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 differently? Also, how do you "bite your tongue" when you know they are doing something that endangers their unborn child?
Apr 1, '02
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.
Apr 1, '02
It isn't our job to judge. It's our job to care for our patients as best we can, and intervene appropriately when we can. We cry...We agonize...We laugh.....Sometimes it isn't easy to put aside how you feel about a certain subject when reality is staring you in the face, but in the real world, they are people too....
I have heard that heroin moms will do what they can to feed and clothe their babies and cocaine moms will sell the baby clothes and formula. Most of them are very remorseful. They don't plan to be drug moms...If all else fails, you have to put yourself into the mind set that there but for the grace of God go I, for if it WERE you, you would expect and at least hope someone would care for you....You don't have to like or condone anything that comes your way, but you do have to remember that you AND the patient are both human....Then name of the drug you were searching for is methadone, by the way, and its withdrawal effects on an infant are worse than heroin or cocaine...
When dealing with questioning people, do it in a respectful way, and remember that someone on methadone will likely tell you that they use more heroin than they actually do, in order to secure a higher dose of methadone. Someone with a drinking problem will likely relate that they use LESS than they actually do...Also, recall that mouthwash has a minute alcohol content, and whether in maternity or some other area of the hospital with regard to clinical area, someone with a drinking issue will most likely be asking for an inordinate amount of mouthwash.....
Good luck....Put your judgements aside and your care to the forefront....It is worth it....
Apr 6, '02
Keep in mind--none of these ladies grew up with goal of becoming drug addicts--no school essay was written, no yearbook picture with the phrase "Most Likely To..."
I took care of a nurse, once, who told me about her first delivery. She had been addicted and abused. Her baby was taken from her. Her labor nurse was so compassionate and supportive that this young woman changed her life--she got clean and became a nurse.
Unfortunately, this is not the scenario in most instances, but you may be the one person to impact someone enough to help them change their life..............
Apr 11, '02
I was just thinking of this thread because the other night we had a patient who confessed to me that she had used coke. She was frightened, in pain and remorseful....Her main concern, other than her baby, was if I was mad at her...No, I wasn't mad at her..Of course I wish she had made better decisions. Yes, I was worried about the baby. No, the infant didn't deserve to be on cocaine...What did I do at that moment? I held on to her as she hugged me to her. I did NOT tell her anything beyond we were going to get her through her labor and delivery and whatever tough decisions or confrontations were bound to come up later...All I did was be her nurse and provide care and comfort. Does it get to me sometimes? You bet your butt it does....Still, she was the patient and I was the nurse.....All judgements aside for that moment in time....
Apr 11, '02
Thank you so much for your reply's to this post. I admire those that can put aside all judgements and deal with the laboring pt. I take your stories and insights with me and when I encounter this situation, I hope to handle it as well as you all do. I don't think this is something I will learn in nsg school.
Apr 28, '02
You will learn as you go...One of my first patients told me that and I have cherished that comment and his advice...You can't cure everyone but you can make a difference.......You will learn the technical things in school and those are important..What you will learn as a nurse will be so much more important..No one cares what grades you made when you are the only one there to hold their hand in their last moments. Along the way you will learn to feel comfortable with silence, and how to "hear" what patients say without saying anything..It is a long, sometimes lonely, often scary and always valuable journey through the woods, but it is a wicked cool adventure all the way!
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