Am I wrong?

Hi all.......just mulling over a few things here and need some feedback please! Last night was a very frustrating night at work......here's the scenario....

My patient was a G2P1, AVBAC. First baby was PCS for failure to progress and fetal intolerance/distress. According to her chart, labor arrested at 4cm? My first "hmmmm" moment......anyway, first baby was OP, second one as well.

So, mom comes in with high expectations and very clear about what she wants/doesn't want. No epi, no IV meds and wants to avoid c-section at all costs. We discuss the options and possibilities. She's very nervous, tearful. I get her calm, coping well with ctx's. She goes from 4cm to 6cm in about 2 hours, to 8 in about another hour. Getting real uncomf now and wants IV meds.....Dr barely will write order. Keeps saying "Don't you mean epi? Are you suuuuuure you don't want the epi?". Through it all, she manages to say no and we give her 1mg stadol. About 1/2 hour Dr is back in room, checks her.....still 8, -1.....then declares her! I nearly fell off my stool...mind you, baby was in no distress, mom was coping well. He tells her the baby "cannot" be delivered this way. Now, haven't we all seen them come out "sunny side up" or is it my imagination? I tried to confront this Dr....suggesting giving her a bit more time, but he was adamant....BTW, everything in the chart indicated that prognosis for SVD was good......adequate pelvis. I'm really scratching my head as to why he was so quick to jump for the c-section. Poor patient was completely devastated.

Thanks for letting me vent!

Joyce

[kittyw]

Not an ob nurse, but just gotta say I LOVE my ob/gyn. He worked so hard to keep me from having a cs (his only patient that day so that may have helped - was at my bedside the whole time - I really think he was bored :chuckle ). My little one wanted to come out "sunny side up" but thanks to some weird positioning for a while he flipped over and came out the "right" way. Hearing stories like this makes me just want to kiss my doc. :kiss

[bagladyrn, RN]

My question would be - what kind of social plans did that doc have that evening? Can't see any other reason for this from what you've posted, and have often wanted to write "doctor impatience" as the reason for procedure. This is another reason I like working nights - I don't have to wake the docs until I'mm ready for them!

[SmilingBluEyes]

OH--- there are any number of reasons why the doctor elected to to this and baglady hit on one biggie; the doctor's preferences, priorities, and schedule. And I agree at night, we make a lot more independent decisions and I do not call them til the patients are ready to push (or have alread, in the case of primigravidas).

If this is a habit of this one physician, you could discuss this with your NM as a problem, but good luck getting it resolved. In most hospitals (where I work is no exception) the DOCTORS hold the trump cards and make decisions quite unilaterally, never taking into consideration patient desires and preferences, let alone nurses'. I don't see ANY reason why the trial of labor could not have continued for this patient in your case; she was right in there on the labor curve and seemed to be doing well. Not being there, seeing all the facts for myself, it is hard for me to give you a concrete answer. But from what you say here it sounds like the Dr. had a strong agenda. How UNUSUAL (hear my saracasm here). Good luck.

[fergus51]

I would be worried about informed consent if that is actually what the doctor said (seeing as it is a lie). I would have informed the patient that babies can be delivered sunny side up though it is a little more difficult, and that until she or the baby are showing signs tht they are not coping with labour, it is her decision whether or not to continue with labour, NOT the doctor's.

[finallyRN]

I had a similar incident several weeks ago. I had a patient who wanted to do labor her way. No IV, no Pit, no Epidural and No C-section. When I came on she was 6 cm (which she had been for several hours). The doctor came in and checked her, told her she would need the epidural or else she would have a c-section. Before the patient had a chance to think about it or even consent to an epidural the doctor called anesthesia. The anesthesiologist was in the room before the patient had made her decision. Anyway the patient got the epidural.

She is comfortable and the Doctor says she is getting pitocin or else a c-section. She placed and IUPC then had me start Pit. The patient was reluctant but accepted. After only an hour and a half of adequate contractions, she checked the patient said she was the same and declared a c-section. I tried to confornt the doc outside of the room but she wouldn't listen. Mind you at no point was the baby in any kind of distress.

This doctor is notorious for giving patient care around HER schedule. I felt so sorry for this lady who got everything she did not want.

[RNMom1969]

Hi again! Yes, the more I think about it now, the more angry I become. There was no reason to declare her.....none at all that I can think of.....other than that Dr's own personal agenda. Man, I am so burned up over this one!

Some nurses do their own cervical checks at our hospital, but need to be RNC in order to do so (on my to-do list). BUT, seeing Doc was around that night, and awake.....he did the checks instead of one of us.

As they say......hindsight!

Thanks for the imput!

Joyce:D

[bagladyrn, RN]

I try in most of these cases to make sure the pt. knows it is her right to refuse ANY procedure and demand that the doctor take the time to explain the rationale for such treatment. I do tell them that there may be cases where immediate treatment may be necessary, and explanations later. If the doctor is hanging around, I ask the patient in front of them "Would you feel better if Doctor So- and- So explains what they are seeing?" "Do you understand what he just told you?" Yes this puts the doc on the spot, but I'm not there for a popularity contest.

[SmilingBluEyes]

Agree w/baglady 100%. I always remind the patients that we (doctors and staff) work FOR them and they have the right to understand FULLY each intervention and its rationale and choose to refuse when they deem. and yes, to confer w/their physician as they need is a good thing, too.

[OB/GYN NP]

This is a tad bit off the subject, but my next thought after reading all of your posts is this...Don't you feel that no matter what you tell the patient, they will tend to trust their doctor more than they trust you? Even if you talk to the patient about this, even if you have a good rapport with them, you've only had a few hours with them, and they really have had a long time with their doctor (all through prenatal care). And many women just tend to take the Doc's word for it...because HE'S/ SHE'S the DOCTOR. Not putting down Docs at all, but it's hard to make your patients trust you enough to be able to get them to defy the Doc when there's a good reason to defy him/her. This is frustrating to me. Anyone else ever have this happen?

[NurseAngie]

Originally posted by finallyRN

I had a similar incident several weeks ago. I had a patient who wanted to do labor her way. No IV, no Pit, no Epidural and No C-section. When I came on she was 6 cm (which she had been for several hours). The doctor came in and checked her, told her she would need the epidural or else she would have a c-section. Before the patient had a chance to think about it or even consent to an epidural the doctor called anesthesia. The anesthesiologist was in the room before the patient had made her decision. Anyway the patient got the epidural.

She is comfortable and the Doctor says she is getting pitocin or else a c-section. She placed and IUPC then had me start Pit. The patient was reluctant but accepted. After only an hour and a half of adequate contractions, she checked the patient said she was the same and declared a c-section. I tried to confornt the doc outside of the room but she wouldn't listen. Mind you at no point was the baby in any kind of distress.

This doctor is notorious for giving patient care around HER schedule. I felt so sorry for this lady who got everything she did not want.

The more I read stories like these the more I am CONVINCED that midwives are the way to go!

~Angie

[fergus51]

Depends on the patient. I have had more than one stand up to a doctor when informed of their rights. At the very least I feel like I have an obligation to inform the mother of the facts, and as great as some docs are, none I know have a crystal ball that makes them right all of the time.