L&D - advocating for patients - page 2

by AJPV 3,724 Views | 16 Comments

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, what types of... Read More


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    Not, it's not harmful. (at least not that they know of!). Though I've heard some say it causes issues with milk production, but I don't work postpartum not sure about that.
    It CAN cause fetal distress if it works TOO well and causes lots of strong contractions. But in that case it can be turned off and rapidly resolves. In rare cases you can have a c/s for fetal distress from pitocin.

    To the OP - epidurals can slow down labor especially if given too early, before a regular labor pattern is established. Doctors actually advise women who are in early labor, contracting irregularly and less than 3cm dilated to go back home or go walking.
    But sometimes they BEG to stay so they can get the epidural, they don't care if that means they may need pit too.
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    But I guess what I'm saying is that if a woman is having an effectual progressing labor pattern, reassuring fetal heart rate tracings (no late or excessive variable decels), she's not post-term, no PROM, no evidence of chorio, no Rh-isoimmunization, no pregnancy-induced HTN, etc., I think she should question an MD's advice to AROM or to induce/augment.


    When I got to the hospital in labor with my daughter back in May, I was 3.5cm/90/-2. The doc wanted to AROM and I refused. I don't think he was happy, but he never really set foot in the door at that point, and my nurse also happened to be my friend and was more than happy to run interference for me. I progressed from 3.5 to 9 in 90 minutes without the first whiff of Pit, and at 9 I SROMed. My daughter didn't start to descend until I started pushing and had he ruptured me earlier, who knows where her cord would have been. Everything might have been hunky dory, it probably would've been, who knows, but all the same I'm glad I refused. And I'm glad my nurse backed me up on it.
    melmarie23 likes this.
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    Quote from adpiRN
    Not, it's not harmful. (at least not that they know of!). Though I've heard some say it causes issues with milk production, but I don't work postpartum not sure about that.
    there are studies out there that show that synthetic oxytocin (Pit) decreases the amount of oxytocin released by infant suckling on day 2, however it may cause increases in prolactin. What results is an increase in milk production, but not in milk letdown/ejection, so mom may end up extremely engorged.
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    I'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??
    AJPV likes this.
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    I 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.
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    I 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.
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    Thanks 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.


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