Patients refusing Pitocin

[Minou]

Hi ,

I am curious about how other L&D nurses deal with an admitted primip, not ruptured , irregular uc's, not really progressing, but oh soooo in pain

( 1/th/high ), this being the reason for admit, and refusing pitocin ...and BTW, you only have 5 labor beds and are backed up with pts waiting for a bed. Now I am all for pt rights and stuff but....do you just babysit her or what ? too high for an "asrom" , of course, you could send her walking but she still officially has a bed....it can be very frustrating... And she has a right to decide how she wants to do it....do you give her a choice : you take the Pit or you hit the road ? well that would be rude, so how do you solve this ?

Minou

[SmilingBluEyes]

A patient NOT in active labor would NOT be admitted in our hospital. She would be on observation status and sent home w/TX rest, as I said before.

Making her a full admit really implies some things here-----meaning, doing interventions best not done at this point.

Might want to look at your policies/procedures and make some changes, if need be, after talking to the physicians involved.

[StBRN]

I have noticed that almost nobody mentioned that some pts. in prodromal labour will refuse pain meds, all the while wanting to stay in hospital when not in active labour. For example, one night in triage, this woman (primip) came in with her husband in what appeared to be early labour (irregular cxns). 1cm/thick/-2 with membranes intact. Quite uncomfortable, but refusing all analgesia. Her husband, the spokesperson (seemingly) was very angry with me that after 4 hours and no cervical change, I was sending them home. As I explained, if the woman wants no pain meds then she is perfectly able to continue this stage of labour at home. I will say that I was as soothing as I could possibly be while teaching about early labour, and tried to remain understanding. In any case, this man was telling me that the baby would not be "safe" at home because his wife was in labour and that this was ridiculous and he wanted to speak to the doctor, etc. Well, anyway I sent them home after AGAIN asking the woman to consider analgesia (which she refused). The husband, needless to say, was very unhappy with me. (I had already spoken to the doc and told the husband and wife this as well as what the doc had said - I was not going to wake him up again to repeat his orders directly to the husband!!!). As it turned out, they came back about 5 hours later (around 1030) and the woman delivered late in the evening. I am glad for her, and she even got to deliver on LDRP (I work on high risk L&D). I think her husband was more upset than her about the whole situation. Unfortunately, this is a fairly common occurence where I work (busy hospital with avg. 450 deliveries/month now). Thanks for listening!