too many interventions in L&D

Specialties Ob/Gyn

Published

do you think there are too many interventions in L&D. It seems lately all our patients are pitted,ruptured, induced and or augmented. Some of our docs give patients arbitrary time limits for each phase if they don,t proceed on scedule it,s time for forceps or c/s. Just yesterday had patient who was G1P0, in labor had estimated 9lb baby, was progressing well baby was doing fine. patient had an epidural which was dosed why to heavy, not use of legs pt pushed first 1/2 hour or so very ineffectively, finally got the hang of it. baby was moving,doc came in at her 2 hour time limit checked patient says baby not moving at all. she called c/s. patient had adequate pelvic outlet, baby was at +2 or greater station when prepped. delivered 9lb 1 oz male by c/s.

do you see this happen a lot in your area?

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YES! Frankly I would rather give birth in the parking lot than with some of our docs and nurses looking after me. Most of the old school docs think that there are set time limits and that episiotomies should be routine "because they heal better". I don't think some of them have read a journal article since they got out of med school 25 years ago!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Yes it is horrible, to me. I hate all the "social" inductions I see. (whatever that terminology means, I find it abhorent). Our epidural rates are thru the roof....it goes on and on. Things have certainly changed since the midwives left the group that practiced at our hospital. It is discouraging to me...I like holding hands, wiping brows, encouraging/coaching....now I just look in on 'em, check their vitals, up the pit, watch the monitor, and let them play cards or watch TV while they are going on the epidural pump. Tell 'em when they are complete and pray they feel enough sensation to push the baby out somehow. Seems to me a lot is lost this way. Oh and Did i mention, they (epidural patients) all have foleys too? NO one can void herself with these epidurals; let alone move her legs.

I mean, the room looks like an ICU bed when we get done putting in the IV, EFM, PIT drip, Epidural, crash cart nearby (for epidurals) and so-on. VERY HIGH-tech, and LOW-hands-on to me. Nurses spend more time out at the desk instead in the room w/the patient. I dunno, but this is a big turn-off to me. I try to spend time in the room w/them, but when they are so comfy, I almost feel like an intruder. ? Go figure???!

But, I guess, it is what the clients and their families anticipate when they come in. They may be contracting every 10 min and only 1 cm, but they think the time for an epidural is yesterday, rather than later. Somewhere, they (the patients), are being told epidurals are the ONLY way to go and no one must EVER go ONE day past her due date or else, it's "pit-time"! SHEESH!!!!!!

Have studies been done to show how all these "interventions" are raising risks of csections and poor outcomes? How many postpartum bladder infections are out there because of all the catheterizations? How many poor labor/delivery outcomes due to premature inductions? I am convinced they are all linked!

I am wondering, if in 20 years, the pendulum will be swung the other way, and we can look forward to fewer artificial interventions and more good old-fashioned bedside, handholding, encouraging nursing. The kind I wanted to do when I came into the field? Or am I crazy? (off the soapbox now)......:stone

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For the most part I do agree Mark. There are many interventions. I work in a very small hospital where we dont have a nursery. It is not uncommon for the doctors to call arrested descent, or CPD, or stop interventions because they dont want anything to happen at night.

The part that I dont agree on is that I feel the pts do have the right to choose an epidural for pain management. Its just making sure they get it at the right time. Here we make sure moms are in active labor before they receive an epidural. I know that it is common practice for some hospitals to give epidurals when women walk in and request it. This I dont agree with at all. But then again its not my choice.

One thing I have seen alot of labor nurses do is once the patient gets an epidural they let the pt stay in that same position until delivery. I have to constantly remind them that the pt should change positions at least q30 minutes to facilitate labor as well as maintain good pain management. We have to do our part as well.

Well, Im glad I found these boards! Great topics!

Andrew

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I'm in total agreement...

i was commencing labour then induced, epiduraled with spinal tap.... panic because doc was panicy (wasn't fast enough... to much for me,) felt like I wasn't good enough... etc etc... then had a baby with anxiety attacks... they kept asking me to consent to C/S - refused and refused...

My sis has been in labour for two weeks... hs been going slow but studdy... and she and baby are doing great.....

Next time in I will refuse epidural, c/s (yet again) induction...

I'll go con solo and if hey keep up offering me... I will tell them to take a hike or to simply F____ off....

Thanks for letting me vent... (still in knots about my l/d)

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TWO WEEKS?!

