Had a primip last night, thought she wanted as little pain medicine as possible, wanted to start with just IV meds. didnt want the epidural if she could help it.
the resident kept pushing her to get it! Seriously, every time he went in the room! "do you want your epidural?" and blah blah blah its going to become more painful, etc. blah blah blah. i got her ont eh birth ball, in teh rocking chair, sitting on edge of bed, etc. i explained to her that she could have the epidural if she wanted it, or iv medicine, or nothing. that whatever she picked was the right answer.
the resident of course tells her he can see she's in a lot of pain (yeah, bud, b/c you've got your hand in her vagina trying to put in an IUPC) and she's laying down for this.
later on, before he goes in her room i tell him not to ask her again if she wants an epidural. he says why not? i said b/c she doesn't want one. she is a grown woman who knows what she wants, knows she can have one if she wants one, and she doesn't want one. he said but she's in so much pain. i said that was because she was laying back like that whileyou checked her, she wasn't like that before you walked in the room. i dont think he believed me.
i said, look, she knows her options. then he says i doubt that.
she did end up asking for an epidural, on her own, a few hours later, with no one bugging her to get one.
ugh. one other resident we have is really bad about pushing ladies to get epidurals, but he'll at least listen when yout ell him to cut it out.
Oct 26, '07
I know this is an old thread, but I had a situation like this a few days ago. The resident was basically telling this girl she had to get an epidural. It went on and on, to the point I had to just break in the conversation and say "it is your choice, we are just telling you the options"..........I think he was pushing b/c she had a hx of drug use. He actually said to her "I won't give you much IV medicine, with your hx, I don't think it is a good idea"!
How do you guys deal with these situations?
Oct 27, '07
We have an OB who pushes epidurals as soon as possible so he can "do his thing" stretching the cervix and " the fibers "......all the while mumbling like the woman has some anatomical error he has never seen before and he must fix it. It is all in the realm of managed labor and 9-5 obstetrics.......well, not really. I work evenings and these docs are hell-bent on getting them delivered then so they don't interfere with office hours or their sleep. I try to be an advocate but the patient is ultimately going to do what the doctor wants her to do as she is scared and vulnerable and yes, in pain which he is telling her will get worse and worse. I don't know where all this will end, everyone with an operative delivery by choice ?? I am glad retirement is in sight for me...........if I live that long.
Oct 31, '07
I once had a very good anestheseologist ask me why a woman would ever consider natural childbirth when epidurals were so easy and successful (his were--he was really good). I knew him well enough to know that one of his passions was mountain climbing. So I asked him why anyone would climb a mountain when you could get the same view from an airplane with much less effort. He had no answer; he actually stopped and thought.
Oct 31, '07
Wow ! That is a fantastic response and put it right on his level and gave him food for thought.
Nov 1, '07
I do not work in L&D but this thread caught my attention. During my last labor..all 1 hour of it. The anestheseologist called me 3 times (via my RN) and asked if I was...why I wasn't and am I sure I do not want the epidural. Jeeze...I am glad I am not easily influenced by stuff like that.
Nov 2, '07
I would love to hear how others handle these situations myself. I'm still so new to this and not really sure how to handle myself or "stand up" to the almighty doc.
I actually had a doc one night refuse to AROM a multip who was near complete with a bulging bag (had only been at the hospital for about 30 minutes and had went from 4cms to almost complete) until she got the epidural.....which to her credit she was all over the bed practically begging everyone to "take the pain away." Long story short, she gets the epidural 5 minutes later (knowing she was almost complete, anesthesia let her lay on her side for placement and took all of 10 minutes to do it), doc comes back in the room to AROM and actually tells the patient "now we can get things going....you were scaring me!" UGH!
Nov 6, '07
I have actually had patients sitting with the baby's head on the perineum during epidural placement pushing !!!!! Our anesthesia has to be called in ( they are not in the hospital........another story ) and I think once they come, they are going to be paid no matter what. As soon as the moms were tipped on their side, out popped the head. So totally unnecessary.
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