I'm a GN and interviewing for jobs in L&D and postpartum. I was wondering if medical terminations and abortions are handled in L&D or on a different unit. How would I go about asking about the hospitals policies during job interviews without alienating the recruiter? Do all hospitals perform these procedures?
I would have no problem caring for these patients in post partum but would not want to be part of the procedures in any way.
We only do medical terminations on my unit. None of the "oops, I forgot to take my pill" or, "wow, I really don't think I want to be pregnant anymore" crap or anything. We'll offer inductions to moms who rupture membranes below 24 weeks (because even if by some miracle we can maintain the pregnancy to the age of viability, there won't be a live baby to take home) and the high risk perinatalogists will give moms the option if baby has a defect that is incompatable with life (anacephalic, trisomy 18 etc) Of course we induce labor if baby is found to have no hearbeat also.
The worst I've had was a termination at 19 weeks for HELLP. The docs had a hard time with that one too, but mom most likely would have been dead within 48 hours if we hadn't delivered the baby... her labs were getting worse by double (ast and alt) or half (platelets) every 4 hours. It's a little easier to deal with knowing that we saved a moms life so she can be around for her 2 other kids
I could not take part in an elective AB, but I'm ok with what happens on my unit. I don't see that we are changing the outcome in any way, just giving mom the choice to do what is best for her under horrible circumstances.
I took care of a woman who ROMed at 19 weeks with twins (twin A ROMed) and the docs wouldn't do anything about it til she hit 24 weeks. She was still hanging on at 24 weeks, so they admitted her, and she made it to almost 28 weeks and both babies are now toddlers. I personally would be kind of leery of inducing someone at
I took care of a woman who ROMed at 19 weeks with twins (twin A ROMed) and the docs wouldn't do anything about it til she hit 24 weeks. She was still hanging on at 24 weeks, so they admitted her, and she made it to almost 28 weeks and both babies are now toddlers. I personally would be kind of leery of inducing someone at
WOW! That's awesome for her, but the exception to the rule from what I've seen. We've had quite a few moms with PPROM pass on the induction, and get treated with prophylactic abx....only to hit viability, get steroids and go on to deliver a baby with hypoplastic lungs. Last year we had one that ruptured at 25.2, managed to not get chorio, sectioned at 33 weeks and baby couldn't be ventilated, at all. We don't talk them into or out of it, but they have a right to know the information and the odds. I don't think I could continue to carry and grow more attached to a baby that would almost certainly die soon after birth, but that's me. Some of our moms accept that the pregnancy is the only time they'll have with their child and want to continue it as long as possible. My job is just to make sure they have all the information, it's her choice what to do with it.
Oh yeah, she was very lucky, no doubt! I've seen what you describe too. I guess I'm more surprised to see a facility that will induce for that than anything. I didn't mean it to come across as a judgement - apologies if it did!
Just wanted to comment on the Catholic Hospital thing... I do not work in Women's Health, I do SICU.
I work in a Catholic Hospital, and I have seen a gravid hysterectomy re: Percreta with bladder involvement/ massive antepartum hemmorhage. Baby was not yet viable, but still alive. Mom was bleeding to death. I am not exactly sure what kind of discussions went on behind the scenes, there....but I am glad they didn't let mom bleed to death.
Any ideas how they got that one past the ethics folks? I am not being funny here, I am just not sure how it happened.
Just wanted to comment on the Catholic Hospital thing... I do not work in Women's Health, I do SICU.
I work in a Catholic Hospital, and I have seen a gravid hysterectomy re: Percreta with bladder involvement/ massive antepartum hemmorhage. Baby was not yet viable, but still alive. Mom was bleeding to death. I am not exactly sure what kind of discussions went on behind the scenes, there....but I am glad they didn't let mom bleed to death.
Any ideas how they got that one past the ethics folks? I am not being funny here, I am just not sure how it happened.
I have seen a similar situation in a Catholic facility - well below the age of viability, mother bleeding profusely - blood running out and onto the floor as fast as it was being pumped in through 2 IVs, in and out of conciousness. The parents and the attending physician knew that the need for termination was inevitable and yet the physician had to go through calling every one of the other providers there trying to find one who would cosign for the procedure. All refused, the ethics committee was called to come in, the woman continued to bleed out while those on the unit were wondering whether the fetus' heart would stop before the mother's. Finally a second round of calls from the physician to his colleagues got one to agree to sign for the procedure.
Just as some others feel about terminations, I feel that what this woman was put through and the risks she was exposed to were unethical and unconscionable. For this reason I try hard not to work in a facility with these kind of restrictions again.