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I think patients have a right to epidurals if they want it, i don't personally like them all that much. i have seen more than my share that worked only on one side, patient unable to push ,no pushing urges. see them given way to early and dosed way to strong. had patient last week when i got rport she had just recieved her epidural at 2 cm, i went in to assess pt she was on pit,getting more iv fluid boluses, had foley in ,unable to move legs at all, doc ruptured her at 2 cm supposedly. i checked her she was 1 maybe 2 if streched and thick, this poor girl labored a total 18 hours on pit got her up to 34 mu per dr orders, she got complete finally, pushed for 2 hours and ended up being sectioned, r/o failure to decend. nurse that took over from me said they redosed her epidural, little while before pushing. pt had no urges and pushed very ineffectively.

I watch my other patients that come in with natural childbirth and/or the midwives patients they do much better, their c/s rate is way less.

I have a good question for everyone. If all these interventions are so good and necessary how is it that the united states has the highest intervention rate but has one of the worst birth outcomes of all the modern countries? got this info from a recent research journal. tell me what you think.

my pet peeve is a doc calling a c/s or using forceps just because he /she is tired or has some place to go!

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I think our poor birth outcomes have a lot to do with poor prenatal conditions as much as anything that happens intrapartum.

That said, I just finished watching a show on TLC about birth, and one doc in the UK offers c/sections on demand and believes that c/sections are the way of the future and will allow humans to better evolve. They made vag births sound like some cruel arcane practice that we should evolve from because it's just icky. I wanted to yell at him through the tv! Like c/sections have no risks and the recovery is just wonderful for the woman after! HELLO?!

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sounds like a real idiot to me, c/s recovery is so much worse!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

NO doubt they have a "right" to epidural anesthesia; I never argued not. But to get it before active labor has really ensued???? It is nice to say you wait til the "right time" before calling the doctor for regional anesthesia, but if that "right time" is already pre-determined by the patient and her dr. before she comes to me, it is very hard to talk her into waiting a little longer. Especially, if the doctor orders "give her what she wants"., w/o bothering to come in and assess the situation him/herself.

Here is my typical exchange w/the dr when the patient shows up:

ME; "So and so is here, 39.5 weeks in early labor. Bag intact,1-2 cm, 80% , 0 station, reassuring strip...".her whole history, you know how it goes, yada yada.

Dr: "Ok get her comfortable, and I will be in in a bit to break her bag and get it over with."

Sound familiar? Yuck.

Personally, I think some re-education of medical and nursing staff, as well as the patient population is in order. I just think we somehow have almost "trained" the public (and ourselves, in a way), to expect a labor that is PAINFREE, PICTURE-PERFECT (ala Baby Story on TV), and FULL OF artificial intervention, before it is really necessary, and NOT TO TRUST their bodies to know what is best!!!

The title of this thread was "too much intervention". I think it is apropos and worthy of careful consideration. I think we need to get back to trusting women's bodies a bit more and not be in such a rush to "save them from themselves" the way we tend to do in Obstetric medicine. It is partly why I consider working in a midwife-run birthcenter all the time. Maybe one day.... JMO anyhow.;)

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"I think it is apropos and worthy of careful consideration. I think we need to get back to trusting women's bodies a bit more and not be in such a rush to "save them from themselves" the way we tend to do in Obstetric medicine. It is partly why I consider working in a midwife-run birthcenter all the time. Maybe one day.... JMO anyhow."

WELL SAID SMILING BLUE EYES

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Yes, I think there are way too many interventions.

Part of it is due to horrible shows like 'a baby story' (can we PLEEEEEAASE get that d*mn show canceled?) that show every woman getting an epidural, plus childbirth classes where they automatically have an anesthesiologist come in and do an ENTIRE CLASS on epidurals, plus the general public perception that childbirth can be 'painless' now and that it is medical malpractice if it hurts. Not to mention, these lousy docs and midwives who enable the whole 'inductions are fine for non-medical reasons' mentality by scheduling social inductions. I hate them. I think a lot of the interventions are done because of public perception of how labor should go, plus docs and CNMs wanting to get pt's delivered out of convenience for the patient OR for themselves.

Part of it is ALSO due to the unusually high rate of lawsuits. Look, people, we all know that ours is the #1 specialty when it comes to liability. We get sued if the kid comes out with a monobrow. Malpractice lawyers advertise on T.V.. While there are legitimate lawsuits, it kills me when people want to sue if the pt. has random fetal distress and needs a c/s, like we CAUSED it somehow. Docs do c/s and internal monitoring and pit and early/unnecessary AROM because they're SCARED. I overheard 2 docs recently discussing the high cost of and how one of them is considering leaving practice because of it. I've seen docs cut a woman for one variable because they'd 'seen a bad outcome once before' and didn't want it to happen again. They're SCARED.

I also think a lot of it happens because WE CAN. I hate that s**t. So we 'can' give an epidural and induce a woman at 1cm....SHOULD WE?? People get all excited about what CAN be done without a second's thought to whether or not it SHOULD be done......

Stepping down from soapbox.

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