Hold that Push!

Posted
by moz moz Member

I had a G2p1 spontaneous labor with an epidural. It was dayshift, she went complete, I had her give a push, and nothing. I called Dr.E (for evil lol) & told her exactly that, and the baby looked great. She stated she would see 2 more patients at clinic then head over to OB. Within a matter of minutes, the fetal heart rate dropped- 70's. Not just an early, they were staying down. I had her push and the head came down nicely, and had another nurse throw some O2 on her and call Dr.E. She told the office staff it was urgent, and got put on hold, so she hollered at the unit secretary to call her stat. She missed the delivery by 2 minutes, and was visibly angry. She never discussed any of it with me or the other nurse, she went directly to the nurse manager and "threw a fit" I'm told. Now, there is an inservice sheet everyone must sign saying basically we will not push Dr.E's patients, even if FHTs are low; instead do other interventions. I haven't read or signed anything yet, as I was working nights this weekend and didn't see our nurse manager.

:banghead:Why not TALK to me, go over the strip with me, anything?

zahryia

zahryia, LPN

Specializes in L&D, QI, Public Health. 537 Posts

I had a G2p1 spontaneous labor with an epidural. It was dayshift, she went complete, I had her give a push, and nothing. I called Dr.E (for evil lol) & told her exactly that, and the baby looked great. She stated she would see 2 more patients at clinic then head over to OB. Within a matter of minutes, the fetal heart rate dropped- 70's. Not just an early, they were staying down. I had her push and the head came down nicely, and had another nurse throw some O2 on her and call Dr.E. She told the office staff it was urgent, and got put on hold, so she hollered at the unit secretary to call her stat. She missed the delivery by 2 minutes, and was visibly angry. She never discussed any of it with me or the other nurse, she went directly to the nurse manager and "threw a fit" I'm told. Now, there is an inservice sheet everyone must sign saying basically we will not push Dr.E's patients, even if FHTs are low; instead do other interventions. I haven't read or signed anything yet, as I was working nights this weekend and didn't see our nurse manager.

:banghead:Why not TALK to me, go over the strip with me, anything?

That's crap. That piece of paper will not help you in a lawsuit. See if you can get another position.

nursejohio

nursejohio, ASN, RN

Specializes in NA, Stepdown, L&D, Trauma ICU, ER. Has 8 years experience. 284 Posts

Yeah.... no. So you have a baby doing that 'get me outta here!' decel, and don't push/deliver her? You have a bad outcome, and she's gonna let you take all the heat for it. No way would I sign that.

jenrninmi, MSN, RN

Specializes in L&D. Has 11 years experience. 1,975 Posts

Yeah.... no. So you have a baby doing that 'get me outta here!' decel, and don't push/deliver her? You have a bad outcome, and she's gonna let you take all the heat for it. No way would I sign that.

:yeahthat:

LizzyL&DRN

LizzyL&DRN

164 Posts

So do all the other interventions and if baby heart rate doesn't come up....Tell her to PUSH!!! The most important thing is a healthy baby and mom, and you got that so good job!

This happened to me the other day, G3P2 came in complete and +2, intact membranes, doc was called and was on his way. Only thing holding that baby in was the intact membranes, when we realize this baby is having big late decels. I had 4 nurses in the room, so I broke her water and had her push. Doc was in room for delivery but didn't have time to catch. Screaming, baby, 8/9 apgars. And doc wasn't mad.

Pinkster

Pinkster

Specializes in Cardiac. Has 2 years experience. 180 Posts

When a baby is coming out, its going to come out Dr. or not.

The Dr. should be glad you knew what you were doing and were able to deliver a healthy baby.

Jolie

Jolie, BSN

Specializes in Maternal - Child Health. Has 36 years experience. 6,375 Posts

Please take a copy of the in-service and sign-in sheet to your risk manager and hospital legal counsel. They need to know the dangerous extent to which your manager is willing to appease an unreasonable physician. We know that AWHONN standards run contrary to this "information" your manager is pushing (no pun intended), and it is AWHONN standards to which you will be held in a court of law. Your manager's in-service won't mean squat at that point.

NewNurseyGirl2009

NewNurseyGirl2009

100 Posts

You did the right thing. Don't second guess yourself because you made a judgement in the best interest of the baby. If you worked med/surg and your patient was coding would you wait for the doc to start the code, um no. I am not a nurse yet but working on it and work in l&d. We all know how some docs can be but your job is to advocate for the best interest of your patient. Signing that paper is not in the best interest of your patient.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery. 17 Articles; 5,259 Posts

I would not sign that paper either, and I agree with Jolie. Someone in risk mgmt needs to hear about it. It might ruffle some feathers but better that than a bad outcome and your license/good name lost.

Smurfette752

Smurfette752, BSN

133 Posts

:yeah:

When a baby is coming out, its going to come out Dr. or not.

The Dr. should be glad you knew what you were doing and were able to deliver a healthy baby.

EXACTLY!!!

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne. 2 Articles; 2,889 Posts

I would not sign it. Just because you sign something a whinny doctor had written up does not mean it will save you from a lawsuit if something does happen as a result of not pushing. Just hearing this infuriates me; especially since the doc put herself into a position of being late when you told her the woman was complete but she still went ahead and saw a couple of more paints in the clinic. I wish there was a web-site for docs like this to be "reported" so women can avoid them when looking for a primary care provider.

edisongirl25

edisongirl25

Specializes in peds and med/surg. 88 Posts

When you have to push, you have to push. It's uncontrollable, or at least it was for me. When my sister was having her baby this past December, the doc didn't make it...her nurse tried to keep her from delivering before he got there, but eventually the charge nurse said if you have to push, go ahead and push...b/c she couldn't help it. Your body takes over and trying not to is like trying to to breathe. The doc was about 5 minutes too late and my nephew was ok. I got to help b/c they needed an extra pair of hands and I'd went to nursing school with my sisters nurse, so it was a nice experience for me.

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