Judgements about big families

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We had an incident today at work that engendered quite alot of discussion. A mom was having her sixth c-section and seventh child. Throughout the case the anesthiesiologist was making comments to the mom about how this was plenty of kids and no one should want to have more than this, how it would be irresponsible of her to have more children (note he was not referring to the fact that she had so many c-sections and more pregnancies could be dangerous.

The nurse in the case talked to him afterwards saying she thought it was inappropriate for him to be making these judgemental statements to a patient. He responded that there was nothing wrong in giving his opinion to the patient. I asked if people thought it was okay to make judgemental statements to patients who had abortions. Everyone in the room immediately gasped no!! The opinions on the statements regarding the number of children were split about 50/50.. Why is it okay to make judgements about family size but abortion is taboo??? I personally think they both are off limits!!

Specializes in Home care, assisted living.

I would love to see my mom's response to anyone who tells her that it is selfish to bring five children into the world. :eek:

She does an exceptional job raising and homeschooling the youngest three (I'm the oldest at 27 and have a grown sister with 4 children of her own.) Mom is very frugal and loves a good bargain, so those at home are well-cared for and Mom has the ability to help those in need as well (such as my sister and her family when hubby was unable to work due to a back injury). And she does this on one income. She gives and gives to her family and friends...anyone would be hard-pressed to call her selfish.

Mom's gotten her share of comments from people, too, but of a different nature. "Wow, you have grown children, too? That's great! Built-in babysitters!"

"You don't look old enough to be a grandma! Those are your grandkids?" "Are you sisters?...You're not? She's your daughter? Whoa!"

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Personally, I would have had no problem stepping and telling this physician that this was obviously this family's choice to have these children. I would also point out that he was upsetting and making this mother uncomfortable and tarnishing her new childs birthday. In private I might have a few other statements to make to him.

Of course, my mouth has never gotten me into trouble before. :rotfl:

Along this vein I was having a discussion with someone yesterday whose family situation is simialr to mine. (children 19, 16, 4, and 9 months)

We were discussing the people who make jusdgement regarding the number of children and the spacing of them, and whether or not we know what causes all thse kids.

For the record Yes, I do know what causes pregnancy.

Whether or not I have lost my mind had no bearing on my decision to have 4 children. (my sanity is a completely seperate issue)

Just because YOU think a complete family is having one or 2 children, doesn't mean I HAVE to think so also.

Each person's priorities are different.

It is funny how people can have even different ethical values about things and just expects others will ahve the same.

As has been mentioned in here numerous times. Many folks would be horrified if someone were to have given this lady a hard time for having 7 abortions, but it is OK to click your tongue at her for having 7 kids??????

That just strikes me as asinine.

I completely agree with your post.

Sadly, one of my daughter's classmates told her that I was not a very good mom because I was having a baby at 40. That it was wrong to have a baby when you are that old.

#1 I was 44, not 40 :D

#2 That has no bearing on whether I'm a good mom or bad mom.

#3 Would having an abortion have made me a "good" mom?

I would probably have changed the subject fast in the OR and had a little private convo with that anesthesia guy and I know the OB would have been there with me. steph

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Specializes in ER, NICU, NSY and some other stuff.

Yes Stevie,

We are bad moms because we had too many kids. We also had them too old.

If we were good moms we would only have had one so we could have afforded a nanny to raise them while we shopped and lunched. Plus, the nanny comes in handy to watch them while you vacation in Monaco.

I was being facetious, so don't anyone get upset because I teased about having a nanny. I would love to have one. :lol2:

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Yes Stevie,

We are bad moms because we had too many kids. We also had them too old.

If we were good moms we would only have had one so we could have afforded a nanny to raise them while we shopped and lunched. Plus, the nanny comes in handy to watch them while you vacation in Monaco.

I was being facetious, so don't anyone get upset because I teased about having a nanny. I would love to have one. :lol2:

I don't want a nanny, I want a housekeeper and a cook. A gourmet cook. Oh and a landscape artist. And a contractor and a bunch of guys to help renovate my house.

So then I could just hang with my kids.

steph

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

Has anyone given more thought to the advocacy issue.....the one affecting this patient in the OP?

Like I said, no one is gonna win the argument as to "how many is too many"......and about "outsourcing" childrearing to nannies, extended-hour daycares, etc.

I personally had my kids to RAISE them myself----but others would not agree w/my choices, either. I still say it is very inappropriate to address this issue w/a vulnerable patient as a dr or nurse, like done in the OP.

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Specializes in ER, NICU, NSY and some other stuff.

I agree with you on that Deb. As I said earlier I would have addressed it at that time in an effort to advocate for my patient. I would have also made a point to discuss it with the Doc one on one later.

I would have probably carried this a bit further by writing an incident report and maybe even personally handing one of those famous patient satisfaction surveys to this mom myself.

