Help!!!! I am so frustrated!!! Tell me how you would handle this patient (the pt that I had last night!) Pt comes in and walks up to the nurses station and says-with a smile on her face- "Hi, I am in labor", she is 36 1/2 weeks. Monitors on, SVE, cervix is 1 cm maybe 50%, -3 station (at least), can barely reach presenting part but it is very ballotable, cervix is a hard as a rock! No contractions on monitor, can't feel any contractions on palpation. I tell the pt that it doesn't look like real labor at this point but will continue to monitor and see if uc's pick up. Come back in 15 min, pt is now hyperventilating, crying, writhing in bed. Still no contractions seen or palpated. I leave the room to go call MD but I notice that the crying stops when I get out to the hall so, I leave the door open, curtain inside the door is pulled most of the way. I wait 10 min, then quietly come back in the room but stand behind the curtain, I can see pt, she can't see me. She is reading a book in bed, breathing normally, doesn't appear to be hurting at all! I proceed into the room and as soon as she sees me, she drops the book, starts with the crying, screaming, rolling around in bed thing again. I asked her about uc's, she says that she is now in constant pain, says that the contractions are 1 min apart and they hurt even worse now-pain is now a 6 on 0-10 scale, was 4 when she came in! So, I reposition toco (again!) and tell her that I will recheck cervix in 30 min. I leave the room-crying stops, so I tried this "test" 2 more times, every time I leave the room, she stops, as soon as I walk in, she starts in again. I recheck cervix, and no change (surprise, surprise). Pt becomes irrate with me, says "I have never hurt this bad even when I was close to delivery with my other babies and I never got past 1 cm until they broke my water and started me on pitocin." I wanted so bad to say, well then I guess we don't have to worry about your baby being born before 40 weeks then do we? MD came in to see pt, SVE, no change, MD writes discharge order, go in to dc pt, offer her ambien, she refuses, gets up to get dressed, starts throwing things around and says "that is just fine, if you won't believe me, then I just won't come in to the hospital anymore-I'll just have this baby at home!" I am thinking-yeah right I thought you didn't dialate until you had pit, do you have some at home? So she leaves screaming and holding her abdomen as she walks down the hall, 10 min later, her mother calls in to check on her. I tell her mom that she went home, she gets rude with me and says "Why did you send her home? She was in labor. I explain to her that the doctor has talked to her daughter and if she needs to know any info about her daughter's condition, she will need to call and talk to her. She then starts yelling at me about how her daughter will just be back in an hour unless she has the baby at home first!!!" I had to bite my tongue to prevent myself from saying "Oh no, that won't happen, she needs to have pitocin to dilate past 1 cm-oh yeah or maybe some real contractions!"
