Discouraged L&D RN

Oct 03, 2009 04:04 AM

by obrn22

I work in a small unit in North Louisiana and I am having a hard time with dealing with how OB pt's are handled here. My husband is in the military and I have been liscensed in 8 states and I have never seen anything like it! Probably 95% of our deliveries are by induction. we admit most of them at MN for cytotec and then pit in the am starting at 37 weeks. I read that ACOGs position is that no baby should be delivered befor 39 weeks unless medically indicated. The doctors here mostly don't give a reason but if they do the fav response is "IUGR" or "lagging AC". Needless to say they don't come out IUGR! If they don't del before 4 or 5 then they are sectioned. The goal for the doctors is to get them all delivered before Friday so their call partners don't have to deliver them over the weekend! The sad part is that the patients here think it is fine and most willingly come in to be induced. If someone refuses to be induced they are labled "granola people" and the doctors are annoyed by them! I don't know how I will be able to not get fired because I speak up to much!! I keep asking my husband when we can transfer out but it will not be soon enough! Is it this way other places?

SiennaGreen · Oct 03, 2009, 06:15 AM

Re: Discouraged L&D RN

OMG- My heart goes out to you. I can imagine how difficult it must be. I am still a student, but have had birth work experience. My goal is to become a CNM, but I know I will likely need some OB exp first. My clinicals have been a similar story to yours and it pains me! Literally, heartbreaking. We're in a major metro area, and I am hopeful that not every hospital is like the one I have done clinicals at.

Best wishes to you. Try to pay attention to what you CAN accomplish. How can you touch this women in front of you, or affect her relationship with this baby, or perhaps; offer her a glimpse of how it might be different, next time.

babyktchr · Oct 03, 2009, 08:04 AM

Re: Discouraged L&D RN

Unfortunately, what you are experiencing is happening all over the place. Though not as extreme as you describe, my unit is the same way. We are victims of the physicians will and not what the patient truly needs. The physicians end up looking like the hero actually. It is disheartening that no one regulates this. ACOG is all about making the rules, but surely (and sadly) doesn't not enforce them. My problem lies in that my department chief is my biggest offender and has no spine when we bring issues to him. My saving grace? I keep data on all inductions and present it at OB meetings. I love to see them squirm when the numbers are presented. Good luck to you in what you are do!!

CEG · Oct 03, 2009, 08:07 AM

Re: Discouraged L&D RN

I used to work at a place like that. It was really tough- I had a job offer at a big hospital in the city with a huge midwifery practice, very busy, etc. I also had an offer at a very rural community hospital. I took the rural job for the easy commute and free parking, etc. I made a huge error. It was just like what you described at your job. I wasn't able to fit in and utimately I left there after 11 months. I was finishing my MSN at the time and I had a lot of great stories to tell in my midwifery classes. Unfortunately this seems to be the way some places are. Those who continue to insist that there is no problem with the US maternity care system or for profit health care are apparently sadly unaware of this. Perhaps you could do postpartum only or something. Hope you find something better.

JenniferSews · Oct 03, 2009, 09:26 AM

Re: Discouraged L&D RN

What you describe is the reason I no longer have any interest in L&D. After spending 12 hours a day sitting at the desk listening to the nurses ***** about the women who even wanted to attempt natural birth, I knew it would eat my soul alive to do that all day. I was "that patient" when my third was born and we couldn't afford another homebirth.

I'm sorry your job is like this. Is there anything you can do to change the culture a little? In every city there is usually a pocket of people interested in a more natural approach to labor and delivery.

Barkow · Oct 03, 2009, 03:37 PM

Re: Discouraged L&D RN

I am in a similar situation- I worked in a very pro-midwifery hospital with very low c/s and epidural rates, and no elective inductions allowed. I had to relocate to an area with very interventionalist OB units, and the hospital I am at now has close to a 50% c-section rate, 90% epidural rate, and most everyone gets electively induced before their EDC. Postdates is considered 40+1. It is primarily the patients who makes these demands, but OBs certainly don't tell them the risks of induction and what they entail, and many pts show up not really sure why their doctor wants them to be induced and very unsure about what to do. There is absolutely no respect for vaginal birth, and c-sections are portrayed as very simple procedures that alleviate the very "inhumane" process of labor. It is really depressing, but I am going to begin a CNM program in a few months, and seeing all the depressing stuff enhances my drive to provide women with more information and different options. As a nurse it is difficult to enact change in an environment where OBs basically get away with anything they want and don't have any accountability.

LDRNMOMMY · Oct 04, 2009, 07:28 AM

Re: Discouraged L&D RN

I have only worked 2 L&D jobs since I graduated. My first job was very much like the OP describes. I thought all L&D units ran like that. Then we moved overseas and I got a job at a small military L&D unit where the difference is night and day. I tried to convince my husband to extend so I could stay employed here! Our docs adhere strictly to ACOG standards and AWHONN staffing ratios. They are respectful to the nurses and value our input. I will never work a job like my first one ever again.

LDRNMOMMY · Oct 05, 2009, 02:16 AM

Re: Discouraged L&D RN

ETA: Discouraged, Is there a military hospital where you are stationed? I can only speak for 2 hospitals mine and one where I lived previously. A large group of nurses where I worked at previously went to the military hospital on the other side of town and are much happier. I can't promise that L&D is awesome in all military hospitals but it's a whole different ball game where I work. I also delivered at the military hospital where I worked previously and it was a great experience. I am currently pregnant with #2 and will deliver where I work.

FLAlleycat · Oct 05, 2009, 03:30 AM

Re: Discouraged L&D RN

We also have a significant number of inductions at our hospital. Quite often, the woman requests it, comes in with unfavorable cervix that takes 3 days to get favorable, then another day to get to complete and ready to push. Guess what. She's too exhausted and winds up with section. When I triage pts who say they're scheduled for induction, I always ask why. If there is truly no medical reason, I give them the above scenario. I also remind them that "postdates" is NOT 40 wks and 1 day. I also tell them they may be the lucky exception and deliver day of induction or the next, depending on cervical status and parity. If a pt is starting her 3rd day of induction and Bishop score is still crappy, again if there is no medical reason, I will discuss options with them . . . continue on present path, have a section, or go home and try later or, better yet, go into labor NORMALLY. If they say the doc said they would be sectioned in the morning, I do let them know their options and questions to ask the doctor. I feel that is my responsibility as their advocate. If the doc won't tell them, I must.

It works. Starts them thinking . . . hmmmmm . . . section or go home?
Alley

RNBelle · Oct 06, 2009, 11:45 PM

Re: Discouraged L&D RN

Yup, I live in a small town, work at a small hospital. And what do we do....induce everyone! Drives me bonkers. Me and my co-workers always get so excited when someone comes in laboring naturally and shoves the kid out in a couple of hours instead of a couple of days. And we don't have the staff for all the inductions that we do. We could function a lot better without all the unecessary inductions. You are not alone.

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Discouraged L&D RN

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