Is this common?

  1. I am a pre-nursing student so I don't know how it actually works in l&D, other than my own experience.

    I was watching some reality childbirth shows. And the woman was moaning in agony and wanting to push but the dr wasn't there! Does this happen often? I was stunned watching it. Thankfully I have a CNM and they stay with you the whole time. Otherwise I might have had a nurse delivery.
    This woman waited 20 mins while wanting to push. I have to say I would not have waited. I remember the urge to push being uncontrollable. I remember while pg with my 1st saying I wasn't going to push until I was ready and what if I didn't have the urge to push. I wouldn't have waited on a dr to push. And boy would I have given the dr a piece of my mind if they tried to make me wait. What is the procedure if the dr isn't there and the mom refuses to wait? If the nurse delivers the baby does the dr/cnm still get the delivery fee? Has anyone had to deliver a baby?

    Thanks
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  2. 15 Comments

  3. by   hmccartn
    I am still a student so dont have much experience.I have 3 months to go and have completed a labour and delivery clinical...I want to work in l+d and from what i have seen..the docs do very little, except where there is complications... the nurse pretty much runs the show for the whole labour..and the docs seem to pop in to help ease the baby out...once you are in school you will be amazed to learn how incredibly educated, competent and skillful nurses are and just how much they do in this specialty area... just my opinion... if a baby is going to come and the doc is there...no amount of insistence from a nurse is going to keep it there... there is no choice but to deliver it if no one is there...
  4. by   Energizer Bunny
    Heck, my midwife almost didn't make it there for me for my second....she was snoozing in the call room and Piper was crowning with no help from me! LOL! I did watch a show on Discovery Health Channel where the nurses said they had to do one delivery a year whether forced or planned so that they were prepared.
  5. by   L&D_RN_OH
    Quote from ayndim
    And the woman was moaning in agony and wanting to push but the dr wasn't there! Does this happen often?
    What is the procedure if the dr isn't there and the mom refuses to wait? If the nurse delivers the baby does the dr/cnm still get the delivery fee? Has anyone had to deliver a baby?

    Thanks
    Thankfully, it doesn't happen often at my facility. But then our docs usually stay in house when their pts are active. Many times we start pts pushing before the doc arrives. If it looks like it will be soon, I try to get the pt to blow through contractions, while we wait. Very rarely do we have to wait longer than 5 minutes or so. I've only delivered one, but have had a few close calls with pts coming in complete, or going from comfy with their epidural to crowning. It is charted as Mother delivered baby assisted by RN. And of course, they still get their fee. Too bad we can't get a cut.
    :chuckle
  6. by   niki1983
    With my second child my labor was induced. I was given cervadil the night before. It put me into early labor by 2am. At 9 am one dr from my group came in to check on me and order pitocin. By 9:15 I asked for drugs. At 11:15 I was told that I was at 4-5 and would have a while to go, so I asked for more drugs. At 11:53am me daughter came into the world with the help of nurse Tina, my main reason for wanting to be an l&d nurse. Shortly after the ER doc arrived to check in and a few min after that a different ob from my group arrived - I fell asleep and don't even remember pushing out the placenta! It turs out that the first doc I saw that am had joined the 2nd doc at another hospital thinking that I was going to have a lengthy labor. And just to add my doc got paid for the delivery.
  7. by   lgowan
    We do push our moms without the doc there. It is kind of a judgement call according to her cervix and station. If they are a gravida 5, we don't push. We just get the catcher's mit and call the doc! I have delivered many babies. It's scary at first, but fortunately, the ones that normally precip are fine anyway, with the exception of an occasional tight nuchal. Done that too! Babies did fine. I have realized it is not the delivery so much that scares me as it is the afterward, when there is a bad baby. Luckily, in a small unit we are all trained in Nursery, NRP, and can rescuscitate and stabilize a bad one for transport to a NICU hospital. We had three last week. (WE average 30 total deliveries a month).

