Help me handle Pitocin.

[epiphany]

I am always on tenter hooks when pit is being used. I expect bad things to happen, and bad things often do. The residences come in and turn it up even when we are not in the room. They do it even when tracings aren't perfect. They barely follow the guidelines for hyperstimulus and hypertonus, and they tend to ignore what what it does it the FHR, except when we get a substantial decel. At that point, we turn it off and put it back on as soon as the baby "recovers". And I rarely agree with their rationale to use it in the first place.

I would appreciate any input and tips.

[miloisstinky]

OMG!! This sounds like a topic for 20/20!!!

[peds4now, RN]

I'm a nursing student and mom of 6 sans drugs. Pitocin in particular scares me to death, because it starts you on the cascade towards a medically managed birth and greatly increases your chances of a c/s. One suggestion I would have-as an RN shouldn't you be making sure your patient is prepared to give informed consent to the Pitocin before it is administered? You can ask you patient if they have been informed of the benefits and risks of it, if they know why they are taking it. You would do this with a Htn med, why not Pitocin. You are allowed to teach them about their meds. They could also ask their doctor. You could ask someone who comes in not really in active labor do you want the Pit or would you rather wait (here or home) to let labor start on its own. People sometimes just need the gentlest of reminders that they still can have a say even though they are in hospital.

But you know, ultimately it is also the patient's responsibility to come into L&D having researched and made some decisions.

[JeanettePNP, MSN, RN, NP]

But you know, ultimately it is also the patient's responsibility to come into L&D having researched and made some decisions.

Of course it's the "patient"'s responsibility to do her own research and make decisions. That's why most moms who've really done their research and are low risk opt for homebirths, birthing centers or other lo-tech options. My energy during labor is too precious to be depleted on fending off unnecessary treatments and procedures by so-called professionals who are paid to ensure a safe birth (ha!) and ought to know better.

[tntrn, ASN, RN]

i have worked in teaching and non-teaching hospitals and never have i ever had a doc increase the pit on me, maybe because they know, or would find out in a big awful hurry, how i felt about it. i did have an attending give me orders to keep increasing the pit on a patient that was actively laboring. he was at home. i told him i wouldn't do it since my nursing judgment was that it wasn't appropriate. he gave me a little more grief and i told him he was more than welcome to come and manage the labor if he felt that to be necessary.

he declined, saying, "well, you're there and i'm not."

sorry for the all lower case thing; i just hand surgery and can only type with one hand

[SuperFlyRN]

That seems to be the norm. We even have a saying when we phone the doc for admission RX-Do you want me to Admit'em, Pit'em, Epidural and Rupture? (those are standing orders) Thank God we can advocate for our patients. We often fudge our dilatation/descent to prevent unneccesary Tuckers or CMI which inevidably (sp?) ends up with an Epis or Lac.

Luckily our Oxy Pumps are programmed and can only be accessed by the nurse caring for the patient so the doctor cannot just go in and adjust as they see fit. Plus all the documentation-they would just rather tell us-but then they do not want to argue with us-so they skip it. Luckily I am argumentative by nature-only prn

[epiphany]

Do I really work is the only place that allows the residents to have so much freedom with pit, I wonder? When I tried to advocate for a pt and her husband to hold off the pit, the resident threatened to make them sign papers refusing treatment, and essentially kicking them home in the midst of labor.

[SuperFlyRN]

Do I really work is the only place that allows the residents to have so much freedom with pit, I wonder? When I tried to advocate for a pt and her husband to hold off the pit, the resident threatened to make them sign papers refusing treatment, and essentially kicking them home in the midst of labor.

That resident sounds pleasant...:angryfire That was something I noticed when I work contingent in the states-the residents just seem to have carte blanche to do whatever-makes you very uneasy. Here (Canada) we have the doc and they will have a resident with them but they are still feeling out their boundries and as soon as you started to refute something, they will back off and they certainly would not go in a room unless accompanied by the RN in charge of the patient.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

What about when a mom's water breaks w/o intervetion and is having contractions that are difficult to talk or walk through? (12 hours after the water broke) Is pit really needed then? I was made feel like a horrible person b/c I did not want the pit at this point but did consent to IV abx. I was later guilted into pit when I felt nature was taking its course just fine. I was so mad b/c then of course the baby was in distress and almost had a section... Baby was born blue, limp, and not crying... Yes, it was a weekend. The jerk doc tried to get me to consent to pit the minute I walked onto the unit b/c my contrax were not horribly painful even though my water just broke 2 hours before.

[SmilingBluEyes]

Pitocin, in the wrong hands and with the wrong intent, can be one of the most dangerous drugs out there.

I respect it 100%----but I respect Mother Nature even more.