Patient Advocacy in L&D

[ChloBear]

I'm a new grad on orientation in L&D/MB. I'd like some feedback on how to effectively advocate for patients in the delivery room in situations where I (and/or my patient) don't agree with the physician's decision, i.e. cutting episiotomies routinely, sectioning a patient because they are in a hurry, etc. In nursing school, I always promised myself that I'd be a good patient advocate but it's certainly easier said than done in the "real world." I'd love to hear how other L&D nurses handle this.

[merlee]

Watch and listen during your orientation to those nurses who are already effective advocates.

Or are you saying that no one is doing this now?

[Kooky Korky, BSN, RN]

Well, Nancy Reagan said it quite clearly. Have your patient "just say no" to surgery, including episiotomy, and whatever else they don't want.

I know it's easier said than done often. A pt has to be motivated to fight a battle when she's in pain and fearful. But if your pt has had good preparation, perhaps by a midwife who, for instance, has talked with her about massaging the perineum with olive oil and help Mom relax, the episiotomy will seem less urgent and less necessary. Same with the doctor who dares to want to cut Mom open for mostly his or her own convenience.

Pts have to be prepared for these things. If not, give it your best try, but accept the patients' decisions.

[LouisVRN, RN]

I don't work l&d but as a nurse and recent l&d pt I think its unfortunate that any laboring woman is in a situation where she and her provider have not established a relationship where she knows her wishes will be respected and followed. I think in this situation your best would be to ensure she understands that any procedure is her choice and she has the right to refuse.

When I had my first son I was pretty uneducated and assumed like a lot of our pts that the doctor would make the right choices for me. This time around my midwife educated me on my choices and made sure I knew that it was my decision. The difference in experience was life chnaging. L&d nurses and midwives rock! :redbeathe