MD's "pushing" epidurals?

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Specializes in postpartum, nursery, high risk L&D.

A few weeks ago I had a primip in active labor who thought she would probably want an epidural, but wanted to try walking in the room, labor ball, etc while the contractions were still manageable. I was supportive of this plan but also made it clear that the epidural was available when she was ready for it. When I ran into the doc in the hallway, he said "labor ball????" (like, "why the hell are you messing around with that, just get her the epidural.") I told him she wanted to hold off on the epidural for awhile and be up and moving while she still could. He just rolled his eyes. whatever.

So when she finally did request her epidural, I already had everything ready to go so I paged anesthesia and started the fluid bolus right then. The anesthesiologist was not super prompt about it, and by the time my patient received her epidural she was very uncomfortable and starting to feel pushy. The MD came in as the epidural was being put in, patient moaning and groaning, and scolded me in fromt of everyone! "I knew you were going to wait too long to get her her epidural!!" and was just pissy in general through the whole delivery!!

Afterwards I confronted him about it (very professionally) and told him exactly what had happened, and he pretended like we were best buddies and all was well with the world, and that the anesthesiologist was the one he was upset with. but he had definitely been inappropriate with me in the delivery.

This evening I had a patient in active labor who, also, knew she wanted an epidural but wanted to try ambulating etc while the contractions were tolerable, which, again, I was supportive of but let her know that the epidural was available whenever. The MD was on the floor for about an hour after she gave me the order for nubain/epidural prn and probably asked me four times if she had gotten her epidural yet! Each time I told her that the patient wants to hold off a little while and be up walking around for now, and then when the patient requested just some nubain the doc hissed, "why doesn't she just take the epidural??" all exasperated.

as a nurse new to L&D this stuff frustrates and confuses me! Shouldn't it be supported and encouraged if a patient wants to be up and moving in labor?? epidurals certainly aren't without their risks, either.

any thoughts?

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any thoughts?

Yes, the way obstetrics is practiced in this country is grotesque.

Keep doing what you're doing.

Altalorraine

P.S. I hear ya about the way some doctors (many, MANY doctors) are nasty to nurses with subtle and not-so-subtle belittling remarks, unchecked irritation (which if it came from a child which earn the kid a reprimand), and general spoiled brat crankiness. I don't know what to do about it other than develop a very thick skin, and then I'm not sure I'll like who I've become. (Sorry for the vent!)

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Specializes in PeriOp, ICU, PICU, NICU.

Wow, how confusing. I am not a nurse, but I would have to guess that you should listen to the patient. It's like darned if you do and darned if you don't right?

Take care of the patient, and deal with the MD later. Good luck

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

Being the patient advocate was never promised to be easy. But you must do this---if a person does NOT want an epidural, you must stand by that choice and respect it. That may mean your taking her physician aside, and telling him or her this is her choice and you intend to back it up, if necessary. Nobody should be pressured into any procedure, particularly anesthesia.

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Specializes in LTC, Psych, M/S.

I am 5 months pregnant w/my 1st. I was under the impression that, during prenatal care, a woman was "offered" the option of having the testing done for birth defects, in particular the AFP for Down syndrome and spinal bifida.

I elected to not have it done - I have heard there is a high rate of false positives and I know someone who had a particularly bad experience with a false result. My MD tried to trick me into having it done, stating "okay, now you just need to go get your blood drawn..." I ask what for and he tries to not answer me. I find it really offensive and am thinking of switching MD's, particularly b/c I am afraid that this is a sign he would be one to do unnecessary c-section, epidural as mentioned above, ect.

Not that I am the expert - I am kindve new to all this, any suggestion or opinion?

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

If you have trust issues w/your health care provider, my strongest and best advice is to switch, if that is at all possible.

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I have found that before. One doc said "She doesn't have the epidural YET?" and I just said "No because she said she doesn't want it YET, so what do you want me to do? Strap her down and force her to get it?". Ended the conversation.

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

Well-said fergus.

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I am 5 months pregnant w/my 1st. I was under the impression that, during prenatal care, a woman was "offered" the option of having the testing done for birth defects, in particular the AFP for Down syndrome and spinal bifida.

I elected to not have it done - I have heard there is a high rate of false positives and I know someone who had a particularly bad experience with a false result. My MD tried to trick me into having it done, stating "okay, now you just need to go get your blood drawn..." I ask what for and he tries to not answer me. I find it really offensive and am thinking of switching MD's, particularly b/c I am afraid that this is a sign he would be one to do unnecessary c-section, epidural as mentioned above, ect.

Not that I am the expert - I am kindve new to all this, any suggestion or opinion?

Yes, I would definately switch drs. That is absolutely ridiculous. And many OBs do *not* give truly informed consent in regards to the AFP.

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Specializes in postpartum, nursery, high risk L&D.

Thanks for your responses. :)

Not for a moment did I ever think this patient advocacy stuff would be easy. Normally if someone is being cranky with me and the problem is clearly their own and not mine, I just let it slide. I'm a laid-back kinda girl, no biggie. But I think what's been frustrating for me as a new labor nurse is that I have the tendency, when someone gets bent out of shape about something, to immediately (in my head) be like, "holy cow, I did something wrong!!"

Plus it confuses me why the docs would be so big on the epidural even when the mom is saying, yeah I'd like to walk the halls for a little while. did they not read the same book about labor that I did?

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Specializes in LTC/Skilled Care/Rehab.

When I told my doctor that I didn't want an epidural during labor, she told me "well, I wouldn't recommend that". So I told her that I was in labor with my DD for 36 hours and didn't have an epidural and thought I would be able to handle it again. Then she seemed shocked and said "I don't know how you ladies can do it without any pain meds". Thanks for the support :rolleyes: . I should have probably looked for another doctor, but I was only a month away from my due date and didn't want that kind of stress. Next time I plan on having a midwife and hopefully they will be more supportive of my choice not to have pain meds. I am in school for nursing right now and I would like to work in L&D one day. I would also like to go back to school one day to become a midwife. I'm worried about having problems with the OBs especially since I have heard about the ways that some treat their patients (and the ways that I have been treated in the past) and I'm sure they sometimes treat the nurses the same way if not worse.

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In areas where epidural are common people doctors and nurses tend to develop a comfort level with them. Also they tend to be surprised and even a little annoyed when people deviate from the norm.

I'm allot like the OP I just let these comments roll off. I get them from doctors about both epidural and pit. The main reason for this is that OB's want to be able to plan when a delivery will happen. Now we all know that isn’t really a reason to change the way you care for a patient and I don't.

Still I can't hate the doctor for this because their lives kinda suck. They never know when they are going to get woken up or if they can spend time with their kids. So when they say stuff like this I just let it go in one ear and out the other. I'm also not above holding the docs hand a little when things happen at times that are bad for them, I say "I'm so sorry it worked out this way, how long will it take you to get here?”

In the cases where they are rude with patients or act put out by a patient’s request/time of delivery. I wait until the doctor leaves and tell my patient "don't feel bad at all, doctors work for you and yes they have a hard schedule, that sacrifice is the reason we respect them and the reason we call them Doctor Smith instead of John."

So you shouldn’t feel bad. Your patient wanted to experience some labor and that was what you helped her do. The situation you present is just another example of how outdated and problematic our healthcare system is. Doctors are overworked and they have too much responsibility. Nurses are often stuck in the middle and don't have the legal clout to back up the job we do.

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