Dealing with doctors.....

Specialties Ob/Gyn

Published

Well I think one of our doctors is mad at me. In a way I really don't care. But I really like this guy as a doctor and I would like to establish a repoire with the group of doc's that we regularly work with. Here's the situation......

Dr. X like to schedule his inductions on the days he is on call so he can deliver his baby's. Well that's admirable right? So g2p1 shows up for induction 0700 (supposed to be here btwn 0500 and 0600 but he doesn't tell her that) I assume care from another nurse around 0830. She is 1, long, high. That's fine he comes in not long after I assume care to AROM.... he is unsuccessful. He doesn't come back 'til about 1330 Pit is at 20 (has been for several hours) 1-2, 30%, -3. He AROMs, clear fluid, He places and IUPC and says turn pit to 10 and go up as needed. I leave it at 10 for a while and ctx kinda space out so I start going up by 2's. She get's 10 of nubain. She had been trying to go natural but about 1530 she is asking for something else for pain. We discuss epidural .... she is 2-3, 70%, -3. I page anesthesia. We get epidural about 1630. At 1800 the doctor is back she is 6-8, 100, -2..... Before he checks her he questions me about why I didn't check her before she got her epidural.... I did check her before epidural... it's on the board.... it's in my notes. After he checks her he says, "it looks like it won't be long so I think I'll just hang around". I set up a delivery table. Talk to the patient.... she is very nervous and would like me to stay for delivery..... I try to be optimistic but don't promise anything.... At 1830 she is Rim, 100..... doctor knows and is in breakroom. At 1850 she is complete and complaining of pressure. Dr is notified...he is no longer in the hospital but says to go ahead and push her. I break down the bed and we start to push. Her epidural is pretty dense so she doesn't do too well the first couple of pushes. 2 nurses from nights come in to assist and one of them is very "encouraging". Well she pushes a few more times and during the last one she does great and we can see about a good amount of head. So we tell her not to push anymore till the dr gets here. She doesn't but the next ctx brings the baby down more until the head is really crowning good. I'm the only one with sterile gloves on and yep you guessed it the next ctx out comes the head. Loose nuchal cord.... I reduce it.... with help from the other RN and then encourage mom to go ahead and push.... well about this time the doctor show's up to do the rest. Well I say congrats to mom and dad.... admire baby for a few..... then leave because it's about 1910. As I'm leaving I visit with a couple of the other nurses and they ask.... "was he mad"..... It had never occured to me that he might be.... anyway. I go get changed and start to leave but see him sitting at the desk and he's is grilling the other nurses about "what happened" etc.... I walked up behind him and he wouldn't even talk to me..... what the he!!

..... anyway I keep wondering over and over what I could have done differently. I know I'm new. But I was not the only nurse there.... I just happened to be the one at the end of the bed. I think He would like to blame it on me because I'm new and he thinks I'm stupid or something. I don't understand what the problem is because there was a good outcome. I did not intentionally deliver this baby.... should I have tried to hold it in? I am very frustrated....

What are your thoughts....

The lady did not have a problem with not pushing. She was not really feeling anything because of her epidural. After talking with some other nurses today at work .... I think the only thing I would have done differently is that I probably wouldn't have broken down the bed. It was the consensus among them that if you are expecting to deliver it is easier to catch the baby on the bed..... of course I was not expecting to catch the baby and I have been frowned at for not having the bed broken down when the doctor got there. I guess this was a no win situation..... *sigh*

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

you did just fine.

stop berating yourself. this is not the first time, it won't be the last.

you did nothing wrong.

I still hate the idea of telling someone not to push. With an epidural, ok, but not otherwise. Another bb member once said it's like giving someone a bottle of laxatives and then saying "don't poop":)

Deb,

I LOOOOOOVVVVVVEEEEE your sig lines!!!!

Gotta love those "macrosomic" 6-7 lbers.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

hehehe thanks fergus.

You did nothing wrong. He is angry and knows that it was his fault that he didn't make it. You are much easier to be angry at than it is for him to deal with his anger with himself.

Thanks everyone for all your words of encouragement! I really appreciate it. I'm not used to second guessing myself and it's hard not to know everything I need to know. You guys are a great support system.

Speaking of not breaking the bed. We rarely break the bed for any doc or CNM. It's much safrer that way, for the most part. There are always sitautions that warrant breaking the bed, but it does not have to be a given.

Specializes in cardiac, diabetes, OB/GYN.

Macrosomia potential aside, as long as the baby was ok, he shouldn't have ruptured at a minus three because of the potential of a prolapse. Right or wrong, jerk or no, it is the nurse who is the patient advocate....You handled yourself correctly....

......She was a great patient for me but somewhat of a frequent flyer on the unit....

Do you mean she was a problem or a worried mother to be? :confused:

z

A hospital where I used to work had the ingenious "Code Pink"...when a doc was getting really out of line and causing a scene, they would call a code pink and all available nurses would come and stand around him, circling him, and just stare at him.

Gotta love it!

Originally posted by z's playa

......She was a great patient for me but somewhat of a frequent flyer on the unit....

I personnally hate that term. She was not a problem at all.... just very "needy" and had had like 20 or so outpatient visits to the unit for various problems.... srom checks, labor checks, pelvic pressure etc.... I am not sure if she was that "needy" in the office. She herself was a nice girl as was her husband... I think they were a little misunderstood by most of the nurses because they were from a very small town and were "country people"... but hey so am I so I guess we could relate......LOL

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