Nursing dilemma relating to OB

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I'm in my last semester of school and gettting ready to graduate in May. I have done precepting at a hospital on OB. We have to do a dilemma paper and I am having a hard time trying to find something. What if a person was on her 5th child, barely legal, and no education or job. No matter how hard I try, I see it as a dilemma due to the fact that she keeps having children and no means of supporting them. She refused birth control, even though I have talked to her about it. I just don't understand how no dilemma can exist. You can keep having children, no education, no job...what is going to happen to your children? Will they follow in the same foot steps. I am totally lost!!! I also thought about someone with mag sulfate running on no pump, no catheter, no nurse and no monitor. Any help would be greatly appreciated!!!

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Specializes in Emergency/Cath Lab.

Its not your job to decide if people should have kids or not. While it might be wrong to you, some people see no issue with it. Take the lady I had one time that was on her 15th pregnancy, this was the 9th that survived to full term. Doctors offered to tie her tubes as the next baby would kill her ( she weighed 400 lbs had major cardiac issues etc ) but she said no. I was blown back by this but it is what they want. You have to check yourself at the door.

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Specializes in Gerontology, nursing education.

Honestly, if you go with this scenario, you run the risk of sounding judgmental. I agree that this situation is not optimal, but just because you have concerns about this person's lifestyle, it doesn't mean there is a dilemma. You've tried to do teaching and she's not listening. I would imagine that other nurses, social workers, and health care providers have tried to talk to this woman as well. What are you realistically going to do that someone else hasn't?

The other situation you describe about mag sulfate running with no pump, no catheter, no nurse, and no monitor does not sound realistic. Have you seen this actually happen in a real life setting? I would imagine not because of liability issues.

There are many ethical dilemmas in obstetrics. One dilemma that faces many rural hospitals is that they don't do deliveries and they don't have staff equipped to handle obstetrical emergencies. What happens to the woman who has an obstetrical emergency who shows up at a hospital that doesn't offer OB services?

Are you supposed to write about something that happened during your preceptorship? Or are you supposed to write about an ethical dilemma in more general terms? I'd strongly suggest you talk with your instructor about his/her expectations for this assignment. And again, be careful about coming across as being judgmental. I speak from experience here. When I did my public health rotation, my instructor jumped down my throat for being "judgmental" when I mentioned in a journal that it maybe wasn't a great idea that my client, a single mom with an entry level job, needed to practice safe sex. (These were the days before AIDS/HIV was on our radar.) I was looking at it from a public health perspective but my instructor thought I was passing judgment. So just be careful.

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Specializes in Medical Surgical/Addiction/Mental Health.

I would venture to say that there is plenty of literature on the subject of which you speak. Can teen parents provide the same upbringing as adults? Are they emotionally ready and mature enough? If she doesn’t have an education, research what the average person makes without a high school diploma. A paper is only judgmental if you don’t have supporting evidence to support your claims. Citing research articles simply state the fact. And quite honestly, teenagers who are having children, especially multiple children are a burden to society and the healthcare system. That may sounds judgmental, but there is research about it.

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As to the mag issue...this person was transported to the hospital I was at by EMT's that had mag running with no pump, no cardiac monitor and no catheter. The patient was only 27 weeks pregnant and they thought she was in PIH. Needless to say she wasn't. We are suppose to write about something that happened during my preceptorship. There really wasn't that much that happened on my 24 hours.

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Specializes in Gerontology, nursing education.

That really limits you, doesn't it?

I think this situation with the mag sulfate would be fine as a topic but you might want to bounce it off your instructor first. Maybe he/she will suggest you go with your first idea since this needs to be something you experienced.

I'm also going to ask one of our other staff members to move this to the OB forum where you might get more answers from experienced OB nurses.

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The mag thing doesn't really strike me as an ethical dilemma, it's more a practice issue. There is no ethical question about whether mag should be on a pump or not, it's just a medical risk to run it without.

As for the other ethical dilemma, if you use the case of the lady refusing birth control maybe you should frame it as your OWN ethical dilemma in providing unbiased care to a patient where you disagreed with her choices.

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