I am so frustrated this week with how possible legal issues are changing the face of childbirth. Even with evidence-based research we are required more & more to intervene or limit women from just having babies because of the fear of lawsuits. Is everyone out there relying on central monitoring or is anyone doing something else to assess fetal well-being? Is everyone out there getting written consents for Vaginal Deliveries? What happens if a woman refuses to sign one & just "has her baby?" What is considered "best practice" based on research & what is just CYA in your facility?
Jan 18, '07
When I started in L&D in 1969, we had all women sign a consent on admission for "Vaginal Delivery, repair of episiotomy, Cesarean Section, possible hysterectomy". No one refused to sign it, as hard as that is to belive today. In the hospital I work in today, we do not have written consents for vaginal delivery. Go figure...
The fact that a pregnant woman in labor comes to your hospital gives a certain "implied consent" that she wants you to deliver her baby. That will hold up for the woman who precips before anything can be signed. Why would someone come to you and refuse permission for you to deliver her?
Jan 19, '07
Yep we get written consents for:
Vaginal and/or csecton delivery
Care of newborn (yep we have to obtain consent to even touch their babies)
Anesthesia as needed/required
for EVERY patient we admit.
Our VBAC consents are lengthy, and somewhat ominous, scary-sounding wording, beyond the above.
Yep sure, CYA is the name of the game in any area of medicine and nursing....but much more so in OB.
Jan 19, '07
We get consents for vag deliveries. I think it goes without saying that we get them for everything else, too. I think it is a little out-there but you're right, CYA is the name of the game.
I really agree with you that OB is waay too overmedicalized. Don't get me wrong, there are times when intervention is good and necessary (like a c/s for complete previa). But really, we (I include myself here) are doing so much to women and their babies, not for them, all in the name of covering our butts in case they decide to sue. Stinks.
Jan 19, '07
no, we don't have pt's sign consents for vaginal deliveries...
though, of course, consent for c/section and vbac.
verbal consent for vac or forceps delivery.
Jan 26, '07
Our pts sign admission consents and then consent for epidural, primary or repeat c-section, baby admission, infant hearing assessment and hep B vaccine (and circ if desired).
We don't have centralized monitoring so we spend alot of time in the pts room. Personally, I hate EFMs. I would much rather auscultate than keep my pt "tied to the bed", though I use EFMs for all inductions, pih pts or any other high risk pt.
I just took care of a pt who had a beautiful, uncomplicated, delivery of twins and guess what??? No EFM! Both babies were perfect. First arrived vertex, while the second one flipped to Breech so fast the doc just had to deliver him that way. It was perfect.
Jan 26, '07
I started out as a Grad Nurse in L&D. Worked at same facility for 2 years. Moved out of state and worked in a teaching hospital in L&D. My manager pulled me aside one day and said, "You are spending too much time with the patient. I want you at the nursing station with everyone else to watch the moniters." Hmmm...that's how I was trained...
Jan 26, '07
I think high risk areas have become over medicalized, I know that those interventions are necessary sometimes though but for low risk, uncomplicated pregnancies I think there is such a fear of being sued that OB's jump the gun sometimes. At least that is the feeling I get from the stats I see about section/epidural/pit rates in the US ( someone correct me if I am wrong though).
I love my unit because of how low tech things are. Our epidural artes are only about 40%. We do use EFM when indicated but we use way more IA and it just gives so much more options then being strapped to a bed with monitors everywhere. We don't even need continuous EFM after an epidural once we have obtained a good, reactive baseline strip. Our hospital policy is also a 1:1 ratio when with a labouring patient. It was funny to see a nurse who got a position on low risk after working where the high risk pts are and she thought I was crazy for using IA and not using EFM and doing VS q15min
. We don't have central monitoring either, since our pts are getting 1:1 care.
Last edit by eden on Apr 25, '07
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