L&D - advocating for patients - page 2
Question for L&D nurses... Do you see a trend in your facility to pressure laboring women into inducing/augmenting labor (eg, with pit) when the situation may not merit this recommendation? If so,... Read More
Aug 31, '11I'm on the postpartum side so I don't know many of the individual reasons for some inductions, but I do know that there seem to be more when certain MDs are planning to go on vacation - a disproportionate amount of their 37/38 weekers will be sitting over on L&D at 1-2 cm dilation hooked up to pit a week before they are supposed to leave... Coincidence???
I had one postpartum mom who said that she had tripped up the stairs and "bumped" her belly (in addition to scraping her knee), so she came in to be checked just in case it hurt the baby. The baby was fine, but the doctor said that since she was already at the hospital and 37 weeks along, why don't they just go ahead and induce her??
Aug 31, '11I can agree that sometimes it is a logistics thing - whether for the physician or the patient. However, where I work, we have had many patient's say "no, I don't want you to break my water" or "no, I don't want pitocin, or fluids, or an IV for that matter!" Our doctors are very good about honoring the patient's requests. We've had patients that have been induced, and not progressing. Her water was broke at 11am and she went all afternoon and into the evening without making change. We had an IUPC in place and her contractions were measuring adequate. Baby was tolerating everything fine, but was not decending. So, the patient began asking questions...."what happens if the baby doesn't come down?" "what if I don't progress?" The doctor was very good about telling her the options that were available to her and reassured her that as long as the baby was tolerating everything ok, a c-section did not have to be done, theoretically until the next morning. The patient was given the power to say when she wanted to call it quits. We've also had failed inductions, that, instead of breaking their water, they've shut off the pit and sent them home.
Don't get me wrong, we have also had the 36 weeker's water broke because she was not progressing in natural labor. We were all SHOCKED that the doctor did that. It was more of a benefit to him for the patient to deliver - she was coming in weekly with complaints of "contractions." But for the most part, I think our doctors try to honor the patient's plans for their birth if medically appropriate.
As for the question on if pit is dangerous. I haven't heard that (except in the instance that baby doesn't tolerate it, as mentioned above.) But I do know that you only have so many pit receptors in the body and dumping pit post partum is only so effective - so I've heard - because no matter how much pit you are dumping, you only have so many receptors. Our lactation consultants would rather put the baby to breast and allow the body's natural oxytocin to do the work instead of dumping in our artificial pit.
Sep 1, '11I don't like the idea of pitting an unripe cervix without an apparent medical reason (even though we now wait til 39 weeks), but by the time the pt has come to me, her decision has been made and she has made the plan with her doctor and showed up for her induction. I have had a pt decide to go home and not be induced after she showed up, but the vast majority have probably been waiting for the induction for some time. I don't have access to my pts prenatally! When they get to me, my job is to support her decision (being a pt advocate) unless she specifically tells me she does not want to proceed. The MD has to come in and assess the pt before the pit can be started, so she does have the opportunity to discuss it one last time (of course we could stop if not ROM'd as well in theory).
As for augmenting, if she has an epidural, delivery is going to probably be expedited and that is probably what the pt wants. I might be slow to start/increase pit or just leave it at 1-2 mu/min if it is ordered but pt is making cervical change and trying for no meds Pit can definitely stress out baby and also the receptors get saturated and then - when we need it for PPH it doesn't work (but thank goodness we have other meds). But pit also has a short half life so stopping the pit can usually stop fetal distress.
Sep 1, '11Thanks for the great replies! I'm definitely NOT in the camp that insists on "all natural" or else you have failed to be a good mom! I have a friend who insisted on having a VBAC against medical advice. She acted like she won an Olympic gold medal for proving those "idiot doctors" wrong. And now she "advises" all women who have had a C-section to have subsequent VBACs - without knowing anything about the other women and without any medical training! Makes me sick. Oh, and her VBAC resulted in a trip to the NICU!
On the other hand, I do want to empower women to ask the right questions when there doesn't appear to be medical merit for early induction - or augmentation when labor is progressing perfectly fine and the woman doesn't want augmentation.