this makes me sick

Posted
by adpiRN adpiRN Member Nurse

Specializes in L&D. Has 3 years experience.

Last week I had a pt in pre-term labor at about 32 weeks. She had some pre-term contractions a few weeks before was given celestone and put on bed-rest, but this time it was the real deal. She was already 4 cm dilated. So her OB decided to let it happen.

But then he comes in and breaks her water!! Doesn't that just seem wrong?! It's one thing to let it happen, but to hurry it along?! And now she's committed to delivery that day, whereas if we'd left her alone there was a small chance her contractions could have spaced out or tapered off, buying her a few more days.

Then, when her contractions did space out, after her epidural, he ordered pitocin!! Also sick. I went to my charge nurse and the residents but they all said to just give it cause there's no arguing with this OB, he does whatever he wants. Plus the real problem was the AROM and now that she's ruptured we had to deliver her before she got an infection.

I gave the pit, but she only needed 2 mu and delivered a couple hours later. So it likely would have happened that day anyway.

But the whole thing just made me angry....

HappydayRn

HappydayRn

76 Posts

Sadly that sounds pretty standard from even my short experience in my OB rotation. I decided I wanted a home birth after seeing what a hospital one is like.

moz

moz

122 Posts

wow. None of our docs would've ruptured her, we would have tried to give her as much time as possible, even if it just meant a day.

Elvish, BSN, DNP, RN, NP

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

I totally get your frustration; that is not in the patient's (EITHER patient) best interest at all. Is there not a way this can be kicked up the food chain to risk management?

LDRNMOMMY, BSN, RN

Specializes in L&D,Wound Care, SNC. Has 10 years experience. 327 Posts

wow. None of our docs would've ruptured her, we would have tried to give her as much time as possible, even if it just meant a day.

Same here. I also agree with Elvish.

Jokerhill

Jokerhill

172 Posts

Not that I disagree about the Dr. doing a AROM, but so that outdated information does not get spread about delivering babies due to premature rupture. It is now acceptable to keep PPROM moms for weeks before delivery. I don't want to start a debate about whether this is right or wrong here, as I know this may not be in practice everywhere, but it seems common in my area now. If you want to debate it we can start a new thread on this treatment plan, and leave this as a bad Dr. thread. Joker

Treatment of Premature Rupture of the Membranes

Premature rupture of the membranes(PROM) occurs as an uncontrollable gush or leakage of fluid. By definition, PROM is rupture of the membrane that occurs more than 12 hours before the onset of labor. If this occurs before 37 weeks gestation, it may be called preterm premature rupture o/the membranes(PPROM).

In the past, due to concern that prolonged rupture of membranes would lead to maternal and fetal infection, babies were all delivered shortly after rupture, regardless of gestational age. Research has not shown this to be beneficial to mother or baby.

Today, one of two care paths generally is followed when a woman has PPROM without labor:

1.

Nothing is done except to wait for labor with monitoring of maternal temperature and avoidance of all vaginal examinations.

2. Corticosteroid therapy is initiated, with or without medications to try to stop labor.

Delivery is only induced in the presence of maternal fever, indicating infection. Most women with PPROM will be in labor, either immediately or within 2 days.

Women with ruptured membranes before 37 weeks usually are admitted to the hospital for observation. The woman may be discharged home before the baby is born if the leakage of fluid stops and certain other conditions exist. The baby should be in the vertex or head down position; there must be no sign of infection; the woman must be able to rest and avoid vaginal intercourse at home; the woman or somebody in her family must be able to read a thermometer; the woman must be able to return for prenatal care visits at least weekly. This is a decision to be made individually for each woman.

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,957 Posts

Not one of our docs would have ruptured her. I would discuss the case with your unit manager and risk management.

MeditationPeace

MeditationPeace

46 Posts

not that i disagree about the dr. doing a arom, but so that outdated information does not get spread about delivering babies due to premature rupture. it is now acceptable to keep pprom moms for weeks before delivery. i don't want to start a debate about whether this is right or wrong here, as i know this may not be in practice everywhere, but it seems common in my area now. if you want to debate it we can start a new thread on this treatment plan, and leave this as a bad dr. thread. joker

treatment of premature rupture of the membranes

premature rupture of the membranes(prom) occurs as an uncontrollable gush or leakage of fluid. by definition, prom is rupture of the membrane that occurs more than 12 hours before the onset of labor. if this occurs before 37 weeks gestation, it may be called preterm premature rupture o/the membranes(pprom).

in the past, due to concern that prolonged rupture of membranes would lead to maternal and fetal infection, babies were all delivered shortly after rupture, regardless of gestational age. research has not shown this to be beneficial to mother or baby.

today, one of two care paths generally is followed when a woman has pprom without labor:

1.

nothing is done except to wait for labor with monitoring of maternal temperature and avoidance of all vaginal examinations.

2. corticosteroid therapy is initiated, with or without medications to try to stop labor.

delivery is only induced in the presence of maternal fever, indicating infection. most women with pprom will be in labor, either immediately or within 2 days.

women with ruptured membranes before 37 weeks usually are admitted to the hospital for observation. the woman may be discharged home before the baby is born if the leakage of fluid stops and certain other conditions exist. the baby should be in the vertex or head down position; there must be no sign of infection; the woman must be able to rest and avoid vaginal intercourse at home; the woman or somebody in her family must be able to read a thermometer; the woman must be able to return for prenatal care visits at least weekly. this is a decision to be made individually for each woman.

fully agree, jokerhill. this statement, however, requires a source reference. apologies if already done, but i haven't seen one anywhere. ;)

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,957 Posts

Anecdote: My own BOW ruptured prematurely at 33 weeks. Doctor left me alone e.g NO induction/augmentation for 5 days until I went into labor spontaneously. They just did daily cbc to be sure I was not getting an infection. My son came 5 days later, I am sure, with lungs a heck of a lot more mature than they would have been earlier. He let my body do what it needed to do and I think that was wise.

MeditationPeace

MeditationPeace

46 Posts

anecdote: my own bow ruptured prematurely at 33 weeks. doctor left me alone e.g no induction/augmentation for 5 days until i went into labor spontaneously. they just did daily cbc to be sure i was not getting an infection. my son came 5 days later, i am sure, with lungs a heck of a lot more mature than they would have been earlier. he let my body do what it needed to do and i think that was wise.

mine went at the same time, but spontaneous labour followed within a few hours, unfortunately. my son then developed rds and became severely ill. had there only been a few days for lung maturity! well, he's a grown-up now with children of his own, so all's well that ends well. but would have been nice to have avoided all that agony. i don't understand the doctor in the op's story, either. in the absence of other clinical problems, i.e. infection, even a few extra hours in utero might have benefited that baby and avoided the need for pitocin on a pre-termer!

cnm in progress

cnm in progress

134 Posts

If that infant had developed complications after birth, I'd like to see how he would defend his actions in court...

Daisy Child

Daisy Child

Specializes in Geriatrics, L&D, Medsurg, Mom/Baby. Has 9 years experience. 21 Posts

I understand your disgust. I would be very upset. The OB's at my hospital would never get away with that... I have known PPROM to be on steroids & antibiotics for weeks with daily CBC's. Report him!