Oh the stuff as nurses we feel we must "keep under wraps"...
I am teaching childbirth classes. Most moms are about 2 months or closer to delivery. Several of my moms have doctors that seem to specialize in "primary elective C/S." These doctors are like used car salesmen and tell these moms whatever they want to hear as they talk them into major surgery. Don't misunderstand, I feel women SHOULD have the choice when it comes to their body, my issue is the doc pushing MAJOR ABDOMINAL SURGERY on someone who may never have considered it to begin with.
MANY have asked how their doctors compare to others when it comes to C/S rates. Mostly I tell them it's OK to ask their doctor what their rate is or I refer them to our state specific numbers and have them look. My heart aches and I just want to tell them "You can bet your butt you'll end up with a C/S if he/she hasn't talked you into one yet" but of course I don't. I DO tell them our monthly rates in our hospital in general. What would you guys do?
Another thing do you guys have some specific websites where these moms can look at risks of C/S vs. lady partsl deliveries? The march of dimes had a good site, but how about some others. I have found some, just seeing if maybe I have missed a better site. I'm not trying to talk these women out of their decision I just feel that some of these doctors really haven't truly discussed the risks in detail--just "sugar coated" it.
I don't want to turn this into a c/s vs lady partsl debate. I am wanting to educate my moms to the best of my ability and be an advocate for THEIR decision. Thanks in advance!
The childbirth educator has a unique and, in ways, powerful role to the patient. This is where all of these things previously mentioned, in regards to elective pcs versus the expectant management of labor, can be addressed. You can even address the "ambushing" of pts by their doctors, if it is done carefully and tactfully. What I used to do is try to make my pts feel very empowered, and very in charge of their bodies. I would explain that NOTHING can be done to them without their consent, that if they are so much as touched without their consent it is assualt, etc. I would not say "Now we all know here that Dr So&so is notorious for doing unnecessary sections, so watch out!" I would not address individual physicians preferences or routines, although I did strongly encourage the pt to talk with her doctor individually. I felt I did it tactfully and legally. I did not commit slander (although I also, like some of you, felt like doing so).
Now, the separate issue of having the pt admitted, in labor (or not), and the doc is pushing for a section. Well, that is tricky in regards to action at the bedside right at that moment. You certainly can't throw yourself over her so the doc can't section her. And you can't sit there telling her how she doesn't need a section and her doc is a nut. You can certainly address her questions and concerns, absolutely. But do it in a way that you are stating facts, not your opinion. No "I don't think you need a section because ABC." But more "There are risks and benefits to each..." and go into understandable detail.
What WILL make a difference is if the unit, as a whole, addresses the issue. If this doc does this routinely, you aren't the only one getting these pts and you aren't likely to be the only one with an issue with it. The unit as a whole, addressing the concern together, is much more likely to make a difference than one nurse going to address the unit manager. If you don't feel the manager will consider the issue, then write a letter as a whole unit, arm the letter with FACTS (research, stats, etc), send it to the manager, the director, and up to the CMO and the CEO if needed. But make yourselves heard! The hospital (and the whole health care system) would collapse without nurses. We have much more power than we give ourselves credit for.
Personally, the doc at our hospital whom we had the same problem (among other problems), this is what we did. We addressed the issue as a unit. We made it clear that pt care was being compromised. We armed our pts with knowledge (not opinion). Not long after the elective pcs stopped. And eventually he was no longer delivering there. You can make a difference, if you don't stop at the first brick wall you encounter! Keep trying!
The childbirth educator has a unique and, in ways, powerful role to the patient. This is where all of these things previously mentioned, in regards to elective pcs versus the expectant management of labor, can be addressed. You can even address the "ambushing" of pts by their doctors, if it is done carefully and tactfully. What I used to do is try to make my pts feel very empowered, and very in charge of their bodies. I would explain that NOTHING can be done to them without their consent, that if they are so much as touched without their consent it is assualt, etc. I would not say "!
