too many interventions in L&D

Specialties Ob/Gyn

Published

do you think there are too many interventions in L&D. It seems lately all our patients are pitted,ruptured, induced and or augmented. Some of our docs give patients arbitrary time limits for each phase if they don,t proceed on scedule it,s time for forceps or c/s. Just yesterday had patient who was G1P0, in labor had estimated 9lb baby, was progressing well baby was doing fine. patient had an epidural which was dosed why to heavy, not use of legs pt pushed first 1/2 hour or so very ineffectively, finally got the hang of it. baby was moving,doc came in at her 2 hour time limit checked patient says baby not moving at all. she called c/s. patient had adequate pelvic outlet, baby was at +2 or greater station when prepped. delivered 9lb 1 oz male by c/s.

do you see this happen a lot in your area?

I thought of something else that contributes to all of these silly elective inductions...

Nobody seems to give TRUE informed consent when it comes to an elective induction. You know, things like IT MAY NOT WORK, IT'S HEALTHIER FOR BOTH OF YOU TO WAIT FOR NATURAL LABOR, etc., etc.. How many of you have had an elective induction pt. seemed FLABBERGASTED when they are on 30mu of pit and have to be shut off for a 2nd day.....LIKE, OMG!!! MOTHER NATURE CAN'T ALWAYS BE FORCED!!! WHAT DO YOU MEAN????

I don't know about you all, but when I get informed consent, I make sure it's truely INFORMED, as in it's not all rosy and perfect and THIS MAY NOT WORK. I have major issues with docs that don't tell patients the RISKS of an elective induction. Why do they only fess up to the risks of a medical induction????? Any of you have this same problem??

Again, stepping down from soapbox....

AMEN SHAY!!! My biggest beef right now is with the fact that our docs want EVERY woman to be on EFM. Despite the fact that it produces worse outcomes for low risk women and actually INCREASES the chance of a lawsuit, none of them seem to trust auscultation! It is driving me crazy!

Originally posted by fergus51

Despite the fact that it produces worse outcomes for low risk women and actually INCREASES the chance of a lawsuit, none of them seem to trust auscultation!

Yep. True dat! Why in the hell does a woman in latent labor with a negative history and normal pregnancy need to be hooked up to EFM??? WHY??? WHY??? WHY??? Let's see.....you're in early/latent labor, so let's STRAP YOU TO THE BED so your pain is worse and your labor becomes dysfunctional!! Yeah!! Great idea!! :rolleyes:

EFM has its' place, we all agree, but man....sometimes I wish I could push all the monitors out a 10 story window....:(

Definitely!! Unfortunately we are on one of the lower floors.... Sigh... I hate the fact that women stuck to these machines can't move around and get things going. Instead we have to AROM em to get things moving....Uh huh...right....

Specializes in Adult internal med, OB/GYN, REI..

exactly...so what do we do??? i am new to nursing, still *******GRRRRR***** waiting for my boards to come back, but I have been in ob for nearly a year, and I HATE PIT!

There are so many doctors that AROM so early and then the women are shackled to bed and the stupid toco can't read if she's anywhere but supine, low semi-fowler's or side lying....it is SO evident that the intervention requires correction....EVEN to mE!

don't the MD's get it????? I need to inflate my ovaries a wee bit and try to stand up to these doctors!

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

I second that AMEN shay. you are so right-on w/the INFORMED CONSENT issue. Social inductions rub me ALL THE WRONG way and if I had my way, would be discontinued just for their very nature. HATE 'EM!

Originally posted by joyrochelle

exactly...so what do we do???

The only thing we can do is educate the public, and try to sway our docs from doing the doggone things. ~sigh~

I love my nm with all my heart but wish to God she had the cajones to stand up to the docs and say NO SOCIAL INDUCTIONS!!!!

Unfortunately, I think it's going to take the insurance companies catching on to put a stop to it. Either that or we run out of pit....wouldn't THAT be a great day??? :)

smiling blue eyes you are so right, i here that same scenario daily. i hate the social induction thank gooodness we dont get many of them. I absolutely hate pit unless it is medically necessary. i always get informed consent i tell them all the risks,increased pain,side effects and possibility of failure. to me consent is not valid unless it is informed.

And on to the fetal monitoring topic, i think it increases poor outcomes with low risk patients and they are definitely much more uncomfortable. i often catch hell because i let my patients of the monitor if their in no distress and are low risk for up to 40 minutes at a time so the can walk move around etc.

i had also gotten a verbal warning in the past for refusing to prep a pt for c/s, doc called it for FTP, at that point patient had been pushing 2.5 hours, first baby and it was a good size, but she was making steady progress, this was one of the docs that had arbitrary time limits placed, he believed you never push more than 2 hours. well we stepped out of the room had heated debate, told him to give me one more hour if she was not delivered, i would prep her then turn in my resignation. he agreed to it. 45 minutes later we had a perfect 9 Lb 5oz baby boy. i stayed and worked there a while longer until i moved. he had just caught me on a particularly bad day and i was not going to take it.

i think it is time we teach women to trust their own bodies in labor. the docs and much of the medical profession need to be reeducated!

Specializes in ER.

Standing ovation for Mark everybody! Wonderful!

thanks canoehead, (blushing). it was a hard thing to do some thought i was crazy even my wife. not quite sure if i wasn't at the time.:). they still talk about it there, i here it almost every time i visit my friends their.

I have worked at many hospitals, I tribute this to being in the military. I have worked at a resident teaching facility to being so autonomous that you prey the doc gets in before the delivery. (Although it is fun to catch a baby everyonce in awhile.) I have become friends with many doctors and have heard their side of the story alot of the time.

NOT saying that I agree with what they do, BUT, do you know how often doctors get sued because they didnt do what the patient wanted and just that one time their were bad outcomes. Or the doctor let a pt push for 4 hours, and the pt ended up with a 4th degree and then went for a c/s. I am in no way sticking up for docs, but I do know that most of the time they are doing C.Y.A.

Or they have been burned before or sued, or knew someone that has or had been sued.

Luckily, I work in a military setting, and our docs are there pretty much all the time. This is also were a midwife is the department head of OB. Where do you see that in a regular civilian hospital?

The pushing thing for 2 hours is a golden rule among many nurses. If it is a primip then you are allowed one more hour of pushing. If the strip looks good, then possible one more hour if the pt has the umph to do it. But I have never seen pushing past 4 hours, and usually not past 3. I have seen 2 very bad outcomes for people that have pushed for 4 hours.

Well, I always try to present all aspects of the big picture, its always easy to point at the other party, so I like to be fair. Trust me though, you do have your moron doctors that have tee times they have to make. They come out and say "break out the c/s consent." And your like WHAT?

Well enough rambling, back to studying. I have my AWHONN FHMPP instructor course tomorrow. WHOHO!

Take care everyone, may the L&D god or goddess be by your side!

Andrew

Wow, Mark! What a patient advocate! I can say that I do suggest, suggest, suggest to the docs, but I've never had the strength to go that far. And you were right, eh? Did the doc back down?

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