G1PO INDUCTIONS

BSNbeauty, BSN, RN · Jan 12, 2016

Number 2348763 reason I will never be a L and D nurse. I would find it very hard to be a nurse in these situations. I work in PP and when I see all these primips being induced for no medical reason it makes me so mad.

SoldierNurse22, BSN, RN · Jan 13, 2016

I find some of our OBs get around this by "making up" a medical reason. I saw this a lot right before Christmas (so they could deliver the majority of their babies between 12/20-12/23 and hopefully not have to be called in on the holiday). There were a lot of "unstable lie" dx for babies that were transverse weeks ago but have been vertex for a while, or GHTN for someone who had one or two semi high B/Ps in the office, but miraculously had normal b/ps all throughout labor for me! Also a few "possible macrosomia", and the baby came out 7lbs.

They anticipated that would happen at my workplace, hence the requirement that the OB comes in and does a complete H&P if the induction changes from elective to medical. It does seem to be a deterrent for some, though others care so little about their patients that they will come in and fill out a false H&P in a heartbeat to support a "medical" induction. Sickening.

Surfandnurse · Jan 13, 2016

@cblover you can certainly pm me regarding your delivery, but I'm by no means a seasoned L&D nurse or midwife.. I've been an L&D nurse for three years.

and I have really appreciated everyone's comments and stories so far, thank you. Helps me understand that I'm not alone.

Alikatz08 · Jan 13, 2016

We have a policy in place where elective inductions have to be at least 39 weeks and need a favorable bishop score filled out, as well as filling out extra paper work so it can get approved. Any induction before 39 weeks has to have a listed medical reason, however I know a doc or two at my hospital who will also make up a bogus reason just to get the patient delivered (either for convenience or because some patients complain about being sore and tired because they are 9 months pregnant and beg to get delivered....ugh). I think more education given to patients about inductions and as others have mentioned, going the full 40, would be extremely helpful! I will find this work sheet and present it at work, I think it can be very useful for those triage's who we send home. Also, man o man, would this education be even MORE helpful if it was started in the OFFICE setting early on. I see so many patients who come in for inductions who hardly know what is going on.

Don't even get me started on how some of the inductions go with the primips who are barely 1 cm dilated and get AROM'd....this infuriates me beyond anything! Or the ones who are induced with an unfavorable cervix. UGH

Silverdragon102, BSN · Jan 13, 2016

May I PM one of you about my recent delivery? It was pretty bad and I want to know what I could've done or MD could've done to prevent some things that happened. I wanted to ask a seasoned L/D nurse or midwife

Can I please remind the membership that we can not offer medical advice and the best people to talk to are your own health providers

PNCC2001 · Mar 4, 2016

Many Doulas do tell women and there partner exactly this; that's why a few hospitals in the U.S. have instituted a ban on Doulas because they don't like educated patients.

SoldierNurse22, BSN, RN · Mar 4, 2016

Many Doulas do tell women and there partner exactly this;

Tell them what?

that's why a few hospitals in the U.S. have instituted a ban on Doulas because they don't like educated patients.

I found a few articles and blogs referencing this, but thankfully, it doesn't seem too widespread.

I think it really depends on who you choose as your OB as to whether or not they educate their patients and give them all the options in a given situation. While doulas an be helpful, they are certainly not the only (nor necessarily the most reliable) source of information. These days, women have plentiful reliable resources at their fingertips. While it's certainly the responsibility of the provider to ensure that their care is safe and evidence-based, there's a certain amount of responsibility on the patient to ensure that her provider is acting with her best interest (and baby's!) in mind, not his/her own.

new_girl_2016 · Mar 13, 2016

SoldierNurse22,

First of all, I want to say "thank you" to you for being an advocate for your patients. As someone who recently had a terrible experience giving birth, I wish you were my nurse. I hope you know how amazing you are.

I had a healthy pregnancy, and a very healthy baby. I was induced because I was one week overdue (my first baby), and I was told my fluid levels were very low (a score of 5). I realize now they were nowhere near critical, but they were on the low side from everything I read. I was also sent to a hospital ultrasound technician over the weekend, and she said the same thing. So 2 doctors told me that the safest thing for the baby would be to induce my labor.

My cervix was unfavorable (barely 1 centimeter dilated), but with Cervadil and Pitocin I made "excellent progress," as it was noted in my medical records.

When my doctor finally strolled in, I was 10 centimeters dilated. My baby and myself were doing great until she showed up. The moment she walked through the door, my nightmare began. After less than 5 minutes of pushing I was told my only options were to have a c-section or a vacuum extraction.

