Cascade of interventions-what have you seen?

CEG · Mar 4, 2008

Well, I think one thing to remember with Pit (having been there myself) is that although it is making contractions stronger, they were probably inadequate in the first place-- so although the contractions have suddenly gotten stronger without the gradual buildup, I don't think they are necessarily unnaturally strong, just that the body's way of getting there is a little different. Want to add that I also think Pit is hugely overused so many women who were having adequate contractions are getting pit as well and that is a problem.

That said, I think the biggest problem I see is women having their first baby told to come into the hospital at 5:00 am at 39 +5 or 41+1 to be induced for no good reason. Admitted at 1 cm, pit started, progress a little, AROM, get the Epi, develop a fever, baby having decels, 5:00 pm, getting close to dinnertime, "stuck" at 6 cm, call a section. It seems that when 5:00 pm rolls around it is section time whether baby is in distress or not. We seem to be undert that mistaken impression that labor takes 12 hours. I believe this is 12 hours from active labor to delivery and this is an average. Not 12 hours from 1 cm and starting pit.

It's really a disservice to women and babies when we look at all the long-term consequences of birthing this way. Of course your OB doesn't care if you have incisional pain for 1 year, it doesn't affect them, except the extra money they make from your extra office visits. Doesn't matter to the residents if you end up with pelvic floor issues for life because of that forceps delivery you may not have needed. they got to practice forceps. Doesn't matter to the doc if your 7 pound baby baby gets an infection in the NICU because they were really 36 weeks not 38 and your scheduled section for macrosomia landed them with respiratory distress. That's the ped's problem.

I have heard so many doctors say "no, my patient's pain is well-controlled" they never see those patients after they are discharged. Or "no that won't affect breastfeeding" when what they know about breastfeeding could fit into a thimble and they don't follow-up on whether moms are breastfeeding anyway.

So, yes I see it and it drives me crazy.

clhRN2b2010 · Mar 4, 2008

Thanks for that reply. I look forward to more.

It reminds me of an article I read recently discussing research looking into the inadequacy of the CDC in tracking mother's health problems in the days and weeks following delivery, specifically pertaining to infections and complications with just the interventions you mentioned- C sec and forceps.

elizabells, BSN, RN · Mar 4, 2008

My cousin was induced at 40wks for MD convenience (for reals, he was going away for the weekend) - ever-increasing pit leading to uterine tetany, leading to crash CS when baby got unhappy. Thick mec at delivery, although thank god the baby was fine, no MAS.

racing-mom4, BSN, RN · Mar 4, 2008

What about Cytotec? We have two Drs who use Cytotec to induce labor. The labors are very strong, very fast and one patients baby was actually breach,resulting in emergency c-section.

Nothing frustrates me more than sched inductions, for a matter of convenience . I myself exp that, My OB was sched to go on vacation, I was at my due date and was more than ready to be done being pregnant so that Dr said "lets give this the old collage try". I was thrilled...Admitted me and started me on Pit, then instructed the Rns to break my water at 3pm ( I am sure in the hopes of being done with me and still make it home in time to pack)

The baby was still so high I was not allowed to get out of bed. Epidural placed and nothing nothing nothing. Now water is broke and baby still not coming. Pit cranked up, contractions are terrible, still not progressing. Crank it up some more. Frustration begins on Drs part and talk of C-section. I start crying, begging, crying some more out of shear exhaustion and frustration. Finally at 4am baby arrives, the after delivery contractions were so hard, even after the baby and placenta was expelled I was swearing there was still another baby inside.

Did I learn my lesson.

Plus lets face it, babies are easier to take care of on the inside vs the outside, so with my next pregnancy I stayed home till ctx were consistent and close. I was not going to risk another pit due to convenience again.

I want to scream when I hear women state their there baby will be born months in advance, because of a sched induction.

We just had a mom deliver on Leap Day via a sched induction because she thought that would be a "neat birthday"!!! :uhoh3: crazy!

grannyNan · Mar 5, 2008

Often in our area the patient demands to be induced either because of social reasons(my mom came from over the hill, or my favorite Dad is scheduled to go to jail for 6 weeks) or they are tired of being pregnant. I understand being tired but the baby will do better and so will you if we don't rip them out before their time.

zerby1470 · Mar 5, 2008

I have seen the flip side as well. I wanted a non medicated, limited interventional birth. And no C-section. Period. My doc was aware of my intentions, and supported me. I was induced after 8 weeks of bedrest at 37 weeks for pre-eclampsia. My time on bedrest bought my daughter time, but did not relieve my symptoms. BP through the roof and shedding protein like no other. So, I get my cervadil and pit drip. BP 228/114. Virtually no changes after a few hours. Pit gets cranked up higher. After 24 hours, dr offers a section. Am adamant that I don't want one, deal with the pain as I had planned. At 30 hours, I am dilated to a 4, consent to AROM. Get my internal monitors, still no pain meds. BP got worse with headache and nosebleeds increasing. At 32 hours, all my support staff were kicked out of my room by my nurse, because my blood pressure spiked (I don't know what it was exactly, but she mumbled "oh christ" when looking at my monitor, and she was a seasoned L&D nurse). At 34 hours I got a reluctant epidural to try to lower my BP. At the time I had a raging nosebleed, and visual disturbances. I was dilated to a 4 . 2.5 hours later I had a NVD. I was in a different profession when I delivered, so did not necessarily understand the gravity of my situation I was in. And while I am glad that I got a vag birth, and thank the gods that it turned out well, I am horrified that the severity of my situation was not explained to me by my doctor - I has high blood pressure and a bloody nose, whats the big deal, right? FWIW, I was induced on a friday, and delivered on Mothers Day, so my doc was in house a LOT over the weekend. But I also realize that my experience is the exception not the rule, and I feel for the women that have the power of their bodies to birth taken from them in the matter of convenience!

RNmama05 · Mar 5, 2008

Every epidural I see that results in a hypotensive, immobile, bed-ridden, horizontal woman is the start of a cascade of interventions.

Belinda-wales, RN · Mar 5, 2008

Often in our area the patient demands to be induced either because of social reasons(my mom came from over the hill, or my favorite Dad is scheduled to go to jail for 6 weeks) or they are tired of being pregnant. I understand being tired but the baby will do better and so will you if we don't rip them out before their time.

Then it is the doctors duty to say NO its because they the doctors have made induction look "normal"- The dotors use it for there own convienance gives vibs to the population that its ok to ask to have your pregnancy induced to fit in with social engadements.

magz53 · Mar 6, 2008

We are preaching to the choir as they say. How can we as professionals at the bedside get the messages out to educate the public ????? I can imagine a panel of nurses on Oprah having an intelligent presentation. I would love to see it. I think educated women would welcome the knowledge and opportunity to plan and participate in their care.

The early inductions for no medical reason, the immobility etc. etc. We are all sooooooo familiar with the scenerios. I just don't know how to get the word out there !!!