OK so I'm just trying to get perspective here. I’m supposed to be asleep and have to work tonight but can’t sleep because of nightmares.
We have an OB where I work that routinely will do this vigorous stretching of patient’s perineum. He also makes people who are 7-8 cm 10 cm. There have been some recent conversations on this board about ironing or stretching but this is far far far beyond any of that. This man will vigorously pull on a women’s perineum, you can see his biceps flexing. Patients will sometimes have pain even with an epidural. He puts both hands in the entrotus and you can see him straining to stretch it. Patients bleed from this. He also is just very rough in his exams. Patients have told me that they hope he isn’t on call when they come in to deliver because her hurts them so bad in the office.
Other nurses warned me about him when I first came to work at the hospital. Other nurses also feel that he is to rough and that he hurts patients. Some say he must hate women. I've heard some say that they feel like he rapes patients when he does these things. Still these actions are and have been tolerated by the nursing staff for many years and that is part of my dilemma
Another problem is that he is a long time attending at my hospital. He is very well respected by the medical staff. He was written up in a local medical magazine as #1 OB in the city. His partners are great OBs and don't do anything like this.
I remember the first time I saw him do this pulling and I was appalled, it was a fast delivery so there wasn’t allot of time for his to do it. Still it was enough that I have just always made sure that he didn’t come any sooner then when the patient was crowning. I haven’t had to deal with this accept for that first time and a few nights ago.
A few nights ago I had to very from this. My patient had a temp so I called him and rather then just giving me orders for antibiotics (as I had hoped). He came in because he wanted to do a C/S. I won't go into all the details but that would have been very premature. I was gearing myself up to stand up to him, to give her more time but when he came in he checked her and said that she was complete. I braced myself because I knew what was coming next and it did.
We set her up for delivery and he began the pulling and stretching he normally does (thank god she had a good epidural because she didn’t feel any pain). After about 5 min of this she started to bleed. She bleed allot, about 300cc. I thought he had ripped her cervix. Fast forwarding a bit she delivered and had a 3rd degree and 2 very deep tears internally.
Generally when doctors do inappropriate things to patient I don't have any trouble dealing with it. I have (in my short career) handled many situations some gracefully and others not but I have always been able to advocate for my patients successfully. In this case I was stumped. This man is mean as hell and any comment by me to him would cause a huge fight and not resolve a thing. So I went outside cried, and tried to think of something I could do but couldn’t.
So anyway here I am missing sleep and I thought "If this were a new doctor that had done this I would have stopped them and reported them for abuse". So I have to ask myself "what makes this guy different". The answer of course is that I was taught to accept it as something that he does. We as nurses have allowed this man to continue abuse. I was able to keep him away by timing my deliveries well and writing orders without talking to him thus protecting my patient. Now that I have seen this and it was my patient I have to do something.
I have searched and searched for information and studies on this type of pulling at the perineum, it doesn’t seem to exist. I doubt there are studies because I just don't think anyone else does this kind of thing. Without a study saying that it's harmful I can't report it to the chief of OB as an unsafe practice. My only choice is to report it as abuse but I have to wonder if it will fly. The patient didn’t know any better. She was upset because I explained the she would feel pain for a long time and that healing can be very long. She did ask me what caused the tearing and I said, "It just happens sometimes" (I left out "when your OB rips you apart").
Because she tore there was a verifiable harm done but the patient doesn’t realize it. another problem is that tearing isn’t all that uncommon in delivery so it can be dismissed as a normal tear. I'm ready to take the heat for turning him in if it means I can stop him but I fear it wouldn’t. I'm worried that I would go threw the hell (that is reserved for nurses who get uppity with physicians) and nothing would happen in the end.
Any advice would be greatly appreciated. Any stories about situations like this that have turned out with the physician loosing his license or at least privileges would be helpful (heck make them up if you have to). I have already pretty much decided that I'm going to report this as abuse tomorrow morning when my manager is in. I probably wont see replies until after that but still the info would help with the crap I’m going to have to take for this.