I have always told my patients that they are entitled to have their concerns and questions addressed. By that I do not mean call administration because your jello is to warm or your bedsheet is wrinkled. I think being bullied by any staff member would be an extremely valid complaint. This would be one that administration would take extremely seriously.

I know an ER doc who got called in because a patient was dissatisfied with the dispensed amount of narc they were prescribed. They got what they requested they just were mad because they didn't get as many as they wanted.

On a more personal level, if I were this patient would I want to be strapped down to a table and be admosnished for my choices of having another baby???? Shoot no!\ :angryfire

I try and take care of my patients like I would want my family taken care of and I would not stand for someone being treated this way.

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Has anyone given more thought to the advocacy issue.....the one affecting this patient in the OP?

Like I said, no one is gonna win the argument as to "how many is too many"......and about "outsourcing" childrearing to nannies, extended-hour daycares, etc.

I personally had my kids to RAISE them myself----but others would not agree w/my choices, either. I still say it is very inappropriate to address this issue w/a vulnerable patient as a dr or nurse, like done in the OP.

As I mentioned briefly, I would probably not make a big deal during the surgery but I would change the subject fast. Afterwards, I agree with the above post - I know for a fact that the OB doc would not have put up with this and there would be a little conversation afterwards. I might also, if this was a trend, write an incident report.

Absolutely I'd be an advocate.

Deb, I had my kids to raise them myself too. Which is why it bugs me that I have to work. :bluecry1: Thank goodness it is only part-time AND I have wonderful inlaws who take care of my son on the days I work. They teach him so much - I am so very lucky.

steph

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

I guess I would have taken the physician aside and mentioned why I think it's an abuse of his power (perceived or real) to say such things in this venue.

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I guess I would have taken the physician aside and mentioned why I think it's an abuse of his power (perceived or real) to say such things in this venue.

I think doing anything during the surgery, besides just changing the subject, would inflame the issue. I'm sure the woman would feel weird having staff members discussing this further over her . . . our CRNA stands right at her head in a very small area where there is no way you could privately talk to him during the operation. Definitely after though. And I know our docs - they would be appalled. Our CRNA would never say something like though, fortunately. He is a very cool guy.

steph

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

I am talking about a private conversation, after the case, not discussing it "over the patient's head" Steph. A guy who did this once, likely will do it again in another case.

gee what is it w/me today? I seem to be misrepresenting myself all over the place. Sorry about that.

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Specializes in Maternal - Child Health.

I was in attendance at a scheduled repeat C-section for a mother who was delivering her 6th child. All but the first had been dellivered by C-section. Following the birth of the 5th baby, the OB had informed the patient and her husband that further pregnancies were inadvisable because of the exptemely poor condition of her uterus. The upper unterine segment had become so thin as to put her at risk for uterine rupture with subsequent pregnancies. Obviously, they had decided to proceed with another pregnancy despite the risk.

The OB made the incision into the patient's abdomen to reveal what looked like waxed paper surrounding dark green fluid. He stopped at that point, and asked the circulating RN to assist the father to the side of the operating table so that he could see firsthand the condition of his wife's uterus. It took most of us awhile to realize what we were seeing: the uterine wall was so thin, as to be essentially transparent. Meconium stained fluid was clearly visible thru the paper-thin fibers that held the uterus together. The OB reiterated his opinion that further pregnancies were inadvisable.

Amazingly, a healthy baby was delivered and the patient's uterus was spared. The couple decided against further pregnancies.

No berating, no guilt trip, no inappropriate comments, just a very powerful image to help the physician make his point.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I was in attendance at a scheduled repeat C-section for a mother who was delivering her 6th child. All but the first had been dellivered by C-section. Following the birth of the 5th baby, the OB had informed the patient and her husband that further pregnancies were inadvisable because of the exptemely poor condition of her uterus. The upper unterine segment had become so thin as to put her at risk for uterine rupture with subsequent pregnancies. Obviously, they had decided to proceed with another pregnancy despite the risk.

The OB made the incision into the patient's abdomen to reveal what looked like waxed paper surrounding dark green fluid. He stopped at that point, and asked the circulating RN to assist the father to the side of the operating table so that he could see firsthand the condition of his wife's uterus. It took most of us awhile to realize what we were seeing: the uterine wall was so thin, as to be essentially transparent. Meconium stained fluid was clearly visible thru the paper-thin fibers that held the uterus together. The OB reiterated his opinion that further pregnancies were inadvisable.

Amazingly, a healthy baby was delivered and the patient's uterus was spared. The couple decided against further pregnancies.

No berating, no guilt trip, no inappropriate comments, just a very powerful image to help the physician make his point.

wow BRAVO to that physician. I think that was handled BRILLIANTLY!
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