L&D nurse/abortions/accepting patients

Specialties Ob/Gyn

Published

As an L&D nurse I have chosen not to participate in terminations. I am in no way being judgemental to those who do.....this is just my personal and professional decision. I have never had a problame with my employer.....in fact they have supported me completely. for example....19 weeker came in ruptured (with heart tones)....MD talked with pt extensively....pt agreed to pitocin. I talked with my charge nurse. No one on the unit that night wanted to take this patient. A nurse was called at home and came in to help. I took care of the patient until this nurse arrived. Of course treated her with the upmost dignity, respect, and compassion. Did not start pit...and gave report to the oncoming nurse. Everyone was very supportive of me....especially my charge nurse.

Fast forward....

A termination was already delivered when I came to work....I was assigned to her. I politly and privatly asked to be reassigned. I was told NO. This patient was already delivered and I had no religious bases for declining the patient. Again....I treated this patient with repect and compassion. However, the patient (who was very understandably emotional) was asking me things like "I did the right thing, right?" "Do people in my situation do the same thing" I am sure she has been asking herself these things to herself since the diagnosis. I didn't know what to say....this was why I didn't want to take this patient.....I didn't like being in this position!!! So I responed with statements like...."I know this was a very difficult decision for you" "is there anything I can do for you to make you more comfortable" I (hope) I never did or said anything to make this patient feel I was being judgemental.....

My questions is...what can I do or say in the future to keep this from happening again....this was a very uncomfortable situation for me.

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Specializes in being a Credible Source.

Wow, feebebe, that's a tough situation in which to find yourself. It sounds like you handled the situation delicately, ethically, and professionally.

You should talk to your boss and explain how it went down and see s/he is sympathetic and will try to avoid a repeat situation.

It's in the best interests of the patients as well as yourself.

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Specializes in ER, ICU, Infusion, peds, informatics.

it sounds like you handled it very well.

there are many cases where i'm not comfortable telling patients things like "you did the right thing," even if i share that opinion.

to me, it is similar to being asked "what would you do?" by a patient. i never tell them what i would do, because it doesn't matter. i'm not them, with their set of circumstances and their set of values.

instead, i use those instances to explore the patient's (or family) thoughts/questions/fears.

i use a similar approach when someone asks questions like "did i do the right thing?"

i tend to say things like "i know that was a difficult decision to make," letting them expound if they wish. sometimes i think the person just needs to talk.

other times, i know they are looking for reassurance and/or approval. but often we do them more good by getting to talk about the situation, rather than just agreeing with them.

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Specializes in Community, OB, Nursery.

I think you did the right thing by acknowledging how difficult the decision was for her, rather than telling her she did or did not do the right thing. "The right thing" is very subjective, even on other subjects way less controversial.

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Specializes in Maternal - Child Health.

I sympathize with your emotional conflict in caring for this patient post - termination, but I believe that it was an appropriate assignment.

In the first example you cited, it was clear that your employer went to great lengths to honor the staff members' conscientious objections to caring for a patient who was terminating her pregnancy. As a Catholic and strongly pro-life nurse, I applaud the professionalism demonstrated by the staff nurses who respectfully declined the assignment, and the managers who worked hard to find a staff member willing and able to care for this patient without compromising religious/moral beliefs or patient care.

But I don't believe that conscientious objection should extend to the post-termination period. The emotional care of a patient who has experienced a pregnancy loss (elective or not) is difficult for everyone, and if those with religious objections are allowed to opt out of this aspect of care, the burden will fall disproportionately to the nurses who don't state such objections. Even nurses who support abortion rights will have difficulty handling questions like, "Did I do the right thing?" Also, to my knowledge, there is nothing involved in the care of a post-termination patient that violates any religious tenets. If a patient initiates a discussion or asks questions that you don't feel capable of answering, you can always consult social services or offer a clergy referral.

I understand your discomfort, but don't believe that it is a sufficient reason to decline an assignment.

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I understand not wanting to care for a patient during termination, it is after I am on the fence about. I am very pro-life so I would not accept care of a patient who is terminating a pregnancy. I am not sure how I would feel about care afterwards. I hope that I could show compassion because I do not know the circumstances behind the termination, but am not sure if I could be. I guess if you think there is no way that you could treat the patient with dignity et respect then your supervisor should reassign you. But there are always people out there who are not going to do things that we do not approve of. That is when you just have to smile and remind yourself that you are not there to judge but provide a professional service.

As for her asking if she did the right thing, I think that you responded in an appropriate manner. You left it open for her to talk further should she need to but you did not give your opinion on her decision.

