Patients refusing Pitocin

Have you had a baby w/ pitocin? It's not fun stuff! :roll

Hi ,

I am curious about how other L&D nurses deal with an admitted primip, not ruptured , irregular uc's, not really progressing, but oh soooo in pain

( 1/th/high ), this being the reason for admit, and refusing pitocin ...and BTW, you only have 5 labor beds and are backed up with pts waiting for a bed. Now I am all for pt rights and stuff but....do you just babysit her or what ? too high for an "asrom" , of course, you could send her walking but she still officially has a bed....it can be very frustrating... And she has a right to decide how she wants to do it....do you give her a choice : you take the Pit or you hit the road ? well that would be rude, so how do you solve this ?

Minou

She's not in labor and doesn't want to be induced with the pitocin. She has that choice, but I think it is perfectly appropriate to get the care provider to discuss discharge with her. She can go home for now, take a tub bath, walk, whatever helps until she is ready to make a decision. Sometimes prodromal labor is a real pain, literally, but it is a fact of life. If she refuses to discharge, perhaps the doc will order a shot of morphine to take the edge off. Sometimes that will relax the mom enough so she can actually go into labor on her own. Of course, if there is not a non-laboring bed in the area, that doesn't help with opening up a bed for the next patient.

I'd have to leave it up to the MD. Luckily, most of our MDs support us. If I say she is 1/th/high and we are short on staff/beds and doesn't want to be augmented. S/he will d/c her and tell her to come back when the pain is unbearable (can't walk or talk thru contrax or srom) or she wants to be "helped along". We have had people refuse to go home and we d/c them anyway and let them walk the hospital grounds. 9 times out of 10 they get bored and go home anyway. OR their contrax stop/slow (imagine that) and they realize we were right when we told them this was probably really really early labor or false labor.

She's not in labor and doesn't want to be induced with the pitocin. She has that choice, but I think it is perfectly appropriate to get the care provider to discuss discharge with her. She can go home for now, take a tub bath, walk, whatever helps until she is ready to make a decision. Sometimes prodromal labor is a real pain, literally, but it is a fact of life. If she refuses to discharge, perhaps the doc will order a shot of morphine to take the edge off. Sometimes that will relax the mom enough so she can actually go into labor on her own. Of course, if there is not a non-laboring bed in the area, that doesn't help with opening up a bed for the next patient.

We were replying at the same time. I agree with the pain med. We often give it to them and make sure they have a safe ride home. They are often more willing to labor the early stuff at home when the pain meds kick in.

I guess my first thought is...why was the patient admitted to begin with? Irregular contractions and 1cm and thick...sheesh. My inclination would've been to medicate her and send her home.

We were replying at the same time. I agree with the pain med. We often give it to them and make sure they have a safe ride home. They are often more willing to labor the early stuff at home when the pain meds kick in.

I wish we could do that...once we give them the morphine, they are ours!

I agree with the gentle nudge out the door; they are often just not aware that this is not labor. They figure it out when the real thing comes, though! :wink2:

I'm glad to see these responses...Here i am thinking i'm not a "supportive" l&d rn....well, the pt did'nt want to go home although we told her she wasn't in active labor and the doc didn't want to p.o. family. but yeah, I would've gladly given her a shot of demerol and off you go.... too painful to walk, to painful to go home... I work days so night shift ended up babysitting her and into the next day when she thought it wasn't fun anymore, she gave in, had pit with an epidural and delivered the next night... ouffffff !

Hi ,

I am curious about how other L&D nurses deal with an admitted primip, not ruptured , irregular uc's, not really progressing, but oh soooo in pain

( 1/th/high ), this being the reason for admit, and refusing pitocin ...and BTW, you only have 5 labor beds and are backed up with pts waiting for a bed. Now I am all for pt rights and stuff but....do you just babysit her or what ? too high for an "asrom" , of course, you could send her walking but she still officially has a bed....it can be very frustrating... And she has a right to decide how she wants to do it....do you give her a choice : you take the Pit or you hit the road ? well that would be rude, so how do you solve this ?

Minou

http://www.mercola.com/blog/2005/aug/18/natural_home_births_safe_as_hospital

Maybe women that are are low risk that want to do it natural could think about what is in this article (home births). The link also has a free link to the full text in the BMJ 2005. Check it out!! At least at home with a properly trained health care provider they will be somewhere that is not always rushed and behind trying to make them do something they really do not want to do. When people are in pain they are very vulnerable and I think their concerns should be addressed and the request granted it at all possible when it come to doing things natural or not (unless there is a serious issue).

I'm all for supporting women's choices when it comes to their birth. That's why that woman should be offered pain control and then sent home. She doesn't need to be in the hospital at that point.

http://www.mercola.com/blog/2005/aug/18/natural_home_births_safe_as_hospital

Maybe women that are are low risk that want to do it natural could think about what is in this article (home births). The link also has a free link to the full text in the BMJ 2005. Check it out!! At least at home with a properly trained health care provider they will be somewhere that is not always rushed and behind trying to make them do something they really do not want to do. When people are in pain they are very vulnerable and I think their concerns should be addressed and the request granted it at all possible when it come to doing things natural or not (unless there is a serious issue).

I agree....I totally respect pt's rights to go whichever route they choose...but they need to be educated and assume the responsibility of their choices...health care being what it is today, we don't ( pt and staff ) have the luxury of doing slow natural in a hospital, we need to find alternatives

I agree....I totally respect pt's rights to go whichever route they choose...but they need to be educated and assume the responsibility of their choices...health care being what it is today, we don't ( pt and staff ) have the luxury of doing slow natural in a hospital, we need to find alternatives

How do you suppose we could go about correcting the problem? Educate them about midwifery and home births? What are some options to allow them the slow (not always) natural births? I am asking because I truly want to know some ways to remedy the problem.

How do you suppose we could go about correcting the problem? Educate them about midwifery and home births? What are some options to allow them the slow (not always) natural births? I am asking because I truly want to know some ways to remedy the problem.

I do too....I guess ideally, this should be started before pregnancy but more realistically, in the doc's office...part of the initial prenatal care should be to educate the pt about the possible ways to do birthing...I guess if you're high risk at any point, well off you go to the hospital but other than that a midwife in a home or "alternative" environment would be great and certainly cheaper than the fast pace, production line of a hospital L&D I do believe we do too much intervening... low risk pts that want the natural way should probably not be in the hospital ( like a real birthing center close to a hospital, or home .with intermittent monitoring, heplock perhaps ) with midwives.

Also it never fails to amaze me how some pts come in with high unrealistic expectations ( birth plan and ball ) yet haven't got a clue...Has anyone possibly mentionned that pain might be involved here ? Or they are adamant about breastfeeding yet have not read 2 lines on it, do not have a clue about what to do....it's kinda sad really

So I guess it's education, education, education.