All well said mombabyrn! And we do have the power....we only need to use it for the right purpose.......supporting women. Not the crappy system that feeds them rubbish!:yeah::yeah:
I too have had to deal wit this in class: most of us started in Ob when pateints screamed for a few hours and then delivered , it took me some time to see epidurals as someing ok for normal healthy mom. 3 o4 years ago when ACOG chaged its position on elective primay sections i was horrified but in tryign to arrange my arguments aginst it i found few concreat arguements that could not be countered on the otherside .
I my mind c/s is as safe and in most cases less scary and uncomfortable for patients. My reservations are my own becuse i like beign a labor nurse and not a circulator I do think pateints walk away with at least a sense of accomplishment if not a life changing event from vainal delivery but many dont value that - so if thats the way they see it then i guess they should have a c/s - eventualy im gunna have to be a vet midwife or soemthing becseu all the humans are going to the OR
Keep in mind that ultrasound estimates of fetal weight are very inaccurate- about +/- 25% at term. I believe ACOG recommends considering a section for a baby above 9 lb 7 oz at term. The outside diameter of your hips has nothing to do with your ability to have a baby, it's all about the inside.
I think ACOG's current recs are consider cesarean if over 4500g (9lb14oz) in a diabetic pregnancy and 5000g (11lb) in a non-diabetic. But I've heard individual OBs recommend section at much lower (estimated) weights.
I think ACOG's current recs are consider cesarean if over 4500g (9lb14oz) in a diabetic pregnancy and 5000g (11lb) in a non-diabetic. But I've heard individual OBs recommend section at much lower (estimated) weights.
I think even those standards are pushing it (no pun intended). If mom is not lying flat on her back, she can probably deliver a 10lb baby lady partslly and be fine. People severely underestimate the capacity of women's bodies to do what they were made to do. I am a big proponent of squatting and the pelvic opening that comes with it.
:yeah:
mombabyrn
21 Posts
The childbirth educator has a unique and, in ways, powerful role to the patient. This is where all of these things previously mentioned, in regards to elective pcs versus the expectant management of labor, can be addressed. You can even address the "ambushing" of pts by their doctors, if it is done carefully and tactfully. What I used to do is try to make my pts feel very empowered, and very in charge of their bodies. I would explain that NOTHING can be done to them without their consent, that if they are so much as touched without their consent it is assualt, etc. I would not say "Now we all know here that Dr So&so is notorious for doing unnecessary sections, so watch out!" I would not address individual physicians preferences or routines, although I did strongly encourage the pt to talk with her doctor individually. I felt I did it tactfully and legally. I did not commit slander (although I also, like some of you, felt like doing so).
Now, the separate issue of having the pt admitted, in labor (or not), and the doc is pushing for a section. Well, that is tricky in regards to action at the bedside right at that moment. You certainly can't throw yourself over her so the doc can't section her. And you can't sit there telling her how she doesn't need a section and her doc is a nut. You can certainly address her questions and concerns, absolutely. But do it in a way that you are stating facts, not your opinion. No "I don't think you need a section because ABC." But more "There are risks and benefits to each..." and go into understandable detail.
What WILL make a difference is if the unit, as a whole, addresses the issue. If this doc does this routinely, you aren't the only one getting these pts and you aren't likely to be the only one with an issue with it. The unit as a whole, addressing the concern together, is much more likely to make a difference than one nurse going to address the unit manager. If you don't feel the manager will consider the issue, then write a letter as a whole unit, arm the letter with FACTS (research, stats, etc), send it to the manager, the director, and up to the CMO and the CEO if needed. But make yourselves heard! The hospital (and the whole health care system) would collapse without nurses. We have much more power than we give ourselves credit for.
Personally, the doc at our hospital whom we had the same problem (among other problems), this is what we did. We addressed the issue as a unit. We made it clear that pt care was being compromised. We armed our pts with knowledge (not opinion). Not long after the elective pcs stopped. And eventually he was no longer delivering there. You can make a difference, if you don't stop at the first brick wall you encounter! Keep trying!