too many interventions in L&D - page 2
do you think there are too many interventions in L&D. It seems lately all our patients are pitted,ruptured, induced and or augmented. Some of our docs give patients arbitrary time limits for each... Read More
Jul 7, '02AMEN SHAY!!! My biggest beef right now is with the fact that our docs want EVERY woman to be on EFM. Despite the fact that it produces worse outcomes for low risk women and actually INCREASES the chance of a lawsuit, none of them seem to trust auscultation! It is driving me crazy!
Jul 7, '02Originally posted by fergus51
Despite the fact that it produces worse outcomes for low risk women and actually INCREASES the chance of a lawsuit, none of them seem to trust auscultation!
EFM has its' place, we all agree, but man....sometimes I wish I could push all the monitors out a 10 story window....
Jul 7, '02Definitely!! Unfortunately we are on one of the lower floors.... Sigh... I hate the fact that women stuck to these machines can't move around and get things going. Instead we have to AROM em to get things moving....Uh huh...right....
Jul 7, '02exactly...so what do we do??? i am new to nursing, still *******GRRRRR***** waiting for my boards to come back, but I have been in ob for nearly a year, and I HATE PIT!
There are so many doctors that AROM so early and then the women are shackled to bed and the stupid toco can't read if she's anywhere but supine, low semi-fowler's or side lying....it is SO evident that the intervention requires correction....EVEN to mE!
don't the MD's get it????? I need to inflate my ovaries a wee bit and try to stand up to these doctors!
Jul 7, '02I second that AMEN shay. you are so right-on w/the INFORMED CONSENT issue. Social inductions rub me ALL THE WRONG way and if I had my way, would be discontinued just for their very nature. HATE 'EM!
Jul 7, '02Originally posted by joyrochelle
exactly...so what do we do???
I love my nm with all my heart but wish to God she had the cajones to stand up to the docs and say NO SOCIAL INDUCTIONS!!!!
Unfortunately, I think it's going to take the insurance companies catching on to put a stop to it. Either that or we run out of pit....wouldn't THAT be a great day???
Jul 7, '02smiling blue eyes you are so right, i here that same scenario daily. i hate the social induction thank gooodness we dont get many of them. I absolutely hate pit unless it is medically necessary. i always get informed consent i tell them all the risks,increased pain,side effects and possibility of failure. to me consent is not valid unless it is informed.
And on to the fetal monitoring topic, i think it increases poor outcomes with low risk patients and they are definitely much more uncomfortable. i often catch hell because i let my patients of the monitor if their in no distress and are low risk for up to 40 minutes at a time so the can walk move around etc.
i had also gotten a verbal warning in the past for refusing to prep a pt for c/s, doc called it for FTP, at that point patient had been pushing 2.5 hours, first baby and it was a good size, but she was making steady progress, this was one of the docs that had arbitrary time limits placed, he believed you never push more than 2 hours. well we stepped out of the room had heated debate, told him to give me one more hour if she was not delivered, i would prep her then turn in my resignation. he agreed to it. 45 minutes later we had a perfect 9 Lb 5oz baby boy. i stayed and worked there a while longer until i moved. he had just caught me on a particularly bad day and i was not going to take it.
i think it is time we teach women to trust their own bodies in labor. the docs and much of the medical profession need to be reeducated!
Jul 9, '02thanks canoehead, (blushing). it was a hard thing to do some thought i was crazy even my wife. not quite sure if i wasn't at the time.. they still talk about it there, i here it almost every time i visit my friends their.
Jul 9, '02I have worked at many hospitals, I tribute this to being in the military. I have worked at a resident teaching facility to being so autonomous that you prey the doc gets in before the delivery. (Although it is fun to catch a baby everyonce in awhile.) I have become friends with many doctors and have heard their side of the story alot of the time.
NOT saying that I agree with what they do, BUT, do you know how often doctors get sued because they didnt do what the patient wanted and just that one time their were bad outcomes. Or the doctor let a pt push for 4 hours, and the pt ended up with a 4th degree and then went for a c/s. I am in no way sticking up for docs, but I do know that most of the time they are doing C.Y.A.
Or they have been burned before or sued, or knew someone that has or had been sued.
Luckily, I work in a military setting, and our docs are there pretty much all the time. This is also were a midwife is the department head of OB. Where do you see that in a regular civilian hospital?
The pushing thing for 2 hours is a golden rule among many nurses. If it is a primip then you are allowed one more hour of pushing. If the strip looks good, then possible one more hour if the pt has the umph to do it. But I have never seen pushing past 4 hours, and usually not past 3. I have seen 2 very bad outcomes for people that have pushed for 4 hours.
Well, I always try to present all aspects of the big picture, its always easy to point at the other party, so I like to be fair. Trust me though, you do have your moron doctors that have tee times they have to make. They come out and say "break out the c/s consent." And your like WHAT?
Well enough rambling, back to studying. I have my AWHONN FHMPP instructor course tomorrow. WHOHO!
Take care everyone, may the L&D god or goddess be by your side!
Jul 9, '02Wow, Mark! What a patient advocate! I can say that I do suggest, suggest, suggest to the docs, but I've never had the strength to go that far. And you were right, eh? Did the doc back down?
Jul 9, '02yes he did, but never got a real acknowledgement or appology from him.
andrew I totaly disagree with the golden rules of pushing limits, one hour for multip and 2 hours for primp is not enough usually. I have numerous patients who have had to push for 3 to 4 hours and have had very few poor outcomes. One example is my wife we have kids all 3 labors were very long, she pushed for 4 hours with first and third baby and 4.5 with second, all did well ahd good apgars 8/9,9/10 and 9/10. according to your golden rule she should have been sectioned all 3 times. the time limits you mentioned are real way too short with patients with epidurals. what is your hospitals c/s rate it must be high with those limits. we have 4 midwives that deliver here, they have lowest c/s rate of all that deliver here. they have the least interventions, very few epidurals and lots of natural births. they allow patients up to 4 hours often if baby is fine, i have even seen them let patient push that was tachy,etc. they have very good outcomes, have not seen them have a bad baby that was term since i have been here. I am always fighting for the patients best interest. i have seen to many sectioned unneccessarily. and find it hard to stand by and watch. the docs and i here have a good working relationship they have come to respect my judgement and intuition. just the other night i call one of the docs and asked him to section one of my patients baby looked real bady ,been ruptured look time, light mec present. he was very surprised , Quote" my mark this is a change, it must look bad ." well he came outt sectioned her baby had nucal cord x3 and real small cord and placenta.
how did the patient get the 4th degree then end up sectioned,never had that happen personally, even though have had numerous shoulder dystocias that i can remember.
Jul 10, '02Andrew, I understand docs do some things to CtheirA, but as for EFM, it actually INCREASES the chance of a lawsuit when used with low risk women. I think there does need to be reform in the lawsuit area! As long as a doc practices according to CURRENT knowledge, she or he should not be sued regardless of the outcome. I don't know why people think that every bad outcome can be prevented.