Leslie

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Thanks for all the responses.....I agree I am there to provide a service and not to be judgemental.....I just don't want to be a position to unintentionally offend.....as I would never be judgemental/offensive on purpose. However, in this circumstance I found myself trying to spend as little time in the room as possible....as to not find myself subject to these difficult questions again. In doing so I personally felt I was lower my standard of care by avioding contact. The whole situation was very uncomfortable.

In response to a previous post, at my facility we try very hard not to have 1 nurse "do all the demises." We have a handful of nurses that will do terminations....they try and take turns. The other nurses also rotate taking care the other demies....so no one is "always having to do demises."

I have also heard a story from another nurse.....who worked at a facility in which she felt she was trying to be "run off" She had made it very clear that she did not take part in terminations....there was a pt. admitted for termination...who had asked at some time during her labor to "check for a heartbeat" and none was found. Then as shift change she was asked to take this patient....she said no.....they said "the baby has been confirmed to not have a heartbeat, you have no reason not to take over this patient" needless to say they sucessfully ran her off.....

I have also heard of a pt being told her baby had trisomy 13...deciding to terminate....went into the office for laminarea....no heartbeat....when admitted to the hospital it was decided that the "non termination nurses" had no right to decline this patient....

what do ya'll think??

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IMHO, this extends to many areas of nursing/patient advocacy/counseling. "Did I do the right thing" is an impossible question to answer.

Maybe it's rude to answer a question with a question, but you might handle it by asking back "Did you do your best? Did you do the best thing you could at the time? Did you make the best decision you could, given your circumstances?"

These are the questions I've used to forgive my parents, who one the whole, did a good job raising me given the circumstances (they were 19 when they got pregnant) and their abilities (HO mental illness X 2) and their resources (limited due to all of the above).

But, they did do their best. Possibly your patient did, too.

Hang in there.

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febebe, I have a really hard time with this. I am solidly pro-choice and, while I respect your right not to participate in a termination, I feel really heartbroken for those women who have to hang around with their dead baby inside of them waiting for a nurse who is willing to help them deliver it.

And yes, I said baby. When I comment on someone's big belly I don't say, "Oh, your fetus is getting so big!"

I don't know what to say. You have certainly acted compassionately when you have acted. I am not sure that waiting for another nurse to start the pit even after fetal demise has been confirmed is compassionate.

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Suesquach.....

In the origional post.....the patient was 19 weeks sromed and the baby had a heartbeat. The MD consulted with the patient on all her options....likely outcomes...bestcase/worstcase seniero....and whatifs.....the pt chose to end the pregnancy. I chose not to run pit.

In addition....I had a patient srom at 17 weeks....md strongly urged her to terminate....urged would be a mild term.....he told her if she did not terminate she would get infected/hystorectomy/die.....

She refused to terminate unless she got infected....went home on bedrest and PO abx....sealed over....and carried to 37 weeks.....

So I do not consider it "not compassionate" to not start the pitocin...but wait for another nurse to come and relieve me of care of this patient.

I feel nothing but compassion for women facing a diagnosis of trisomy 13/lethal dwarfism/anacephalic.....and I chose not to take part in personally giving a medication to end the life of a fetus. I do not judge them....I do not judge the nurse taking care of them. I just chose not to. I would also like to state that I had a close family member chose to end a pregnancy after a devisting diagnosis of the baby. I do not love them any less....I attended the funeral.....and gave and continue to give all my love and compassion.....

but it is a fine line.....at my facility I have seen terminations for down's, for missing limbs, and other non-life ending complications...again I am not judging I am just stating that I have a moral objection to personally participating....and at our facility you can't pick and choose which terminations you will participate in.....so I choose not to participate at all.

I would also like to add that in my career I have had 3 opportunities to care for patients who decided to carry their babies to term with a terminal diagnosis. It was truly an honor to care for these women....I consider it an honor to be blessed with the privlige to attend births and care for laboring moms......but to care for a mother so strong and brave to go to term. I carry these women in my heart!!!

I started this thread to get advice from other nurses as to "what to do in sticky situations" I have no intention to start a prolife/prochoice debate.....I appreciate all comments/stories/suggestions.....

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I misunderstood, febebe. Thanks for clarifying.

This is not an easy issue for any of us.

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We all stick our foot in our mouths sometimes we need to try not to but get over it and not beat ourselfs up. i understand not wanting to care for these patients I do (no body wants to take care of demises) OK maybe a very few select passionate people do, I'm not one of them. In my hospital everybody gets them (not the terminations mind you the ones who want to can opt out or more importantly the ones who will volunteer) The only time you are not expected to take a demise patinet is if you are pregnant and that is for both the sanity of the nurse and the patient.

I once told a patient I was going to be an indian giver and take her water away because the doctor had just given me an NPO order (new transfer never seen the patient and her name was very caucation sounding something like april smith) wouldn't you know it she was native american. Not good, insert foot into mouth (chomp chomp)

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