Jump to content

Help me analyze this delivery...

Ob/Gyn   (2,626 Views 16 Comments)
by shortstuff31117 shortstuff31117 (Member) Member

shortstuff31117 specializes in OB.

5,757 Profile Views; 171 Posts

Pt. comes in about 3 am in active labor, SROMd, 6-7 cm. Second baby, history of 1.5 hr labor. I call doctor and suggest she be on her way. Pt. doesn't want epidural, which is fine with me (doctor doesnt like it but whatever). Pt. is complete around an hour or so later and pushing. Heart tones go into the 90s-low 100s with good variability. Other nurse working with me checks and thinks baby is OP so starts helping to rotate baby. Encourages pt. saying good pushing, baby is rotating! Pt. is pushing well at this point, not tensing or anything.

After just a couple minutes, the doctor walks in, looks at the pt. and yells "Your baby doesnt like this, you have to push him out now!"

The pt. immediately tensed up and pushed but was totally fighting the pushes. Doctor continues to yell at her, basically scaring the crap out of her. When it had been maybe 10 min of pushing, the doctor screams out to get anesthesia here, that we may need to do a crash section! All this time the heart rate has remained in the 90s - low 100s. About this time she puts on a vacuum and finally pulls the kid out, with the worst vacuum marks I have ever seen. Luckily the baby was fine, screamed right away.

I have seen quite a few deliveries where the baby drops their heart rate like this, but never have I seen a doctor freak out like this!

Has anyone else experienced this? Was this doctor way out of line?

Share this post


Link to post
Share on other sites

KellNY is a RN and specializes in High Risk In Patient OB/GYN.

710 Posts; 7,492 Profile Views

Was this doctor way out of line?

You know the answer to that as well as all of us here. ;)

Share this post


Link to post
Share on other sites

SmilingBluEyes has 20 years experience.

2 Followers; 19,560 Posts; 65,110 Profile Views

Sounds like this doctor was indeed WAY out of line, to hear you tell it. You might pull him or her aside and ask WHY she/he reacted this way and "educate" you a bit (putting it politely, in other words, not the dr on defensive). I have done this many times and sometimes, the doctor has actually admitted to me he/she was wrong when talking it over. I have not been afraid when I felt the situation was wrong, saying so.

Approach this person at a calm time ALONE and simply ask "why"!

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

1,795 Posts; 16,660 Profile Views

Do you work w/ this dr. a lot??? Is she new? No big deal for somewhat low HR w/ good variabiltyas the patient is pushing. A multip will push this kid out usually no big deal. That is not to say you'd just ignore it, but really could be head compression and the rapid descent. If you get nowhere talking to this physician, then talk to the NM and head of OB (hopefully, it is not this particular doc) because she shouldn't be scaring patients like this. Thank God you nurses were on top of things and acting reasonably!

Share this post


Link to post
Share on other sites

mitchsmom specializes in OB, lactation.

1,907 Posts; 7,743 Profile Views

Maybe you pulled her away from a good show she wanted to get back too ?

:yeahthat:

Grumpy & wanting to get back to bed fast is what I was thinking...

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

700 Posts; 6,085 Profile Views

yeah he was way out of line. of course as a lowly nurse you cannot challange a Medical Dieity. So you cant find the vacume, wheil looking for it wisper to the patient that she is doing fine and to keep pushing, before you knwo it this crazed OB is goign to be screamign for her to stop pushing before the baby falls out so he get his gloves on.

As a new nurse I saw so many bottons torn to bits becuse a doc paniced or just becuse they wanted to get out of the hospital.

I learned to redirct the doctor and keep the patient pushing and most of the time the doc rolls their eye as the baby slides out wihtout instramentation.

Another thing to do is offer informed consent on the risks/beifits of suction. some patients will refuse a vacume after that, some choose to do what THE DOCTOR says but youll be surprized how careful they are of that ladys bottom. so wither way you win. the trick is to do it in a way that the doctor doesnt want to kill you.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

167 Posts; 2,683 Profile Views

yeah he was way out of line. of course as a lowly nurse you cannot challange a Medical Dieity. So you cant find the vacume, wheil looking for it wisper to the patient that she is doing fine and to keep pushing, before you knwo it this crazed OB is goign to be screamign for her to stop pushing before the baby falls out so he get his gloves on.

As a new nurse I saw so many bottons torn to bits becuse a doc paniced or just becuse they wanted to get out of the hospital.

I learned to redirct the doctor and keep the patient pushing and most of the time the doc rolls their eye as the baby slides out wihtout instramentation.

Another thing to do is offer informed consent on the risks/beifits of suction. some patients will refuse a vacume after that, some choose to do what THE DOCTOR says but youll be surprized how careful they are of that ladys bottom. so wither way you win. the trick is to do it in a way that the doctor doesnt want to kill you.

Sorry I think the above is passive aggressive. What if while you "can't find" the vacuum, the heart tones really go into the toilet? What if you delay asking for what the doctor wants and the result is not a good one.

If I really think what the MD is doing is unsafe, then I will initiate the chain of command right away.

Otherwise, like it or not, the MD is in charge of this patient. If you don't have time to express your concerns in a professional manner and it is just a matter of your preference for this patient, do what the MD wants.

Share this post


Link to post
Share on other sites

KellNY is a RN and specializes in High Risk In Patient OB/GYN.

710 Posts; 7,492 Profile Views

Sorry I think the above is passive aggressive. What if while you "can't find" the vacuum, the heart tones really go into the toilet? What if you delay asking for what the doctor wants and the result is not a good one.

