Crash Sections

[Mofe'ny]

Just wondering if this happens at other hospitals. I work WBN & NICU, so I don't understand all L& D ! We had a crash section the other night with mom only having a local anesthetic!!!!!:imbar I wasn't working (Thank Goodness). But I understand that anesthesia couldn't get to the meds because his key was bent. FHR had dropped to the 40's, and the baby was born 12 min. after it dropped. The baby was just transitioned with O2 hood, and ended up going to WBN the next day!

This is the 2nd section under local in the 2 & 1/2 years that I've worked here. We do about 800 deliveries a year. does this happen anywhere else???!!!

[Jolie, BSN]

I have no problem with patients who have birthplans. We should make every reasonable effort to respect and accomodate their wishes. However, I draw the line at providing poor nursing care. If we have tried every possible measure to make a patient comfortable, and she is still in pain beyond what she can handle, then it is my job to offer her prescribed pain meds. Not to do so would be negligent. She can always refuse, a choice which I will respect.

I have even had patients write in their birthplans that "the nurse is not to give me pain meds, even if I ask for them." I addressed that right away, telling the patient and her partner that that constitutes poor nursing care, and I won't be a party to it. If I offer and the patient (not her partner) refuses, that is fine, but I will not ignore a request for pain meds because of something written in a birthplan weeks before the onset of labor when the patient had no idea of how intense labor pains would become.

This same patient refused Motrin after delivery, despite obviously intense afterbirth pains that were not lessened by moist heat, etc. The moment her husband went out to the car to get something, she was at the desk begging for medication, and pleaded that no one let her husband know that she had taken it. This was obviously an inapropriate control situation, with possible abuse. One which required social work intervention.

My point is, that we don't always know why a particular request is made in a birthplan, and it is our job to question those that are inappropriate and interfere with good nursing and/or medical care.