The motivation was that my baby was in danger, since when I pushed my baby had 2 decels. As I realized later (I got a second opinion), my doctor lied to me about the condition of my baby. Those decels were not late, or prolonged. They were not dangerous, and the baby quickly recovered.

The most logical explanation is that the doctor herself (!) caused the decels. She had her fingers in my lady parts when I pushed. She was actively doing something, while watching the monitor. No, I didn't connect those two things at that moment. I learned later that some babies simply react like that when they are being touched. None of it was explained to me. The interventions that followed were the biggest nightmare of my life.

I didn't know at that time how to read the monitor strip. I didn't know the difference between early, variable or late decels. I didn't know what prolonged decels meant. My decels were not prolonged, although that's how she documented them in my medical records (I learned later).

The only thing I knew at that moment was that I pushed for less than 5 minutes, and I had a bad feeling about it because she went to the extreme interventions so quickly. But I also felt that I didn't have enough information to reject things. I was scared for my baby. I can't begin to tell you how easy it is to manipulate a woman in active labor into doing what the doctor wants. All he/she has to do it tell the woman that her baby's life is in danger. This is someone we've been going to for 9 months for appointments. This is someone whose opinion we trust. Besides, how do you get a second opinion when you are 10 centimeters dilated?

I frequently read that the women should advocate for themselves, and be better educated. I absolutely agree with that. Yes, it was my fault for not firing that doctor the moment she said the C word after 5 minutes of pushing. But, honestly, for me to do that, I should have known how to read the strip. So, in a way, yes, it was all my fault. But isn't it also the whole point of paying thousands of dollars to someone who is supposed to help you understand all of it? I kept asking my doctor what the decels meant. And she kept repeating one thing, "the baby is not tolerating labor, the baby is not tolerating pushing." That was it, combined with a very concerned look on her face.

The problem is that not every doctor is good and cares about his/her patients. When you are being lied to, very often there is not much you can do, unless you know as much as your doctor.

There was one thing that could have saved me. From the awful, completely unnecessary interventions, and the months of agony that followed, when I blamed myself for not going with my gut feeling. I had no reliable information given to me by my doctor, so all I had were my suspicions (that were later confirmed when I finally got a second opinion).

The one thing that could have saved me (since my doctor was very crooked) was my nurse's support.

She knew how hesitant I was about the interventions. She saw how scared and confused I was. She did roll her eyes when my doctor started talking about the c-section. But that was it. She went completely silent, and was moving like a ghost until the doctor (and her entourage) left, and I was wheeled into the recovery room.

I can't really blame my nurse. I understand that nobody wants to risk their jobs. But if you truly care, there is one simple thing you can do, especially if you know that the doctor is lying to the patient for the doctor's convenience. Support and encourage your patient. It can be as simple as saying, "Are you sure you want this? You have the right to refuse any intervention."

Since I didn't have enough information, and the nurse went completely silent, I felt like she sided with the doctor. And I wasn't educated enough to go against everyone in the room, based only on my gut feeling, and to risk the life of my baby.

Again, SoldierNurse 22, and other great advocates, I wish you were with me when I was giving birth. Please know that your support is absolutely vital to your patients.

I thought I would post my story here, because I don't know what else I can do to help other women protect themselves from unscrupulous OBG/YNs.

new_girl_2016 · Mar 13, 2016

Sorry, I was mostly replying to the OP, Surfandnurse. I got the names mixed up, and I don't see an edit button.

Race Mom, ASN, RN · Mar 14, 2016

When I was an L&D nurse, I would always advocate for my pt. Docs would come in and want to AROM the pt and up the Pitocin. The pt would just nod in agreement. When the doc would leave, I would tell my pt "you don't have to have your water broken. You can let this go more natural. All you have to do is tell the doc that you want to wait for interventions." The pts always expressed gratitude but allowed the doc to AROM them. Nurses need to really be strong and not worry about what the doc thinks. I always advocated for my pts. After that, it was their decision. Of course, this means that I have gone head to head with a few docs. I don't care if they don't like me. I have seen too many poor outcomes from wanting to deliver in the 9-5 world.

AspiringNurseMW · Mar 14, 2016

When I was an L&D nurse, I would always advocate for my pt. Docs would come in and want to AROM the pt and up the Pitocin. The pt would just nod in agreement. When the doc would leave, I would tell my pt "you don't have to have your water broken. You can let this go more natural. All you have to do is tell the doc that you want to wait for interventions." The pts always expressed gratitude but allowed the doc to AROM them. Nurses need to really be strong and not worry about what the doc thinks. I always advocated for my pts. After that, it was their decision. Of course, this means that I have gone head to head with a few docs. I don't care if they don't like me. I have seen too many poor outcomes from wanting to deliver in the 9-5 world.

I want to be you when I grow up