Nurses role if Dr is not giving all options (VBAC specifically)

[maiday]

Hi!

I am in nursing school and writing a paper on ethical dilemma's in childbearing nursing. We are allowed to choose any topic as long as we can define the ethical dilemma and how it relates to BENEFICENCE, NONMALEFICENCE, JUSTICE and AUTONOMY. I have chosen to write my paper on VBACs. I believe it's an ethical dilemma considering how many hospitals will not even offer this as an option. I will be discussing VBAC in general, but my question is as a nurse, what would you consider your role to be if the Dr. you are working with does not do VBACs and is not giving your pt the full story. The Dr. is pushing the pt to have a repeat cesarean and not giving both sides of the story.

I chose this issue because it's personal to me and the above situation is not hypothetical except for the nurses role. I was pregnant after having my first child cesarean and the hospital my Dr. is affiliated with will not do VBACs. My Dr. did not even offer VBAC or tell me that might be an option, she assumed I would have a repeart c-section. I had to pry my options out of her and tell her flat out I wanted a VBAC. She tried to tell me that is was extremely risky and talk me out of it, but finally consented and said that at 36 wks my care would be transferred to a hospital an hour a way that would do VBACs.

Sorry for length. Also, I am not asking for opinions on VBACs, I've done my research there, but thanks. I'm just asking for what you would consider your role to be if the Dr. was not fully informing their pt.

Thanks!

[ukstudent]

There is no informed consent for lady partsl birth. Therefor it is not the nurses job to make sure the patient is fully informed, that is the patients responsibility.

The choice of doing VBAC's is not always the Doc's. It could be the hospitals policy in which they are practicing. As for the nurse, are you talking about a nurse in a doctors office (which is probably not a nurse but an MA) or are you talking about a nurse in L & D which works for the hospital and not the individual doctors that can practice there.

[maiday]

I guess I'm talking about any nurse who may deal with this type of situation. I would consider this to be similar to any type of procedure a Dr. ordered that a nurse didn't necessarily agree with.

And you're right as far as it's not always the Dr.'s choice. That is the case with the hospital near me, they do not allow VBACs. But I would still consider it to the Dr.'s responsibility to give the women all her options. With me, VBAC was a viable option, care just had to be transferred. She would not have even told me this if I had not pushed her.

[schack]

I am new to OB, so my experience in this matter is limited... our facility does not offer VBAC presently. Neither does are larger, "sister" facility. Our doc's have no choice in the matter. As for my role, I would not even meet the patient until she came in for her scheduled repeat section or came in labor. I really am not interacting with the patient during a period of time in which she would be gathering information about her options. Not sure if this helps you... :icon_roll

[netglow, ASN, RN]

MDs often only offer services they personally provide. If you ask about another procedure, and that physician is not comfortable with liability, or does not have the skillset (referring to surgical) to offer it, or does not intend to acquire the skillset to offer it, usually they will not discuss it as an option. However, it is ethical to do so. They should refer you for a consult. You bet they know who does it, and who is good at it.

The probable reasons why that specific service was not offered are: MD or facility or both have weighed risk of poor outcome and liability to his/their license. Also, a C/S is quite profitable, as well as offering more control over the situation.

[ukstudent]

Your doctor not giving all options has nothing to do with the nurse working in L & D. Like I said before, it is unlikely that the "nurse" in the doctors office is a nurse. Even if she/he is what do YOU think their responsibility is? Do you think they should have come up to you and said you should have a VBAC? Because if they did, that would be practicing medicine without a license.

You might have an emotional reason for wanting to write about VBACs but as you have laid it out, it does not meet the requirements set.

[maiday]

Whoa UKstudent! I'm not saying any nurse did the wrong thing in my situation. I do think my Dr. should have given me all the options, but that is the Dr., not any nurses or MAs.

I think VBAC fits the requirements perfectly because as a nurse you certainly may have patients ask what is your opinion on things, including VBAC. In clinical alone, I've seen nurses asked "should I get an epidural?", "should I circumsize my son?" And that's just from clinicals. You may not be the person who is supposed to inform them, but if they trust you, they will ask. It's our job as nurses to choose how to respond to these questions. Even if you just reflect the question back to them, it's always good to have an idea of how to respond.

I was just curious to see if any nurses had an opinion or had dealt with the situation.

[ukstudent]

As the nurse you are not meant to be giving advice, especially not medical advice on what the patient should or should not do.

Your paper as I understand it is about ethical dilemma's in childbearing nursing. Is the fact that your doctor did not want to tell you about VBACs and ethical dilemma/problem, yes but it is medical not nursing.

If a patient comes into L&D for a scheduled c-section after a prior section and asks the nurse "if she thinks she should do this", the nurse can not say "no you should leave this hospital, go to the one two towns away where they do VBACs" . The nurse would not know all the patients medical history that might pertain to the need for another c-section.

To give an opinion is to give medical advice. There is no ethical dilemma here for nursing.

[maiday]

As I said in my first post, I'm not looking for an opinion on VBAC or whether I should choose this topic. I was just wondering if anybody had any experience with this issue. My professor has approved this topic and a similar topic which would be circumcision. Similar in that they are ethical issues that a nurse may be asked. Not necessarily in L&D, but in any area.

I was not looking for an argument, and am a little surprised to have gotten one.

Thanks to those who responded. I'm going to write my paper now.

[dishes, BSN, RN]

Maybe the paper can describe what nurses can do when they believe a patient has not given informed consent to a plan? In the case you describe, the office nurse can discuss her concern with the obstetrician and ask the OB to inform the patient of all options so that the patient can give full informed consent. I don't think it is office nurse's role to provide information behind the OBs back and it may harm the patient's trust in the OB and or nurse. When you write an ethics paper, you don't need to solve the problem, you just need to show you understand all the ethical aspects of the situation.

regards

dishes

[maiday]

Thank you dishes, that's the kind of thing I'm interested in.

The paper is somewhat broad and maybe I'm not explaining it great, but that is the kind of thing I would discuss in my paper.

[teensmom]

I very much agree that vbacs are a good option. However, I am an L&D nurse at a hospital without a fulltime in-house anesthesiologist so we don't do them. We send them to our sister hospital that is larger, with a bigger staff. Anyway, I have never asked a c-section patient if they wanted a vbac. If someone comes in for the second c-section I don't push my opinion on them and tell them they should have a vbac. If someone asked me I would be happy to tell them that our sister hospital does them. Our hospital is very popular though with the "home birth" type of patient because we have a very low c-section rate and we use doulas and midwives. One time we had a patient that lied, denied she'd had a c-section before, the scar was supposedly from an appendectomy-very strange. I can't remember what happened, I think she got sent to another hospital when we got her records. So I really don't think this pertains to nurses, doctors are supposed to get informed consent for surgery not nurses.