Am I wrong?

[RNMom1969]

Hi all.......just mulling over a few things here and need some feedback please! Last night was a very frustrating night at work......here's the scenario....

My patient was a G2P1, AVBAC. First baby was PCS for failure to progress and fetal intolerance/distress. According to her chart, labor arrested at 4cm? My first "hmmmm" moment......anyway, first baby was OP, second one as well.

So, mom comes in with high expectations and very clear about what she wants/doesn't want. No epi, no IV meds and wants to avoid c-section at all costs. We discuss the options and possibilities. She's very nervous, tearful. I get her calm, coping well with ctx's. She goes from 4cm to 6cm in about 2 hours, to 8 in about another hour. Getting real uncomf now and wants IV meds.....Dr barely will write order. Keeps saying "Don't you mean epi? Are you suuuuuure you don't want the epi?". Through it all, she manages to say no and we give her 1mg stadol. About 1/2 hour Dr is back in room, checks her.....still 8, -1.....then declares her! I nearly fell off my stool...mind you, baby was in no distress, mom was coping well. He tells her the baby "cannot" be delivered this way. Now, haven't we all seen them come out "sunny side up" or is it my imagination? I tried to confront this Dr....suggesting giving her a bit more time, but he was adamant....BTW, everything in the chart indicated that prognosis for SVD was good......adequate pelvis. I'm really scratching my head as to why he was so quick to jump for the c-section. Poor patient was completely devastated.

Thanks for letting me vent!

Joyce

[SmilingBluEyes]

OB/GYN NP no I dont' think they TRUST the doctor more; I think it is a matter of power over *lack* of power. Many physicians are in the authority position and exercise it STRONGLY, leaving little room for doubt or choice on the part of their patients. This is where nurses and doctors differ oftentimes (not always). As a nurse, I am always offering choice whenever possible and empowering my patients w/education and confidence-building. I believe my patients trust me implicitly, for this and other reasons.

I believe it is that patients are afraid to "go against their doctor" and simply give in to what is suggested, due to this perceived lack of power. Happily, I am seeing more and more well-informed and assertive patients who DO challenge convention and staid thinking. GOOD FOR THEM!

[sherryrn76]

the more I read, the more I love my hospital. We are a teaching hospital but still have plenty of private MDs. We do approx. 300 deliveries per month. ALL of our docs are reat about following guidelines for c/s..labor curves, adequate MVUs, etc. One of the first things we do on admission is to give the patient and family the number to our patient advocate line and explain that they have the right to refuse anything they are not comfortable with. Yes you can deliver "sunny side up". My oldest was direct OP as was her child! Both were lady partsl. Hers was with an epidural, mine without..back in the Lamaze days when epidurals were not offered and Harvard pumps were used for Pit and the MD HAD to be in house while Pit was running. I had a fourth degree but stil beats a tummy full of stitches. Had two more children with no problem. Remember we are above all, patient advocates! Good luck. I'd be angry too!