I was not entirely sure how that worked. I know we got to save her, I just had no idea what the procedure was with the ethics folks. It was more than moderately disturbing to me that it even got that far.
I asked when I interviewed at one hospital and was told that "you don't have a choice, you have to", and I didn't take the position.
Where I am now, a tiertary hospital, after I worked there and I realised that they did do terminations, I submitted, in writing, a letter explaing that I could not participate in a termination, although I had no problem with caring for patients with stillborns or inevitable abortions. they gave me a little bit of push back ( I think to see if I was truly doing it for issues of conscience). I responded that I would ask my local churches to come down and show their support, and there was no way they wanted THAT publicity...They are now doing KCL inections of late term terminations 21-24 weeks, but I will not take care of those patients either, as I consider that part of the termination procedure.
I have been told that if no one is available, they may have to call someone in and then they won't need me...in 15 years that has never happened.
Bottom line is you need to live with yourself and not endanger your soul, if that is the reason for your refusal.
To each his own for beliefs.. but I don't really understand how taking care of a woman after any procedure would "endanger your soul". Looking after someone post-procedure is not the same as participating in a procedure you do not agree with for religious purposes.
To each his own for beliefs.. but I don't really understand how taking care of a woman after any procedure would "endanger your soul". Looking after someone post-procedure is not the same as participating in a procedure you do not agree with for religious purposes.
yeah, i would like to know how letting a woman die, is good for your "soul"?
I know that planned parenthood does abortions, as does some other non ob-gyn office. I have never had one or wanted one so I dont know if the private ob-gyns do them.
my l&d unit does incompatible with life abortions, often when mom has had that 2nd trimester ultrasound and found something devastating (anencephaly, etc). We do sign a form upon hire indicating whether or not we have a objection to caring for certain patients (or something to that effect that you can say you wont do terminations)
I work in a Catholic Hospital, and I have seen a gravid hysterectomy re: Percreta with bladder involvement/ massive antepartum hemmorhage. Baby was not yet viable, but still alive. Mom was bleeding to death. I am not exactly sure what kind of discussions went on behind the scenes, there....but I am glad they didn't let mom bleed to death.
Any ideas how they got that one past the ethics folks? I am not being funny here, I am just not sure how it happened.
I am about to start clinicals so I am not yet a nurse (so forgive me for asking this question): It was clear that mom would die without the termination, correct?
If so, there was no ethical dilemma. There is common misconception about the Catholic faith here. The life of the baby (or fetus if you prefer) and the life of the mother are EQUAL. One does not trump the other. Therefore, terminating the pregnancy to TRULY save the life of the mother is okay. The fact that the baby was not yet viable just made the decision even easier. Both would have died otherwise.
Just wanted to comment on the Catholic Hospital thing... I do not work in Women's Health, I do SICU.
I work in a Catholic Hospital, and I have seen a gravid hysterectomy re: Percreta with bladder involvement/ massive antepartum hemmorhage. Baby was not yet viable, but still alive. Mom was bleeding to death. I am not exactly sure what kind of discussions went on behind the scenes, there....but I am glad they didn't let mom bleed to death.
Any ideas how they got that one past the ethics folks? I am not being funny here, I am just not sure how it happened.
Yes. Catholic teaching is that the diseased pregnant uterus may be removed even if the unintended end results in the death of the child, because it is the uterus that is the problem, not the baby itself. So a hysterectomy in this case would be morally acceptable.
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nursejohio, ASN, RN
284 Posts
We only do medical terminations on my unit. None of the "oops, I forgot to take my pill" or, "wow, I really don't think I want to be pregnant anymore" crap or anything. We'll offer inductions to moms who rupture membranes below 24 weeks (because even if by some miracle we can maintain the pregnancy to the age of viability, there won't be a live baby to take home) and the high risk perinatalogists will give moms the option if baby has a defect that is incompatable with life (anacephalic, trisomy 18 etc) Of course we induce labor if baby is found to have no hearbeat also.
The worst I've had was a termination at 19 weeks for HELLP. The docs had a hard time with that one too, but mom most likely would have been dead within 48 hours if we hadn't delivered the baby... her labs were getting worse by double (ast and alt) or half (platelets) every 4 hours. It's a little easier to deal with knowing that we saved a moms life so she can be around for her 2 other kids
I could not take part in an elective AB, but I'm ok with what happens on my unit. I don't see that we are changing the outcome in any way, just giving mom the choice to do what is best for her under horrible circumstances.