If I really think what the MD is doing is unsafe, then I will initiate the chain of command right away.

Otherwise, like it or not, the MD is in charge of this patient. If you don't have time to express your concerns in a professional manner and it is just a matter of your preference for this patient, do what the MD wants.

Do what the MD wants? Great advice to a member of a profession who's job (and ethical) duties call for playing the vital role of PATIENT ADVOCATE. Didn't you cover that in your BSN courses?

There were no signs that the FHT would go down the drain. Every birth runs that (small) risk--should we "do what the md wants" if she starts trying to suck ALL the babies out? The fact that FHT could become nonreassuring is not evidenced based practice (doesn't nursing try to adhere to that too?) and has no rationale. If that were the case though, and the baby did start to go south, the vacuum could be quickly "found". (Not that I'm advocating for that method....I'm not sure what I would have done, personally)

And what chain of command would you go through? This doctor was not described as a 3rd year resident or anything where you could get the cheid or attending. I get the impression that she was a private doctor.

What she was doing was unsafe, but doctors know how to cover their donkeys and could easily give the generic "It's what I feel is best for the patient and fetus", just like they do on plenty of BS c-sections, BS episiotomies, BS cord tugging, BS inductions, BS frequent vag exams, etc etc etc.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

167 Posts; 2,683 Profile Views

Do what the MD wants? Great advice to a member of a profession who's job (and ethical) duties call for playing the vital role of PATIENT ADVOCATE. Didn't you cover that in your BSN courses?

There were no signs that the FHT would go down the drain. Every birth runs that (small) risk--should we "do what the md wants" if she starts trying to suck ALL the babies out? The fact that FHT could become nonreassuring is not evidenced based practice (doesn't nursing try to adhere to that too?) and has no rationale. If that were the case though, and the baby did start to go south, the vacuum could be quickly "found". (Not that I'm advocating for that method....I'm not sure what I would have done, personally)

And what chain of command would you go through? This doctor was not described as a 3rd year resident or anything where you could get the cheid or attending. I get the impression that she was a private doctor.

What she was doing was unsafe, but doctors know how to cover their donkeys and could easily give the generic "It's what I feel is best for the patient and fetus", just like they do on plenty of BS c-sections, BS episiotomies, BS cord tugging, BS inductions, BS frequent vag exams, etc etc etc.

I clearly stated that unless it was unsafe. I took this to be a differing of opinion for care.

I also stated that I talk to the physician about my concerns outside the patient room.

If it is truly dangerous, I call my charge nurse, and if she can't intervene where I have tried, I expect her to call the chair of the department.

My main point is that the physician is ultimately responsible and while we may not agree witht the treatment plan, there are times when we need to go along with it.

By the way, we just had a 41 6/7 week baby who died during second stage.

A review of the tracing by many nurses and physicians did not show anything that indicated this baby would suddenly die. (mom was septic but temp was only 100.7)

I also don't agree with you that a baseline in the 90's is not an indication that FHTs could worsen.

I am a HUGE patient advocate, I just go about it in a different manner

I would also speak to the MD about scaring the patient after the delivery. I would remain calm for my patient, speaking quietly in her ear during the delivery despite the chaos.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

700 Posts; 6,085 Profile Views

Yep its totally passive aggressive.

I’m glade you work with docs that don’t hold it against you if you institute chain of command. I'm also glad that you commonly agree with their POC. I however don't have that luxury. I work with some good docs and some bad ones and even the good ones have bad days were they are tired or make mistakes.

If I have to be passive aggressive to keep bad stuff from happening I will. I have seen horrible things happen because doc's are in hurry and I have seen good nurses challenge them and have seen those nurses hit the street for it.

Yeah I’m passive aggressive but I will never see another bottom ripped to a 4th or a patient who needs suturing b4 delivery because of docs wanting to get home for dinner. I also would rather not lose my job fighting a loosing battle. So call me passive aggressive if ya like, I can't deny it. I can say that it is effective and that docs don't get away with unnecessary interventions nearly as often as they used to with me.

Also the phsician is not ultimatly responsible for the care of the patient, we are suposed to work colabratively but thats doesnt always happen. If you ahve ever been to court you find out that the psyican is ultimatly responsible for very littel adn if the lawyer wants to get you all he has to do is bring up your responsibilty to advocate for a patient. "if you didnt agree why did you let them do it?". Vacume is a medical desition but we still ahve a responsibility to not participate in things we see as unsafe. However when you have a disagreement with a doctor you quickly find out that hospitals dont care. so passive agressive is all thats left

Also a 41 6/7 weeker? Omg that’s the problem right there as much as I hate inductions, there are reasons to induce and a patient reaching 42 weeks is pretty risky.

Can I ask where you work? Don’t have to be specific but how many deliveries does you hospital do? What part of the country is it?

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

2,441 Posts; 14,310 Profile Views

As a future student, I'm reading this and not knowing anything about L/D, (except giving birth myself) the situation sounded horrific.

As an RN, what in the world are you supposed to do when you see a doctor out of control like that? To me...things like this will be the most difficult part of nursing, having to sit back and watch a clear mistake being made.

The baby was Ok...but what if it wasn't and the vacuum caused damage when the nurses there knew there was no need?

All the money in the world doesn't fix a damaged brain. This is just so sad.

Share this post


Link to post
Share on other sites
Guest
This topic is now closed to further replies.
×