruptured for 14 hours, with clear fluid. She was placed on the monitor. Contractions were q10min and palpated mild. FHR was 140-150 baseline with good varitability, but did not meet the criteria for reactive. With contractions the FHR dipped down to 120's and (lates). The matermal temp was 99.1.

    This patient was sent home by the CNM on duty with the hopes of spontanious labor so she could have a natural vaginal delivery.

    I showed the monitor strip to the CNM and my charge nurse. They didn't have a problem with it. The OB on call for the CNM group happened to walk in the door about 30 min later. I pulled him aside and let him view the strip. The CNM was directed to call the patient back to hospital for further evaluation,and it's a good thing. The fetus was in distress and the patient was sectioned and given a healthy, alive infant.

    Now I'm on the poop list of the CNM. Too bad, she is on poop list as well.

    Today I look for another job.

    Susan
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  2. 27 Comments

  3. by   Vsummer1
    Sounds to me like you are doing a great job of advocating for the patient. If not for you.... well, we won't think about what we will never know.

    Too bad people you work with don't see what an assett you are.
  4. by   SmilingBluEyes
    you done good.......don't worry about being on anyone's poop list......and if this is common practice there, i would do exactly what you are. Find a new situation whereby good nursing care is supported, not undermined. That midwife is threatened by you.......she should have kissed your azz.....I am glad that patient and her baby had YOU to look out for them, or else the outcome could have been grave!
  5. by   lilyrn1967
    you did the right thing always follow your instincts and get another opinion if you don't a gree with the first one. job well done for mom and baby
  6. by   SCB
    It never fails to amaze me. One would think that a CNM would be smart enough not to let this happen. Two weeks ago we had an unengaged, 42 week, G1 present in labor. The CNM thought she was feeling a bag, the fetus went into distress for whatever reason, at 7cm. When the baby was deelivered by c/s it was found to be breech. The nurse caring for the patient asked the CNM to look with ultrasound for presenting part. The CNM refused.

    It's a no wonder why midwives get a bad rap.

    I'm also starting to think that CNM's have a pride problem. I've seen them put the nurses down and talk real mean to them. I guss it's a food chain thing. Kinda sick when patients get poor care.
  7. by   anitame
    This sucks. It also makes me very glad to work where I do. If there's any question about presentation, I can always do a quick U/S. The midwives (and docs) are glad for us to do this. It can save their butt. And a VBAC, ruptured 14 hours, sent home with LATES?? OUCH OUCH OUCH Sounds like a lawsuit waiting to happen! I'd be looking for a new job too. Be proud of yourself, you just helped save a family!
    Anita
  8. by   SCB
    Where I work the CNM's have a cow if we nurses do anything with their patients, other than what they tell us to do.

    The MD's are great and the nurses do what they need to do.

    I can't stand working with CNM's. I used to want to be one, but not anymore. I'll find a job outside of OB or work were their are no CNM"s.
  9. by   finallyRN
    SCB you did the right thing. Who cares whose poop list you are on when it comes to someones life. Someone said it before but that CNM should be thanking you because she was the one who sent her home. I am lucky the midwives at my facility are in general better than our docs. We have a few midwives that can be problems though.
  10. by   emily_mom
    Good for you! I would have done the same thing...be it a CNM or Dr.
  11. by   at your cervix
    OK, first off , I want to apologize if this in any way sounds like I am siding with the CNM in this case-she was wrong to send pt home in the first place, BUT... did you tell her that you were going to discuss it with the OB? I have found that if I have a problem with the way a situation is handled and I feel that I need to initiate the chain of command, it is always better to let the person know how you feel-let them know that you didn't agree with the strip and because your name is on the chart, you feel that it is necessary to initiate the chain of command. I guess that leads to my next question-Was talking to the OB the proper chain of command? If not, you should have initiated the proper chain of command. You will probably still be on her list, but if you are up front with people when you have a problem, you need to let them know and not go behind their back.
    Good job on helping this mom and baby!!!!
  12. by   Motivated, SN
    I'm not even a nurse yet and I know that this woman shouldn't

    have been sent home. As a doula, I had a patient that was G3P2

    sent home with contractions 2-3 min. apart; after being given

    Benadryl by the CNM. I thought I was going to end up

    delivering the baby. LOL Thankfully, I didn't have to. After

    1/2 hr. of CX's getting stronger, I took her back to the hospital.

    You did the right thing. Not enough people today are

    accountable for their actions.
  13. by   OBNurseShelley
    OMG, if I WERE you, I would HIGH TAIL IT OUT OF THAT FACILITY, all i can say is, WHAT A LOAD OF CRAP!!!! NO wonder CNM's are given such a bad rap, for pulling stuff like that, what ON EARTH WAS SHE THINKING, thank GOD you knew better!!!!!!!! I agree the appropriate chain of command should be initiated and documented so, to cover yourself. I can't believe these CNM's you work with call themselves educated. I am very fortunate to work with a great group of private phsyicians a few CNM's, residents and perinatalogists. I would NEVER work in a facility where a patient's safety would be jeopardized like you have described. ABSOLUTELY UNCALLED FOR, and I wouldn't blame any of their patients for suing if a bad outcome happened. My advice, find a new job!!!!!!!
  14. by   mother/babyRN
    I think it can be like this in any facility. It takes a strong person and advocate to keep "bugging" people. I might have told the CNM that I was uncomfortable with her choice of sending the pt home, given the circumstances, and then asked if she had signed a VBAC consent form. If,after saying that to her, she continued to elect to send the pt home, I would have mentioned that I needed to contact the OB for my own peace of mind. And, I would have typed (via computer) or written (via hollister), the exact gist of the conversation prefacing the missive with, "So and so given report and made aware of xyz factors, inclusive of..." You are also liable in a court of law if something inappropriate is done against the standards of accepted care, and believe me, having been in the position of having to go over someones head ( in this case, another MD), it IS nerve wracking, but nothing matches the satisfaction of knowing that you did your absolute best to advocate for the woman , her baby, and ultimately, the entire family..You are an asset to your facility, and eventually you will garnish respect by doing what you feel is just for the pt. It sometimes takes a while, and there is wisdom in time spent refining your approach to people with varied personalities and confidence. Take care...Keep up the good work...

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