Help me handle Pitocin.

camay1221_RN · Feb 22, 2006

Epiphany,

I don't have any great advice on this one, but I feel where you are coming from. I was in L&D for six months last year and the biggest thing I hated about working down there was the evil Pitocin! Now, I know there is a time and a place for it, but I have also found that a great deal of it is being used without any reason other than to speed things along for the convenience of the residents and attendings. Please no flames, that is an opinion!

Unless things are different at your facility, you are the one responsible for managing the Pitocin and it is your license being put out there, not the residents! Tell them hands off. I had a resident get p*ssed at me for turning off the Pit on a pt that was hyperstim. He said it wasn't hyperstim if the baby wasn't in distress?!?

Good luck to you!

I know you will get some great advice from the RN's on this board.

SmilingBlueEyes(love ya Deb!) is my go to girl for these kind of questions! Among many others who work in the wonderful world of OB.

shortstuff31117 · Feb 22, 2006

I feel the same way. I'm not currently working as a nurse but I did a lot of OB in nursing school, and I always wondered why so much pitocin. I even had a patient who came in with light contractions and since she was going to be induced the next day they decided to give her pit. WHY?? I didnt understand the full impact of pitocin until it was given to me while I was in labor and I ended up with a c-section probably because of the pit. So I too have been wondering how I will deal with the pitocin issue when I start working.

Carrie

epiphany · Feb 22, 2006

Additionally, it seems the only fate for the mother if the baby doesn't like the pit, is c/s. Most of that end up as emergency c/s. If the baby reacts really rapidly, and there's no way to even try, they'd sit down and have a "talk" with the mother. This just happened to me two days ago. I stopped the pit 3 times. Finally, they sat her down told her that best course would be c/s. She was a G1P0, 41 weeks, no other problems.

In one of our FHR classes, they warned us constantly about what the pit can do, and I asked why we pit so liberally if it's so dangerous. The answer was that a hospital is a conveyor belt system, therefore, our job was to protect the patient from this danger. To suggest that the job of the nurse is to protect the pt from the hospital's policy is really screwy to me.

RaeT,RN · Feb 22, 2006

See, this is why I'm glad as a new grad I don't work in a teaching hospital with residents. I can tell you though, that we did have one MD who would walk in and turn up the pitocin on his pt's without telling the RN's (he also had NO IDEA what the concentration on the pit was, which is even more scary.) It seems to me like this becomes a chain of command issue.

It really does seem like Pit makes our lives so difficult, does it not?

The more time I spend in this field the more I see how much is done in the interest of convenience. Kind of disillusioning.

sanctuary, BSN, MSN, RN · Feb 22, 2006

Waaaaay back in the olden days, a pit drip was not even considered until the patient had been in labor for 18 hours. Is this not still the case? Does the patient have a dedicated nurse? And what do you mean that the docs just come in and turn it up??? I'd have to : 1. Report a Med Variance and 2., report the Dr. for pt abuse. :nono: What you are mentioning is not good medicine. Perhaps a hospital or nursing policy?

epiphany · Feb 22, 2006

Yep, you heard me right. They come in, up it in increments of 2 millunits/min regardless or whether or not we are there. We are given orders to titrate, but they pretty much ignore us. They do give us the courtesy of writing on the tracing. I spoke to each resident on two occasions each time it happened. They looked at me like I was crazy because, I guess no one else had questioned them. I couldn't find it anywhere in the policy or procedure to use to confront them. This alone is driving me bonkers. I have a six months orientation, so now I still consult with my preceptor, and let her be responsible. That's why I need to have dialogue about this here right now. I need to look it up and know what I am talking about when I'm on my own confronting the residents.

tdr61 · Feb 22, 2006

Yes, pitocin is an extremely powerful drug. As a nurse you have an obligation to protect your patient. If the residents and/or doctors are turning up the pitocin you need to tell them not to do it (yes I know that may be difficult for newer nurses) if you don't feel you can do it then tell the charge nurse. If she will not tell them take it up the chain of command. Yes, the resident would be responsible if he/she turned it up without telling anyone but if they are documenting it on the strip then the nurse would be aware and therefore would be just as responsible for not stepping in and doing something to protect that patient. I've irritated more than one physician and resident in my time because of this very issue. But the way I look at it, I'm not here to make their life easier...I'm here to make sure at the end of the day my patients got the best care and treatments I could give. The doctors and residents will get over it but someone needs to put their foot down even if that means taking it to the top. What they are doing is unacceptable in my opinion (please no flames! :) )

Ten

JeanettePNP, MSN, RN, NP · Feb 22, 2006

Thank God I smartened up and had my last two at home with a midwife. The things I read on the OB threads here only affirm my decision.

mommy2BCD · Feb 22, 2006

I went into labor at 36 wks. 5 days. I went into the hospital and was a a standstill with labor. So instead of sending me home, my dr. decided to break my water and start me on pitocin? I was confused to say the least. This was my first baby. Thank god for the epidural because aparently they had it turned up so high that at one point a nurse came running in the room becuase my contractions were seriously one right after another and topping the charts. It upsets me when drs. do things out of convenience. Labor is supposed to be a natural process ...what happened to that thought? :rolleyes:

epiphany · Feb 22, 2006

I went into labor at 36 wks. 5 days. I went into the hospital and was a a standstill with labor. So instead of sending me home, my dr. decided to break my water and start me on pitocin? I was confused to say the least. This was my first baby. Thank god for the epidural because aparently they had it turned up so high that at one point a nurse came running in the room becuase my contractions were seriously one right after another and topping the charts. It upsets me when drs. do things out of convenience. Labor is supposed to be a natural process ...what happened to that thought?

I may be bias because I hate this drug, but this the pattern I've observed:

1. They push for getting epidurals with pts with pit - that way they get no feedback or resistance from the mothers. They can do whatever they want - there would be a tornado happening inside and the mother would be smiling serenely, totally unaware.

2. They always rupture the membrane as soon as they can in the interest of "monitoring the contractions" with an IUPC. Ironically, a ruptured membrane is the excuse for more pitocin because labor is now imminent.

I often want to tell the mothers "go home. run! Run before they break your water, and it's too late!"

RNnL&D · Feb 22, 2006

I went into labor at 36 wks. 5 days. I went into the hospital and was a a standstill with labor. So instead of sending me home, my dr. decided to break my water and start me on pitocin? I was confused to say the least. This was my first baby. Thank god for the epidural because aparently they had it turned up so high that at one point a nurse came running in the room becuase my contractions were seriously one right after another and topping the charts. It upsets me when drs. do things out of convenience. Labor is supposed to be a natural process ...what happened to that thought?

Why your doc was breaking your water and giving Pitocin when you weren't term is beyond me...... :uhoh3: