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VBAC with little to no interventions (super long)



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No. 10
Old Jul 08, 2006, 07:39 PM
Updated Jul 08, 2006 at 07:43 PM by SmilingBluEyes

Default Re: VBAC with little to no interventions (super long)
Just wanted to make another note here.

Just yesterday we had a TOLAC that sadly,failed at the last minute. The pt pushed and baby tanked---and fast. When they went to open her up in OR, a small portion of baby's arm and hand were waving through a nice little window in the old incision in the uterus. No s/s prior to this, the labor was uneventful and things going very well. And patient was an excellent candidate for TOLAC/VBAC. Of note also, the uterus itself was nearly transparent in the spot around the window.....can we say, scary?

Just goes to show you never know...and how risky this really can be in some cases. That is why I say, know your policies and protocols and stick to them strictly!!!! Can't be too careful EVER.
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No. 11
from RaeT,RN
Old Jul 09, 2006, 04:47 PM

Default Re: VBAC with little to no interventions (super long)
Thanks so much for all your input! I definately agree that it is a control thing; especially with ending up with a c/s the first time, not at all how she wanted things to go. . . not sure if they were scientologists or not. . .

The more I think about the whole situation, the more I AM inclined to speak with my nurse manager about it. The thing about this MD is that she is constantly asking the nurses to cover her butt (ie. "I'm sorry, but my daughter is in bed and my husband is asleep, so I will not come up there tonight. Tell the pt in the nicest way you can that I'm sorry no one saw her today, but we're confident that she's stable and I'll see her in the morning." NOT KIDDING. This happened a few months ago.) I really felt that she had put me (well, all of us, really) in a sticky situation and believe that something was missing in the communication between the two of them earlier on. Not wanting to be the bad guy, I'm sure she just decided to let the nurses deal with the pt when she came in in labor. The pt had a birth plan, too, so you'd think all of this would've been discussed before she hit the door.
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No. 12
from RNnL&D
Old Jul 12, 2006, 11:14 AM

Default Re: VBAC with little to no interventions (super long)
I agree with everyone else. The patient should have been informed ahead of time of what is involved with a VBAC as far as hospital protocol. I'm glad you were able to empower the pt and allow her to make decisions for herself. As fas as pt not following protocol, difficulty monitoring, etc., all you can do is document, document, document.
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No. 13
from RNnL&D
Old Jul 12, 2006, 11:17 AM

Default Re: VBAC with little to no interventions (super long)
Originally Posted by RaeT,RN
The pt had a birth plan, too, so you'd think all of this would've been discussed before she hit the door.

I've discovered that while docs may discuss the reasons, risks, benefits of induction, CS, etc., the don't generally inform pts about the nursing care involved. As in, the scheduled inductions coming in, not knowing they will need and IV and continous monitoring. Why don't docs discuss this, so the nurse doesn't look like the bad guy? Ugh!
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