    Lisa
  8. by   SmilingBluEyes
    what lgowan said!

    by the way, I LOVE YOUR AVATAR, LGOWAN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I love Aerosmith!
  9. by   mother/babyRN
    Midwives do not always stay with you my sweet. Nurses do...Midwives are nurses, I know, but on the night shift, everyone wants to get some rest....First time moms can push for hours and sometimes the midwife will be there, however, mostly it is your labor nurse, who is also competent...Some moms and dads don't want people in their face all the time...You don't know how you will be unless or until you are in labor. Not everyone groans or screams. Some are in the zone and are silent or focused in a different way. Everyone is different and I have to say, I personally would rather have a doc there but even when a midwife is there, a doc is supposed to be able to respond asap....Thank goodness...
  10. by   mother/babyRN
    What Igowan said as well...And the scariest two I have delivered were a shoulder dystocia and a preemie footling breech..I thought I was going to keel over just thinking about it...During the ordeal I was fine. It is afterwards when all is said and done and you think about what could have happened, that you feel that way...Kinda cool though, too...We push our moms too and the docs know the nurses well enough to know who knows what and who to trust completely..Kind of a nice feeling...
  11. by   colleen10
    During my L&D rotation the patients pushed in their birthing rooms with just the nurse present. When the nurse felt it was close to the actual birth they would call in the doctor and tech and other nurses. The doctor really only showed up to catch the baby and placenta and stitch mom up if need be.

    The nurses were the ones who took the babe over to the isolette for APGAR scoring, drying off, warming up and physical assessment. Doctor didn't even look at the baby aside from when he delivered it.
  12. by   Dayray
    L&D nurses are really good at getting the doctor there on time in fact its a big part of the job. We push with our doctors out of house. It's best to know how far out they are. With a primip 1 - 2 hours of pushing is common. With a multip it can be a little more tricky and sometimes you need to call them at 6 or 8 cm to get them there. Its a sense you develop and really hard to put into words but if there are 2 L&D nurses in the room they will both know its time to call at the same exact moment. I really don't want a doc in the room any longer then they have to be so I get them there about 5 - 15 min before the baby will deliver.

    No matter how good you are sooner or later someone is going to surprise you. Some doctors will get really mad at you for this but most understand it comes with the territory.

    If you ask a patient what it feels like to fight the urge to push they will tell you that it is excruciating. It's one of the worst pains imaginable. So the few times it's happened to me, I tell them to push. I've only ever had to catch one baby in 2 years and have had 1 other caught by a resident because the doctor didn't make it in time (these weren't patients I was pushing by the way, they just progressed really fast all on their own).

    Now don't get me wrong, I don't want the liability of catching babies as an RN so I don't run around trying to precip but in all honesty it's not brain surgery to catch a baby so Id rather catch the baby then make a patient pant and fight the natural instinct of their body.
    Last edit by Dayray on May 12, '04
  13. by   mother/babyRN
    I have to say that when I had the urge to push it wasn't so much painful and certainly NOT excruciating ( and I was on pitocin with no epidural), but definitely intense...To let someone know how it is I liken it (everything comes down to the bowels) to a bout of severe diarrhea when you have to go right that minute and feel as though you can't hold it. It is actually usually a great relief to push.. So I tell people that labor is the hardest part because you're body is doing things to you that you do not have control over...Pushing is usually better because, like a loose tooth, it hurts but it hurts good, and delivery (as I recall) is usually the best of all, unless you are stretching a perineum and that can be burning....I have never had a patient tell me it was intensely painful when the urge to push came....Just INTENSE.....
  14. by   Energizer Bunny
    Quote from mother/babyRN
    I have to say that when I had the urge to push it wasn't so much painful and certainly NOT excruciating ( and I was on pitocin with no epidural), but definitely intense...To let someone know how it is I liken it (everything comes down to the bowels) to a bout of severe diarrhea when you have to go right that minute and feel as though you can't hold it. It is actually usually a great relief to push.. So I tell people that labor is the hardest part because you're body is doing things to you that you do not have control over...Pushing is usually better because, like a loose tooth, it hurts but it hurts good, and delivery (as I recall) is usually the best of all, unless you are stretching a perineum and that can be burning....I have never had a patient tell me it was intensely painful when the urge to push came....Just INTENSE.....
    You are quite right (at least for me) as far as the sensation of pushing. I know that with my last two, it was a feeling like there was no way I could NOT push whether they liked it or not (and in one case..no one was in the room with me, not even Bryan!). I loved pushing and once the baby was crowning, there was no stopping me, not even to suction!

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