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 ?
I had a pt last night, primip, 30yrs, 1/90%/-1 (hey at least she was thinned out :)) contracting every 10 mins, 41 wks (hey- how did that happen- I didn't know you could stay pregnant that long under an OB's care :chuckle ), who was dying from pain so the OB kept her with plans to possbily induce if she did not change on her own. Anyway, she has one of her 6/hr contractions when the Ob is in the room and looks directly at him and in all serious says "I didn't think this would hurt". He was kinda flabbergasted and said "you mean having a baby" and she said "yeah". I did my whole "that's why its called labor, its hard work speech" but she still expected a painless birth. Sometimes I wonder where this "pregnancy isn't uncomfortable/labor doesn't hurt" myth comes from. Even the stupid baby story which everyone seems to watch shows "some" pain. Anyway....
Sometimes I wonder if people get this idea form the doc telling them how wonderful epidurals are and how they "won't feel anything."
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
See our MDAs are VERY good at "reality checking". They tell the patients UP FRONT there is NO pain-free way to give birth and that they WILL feel the birth---and perhaps some pain as the baby comes out. They give them a quick down-and-dirty anatomy lesson about the nerves down low and how the epidural is not likely to cover those---but how that is a good thing----so they can PARTICIPATE in the delivery.
This speech is given PRIOR to or DURING the procedure. The family KNOWS then, there WILL be discomfort and expects it.
I'm only a nursing student and mom of 2, so maybe I'm clueless... Wouldn't it be "wrong" to give pitocin to a woman who doesn't require it for medical reasons - health of mother and/or baby? I know scheduled inductions are pretty common, but is it legal?
I was induced with my first at 39 weeks due to to pre-eclampsia, and it was sheer hell on earth. My second was born naturally at 40 weeks. What a difference!! Yes - the second was still painful to push out (9 lbs.), but labor is a lot less painful when your body initiates it rather than pitocin.
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.
One means would be to have a doula program implemented at your facility, where women could be assigned a doula if they want one.
Our local hospital does not do this, but I can see where it would work. I know hospitals have trained doulas, or had them receive outside certification, and then when the woman comes for her 34 preadmission clinic, she is offered the opportunity for a doula. Especially if she wants a natural childbirth, or seems to have very little social support, or very little idea of what birth is going to be like. I don't know the details of how a hospital based system would work, but I have heard of them, and attended a lecture on the benefits a couple of years ago. The lecturer stated their hospital noticed an immediate decrease in sections for FTP, and an immediate increase in patient satisfaction, even if the birth didn't have an ideal outcome. Nurses also were happier, as they had extra support, and had their hands free to do other work (paperwork most likely).
Some programs are volunteer, in some the doulas are paid by the hospital. It might be something worth looking into.
10 years ago, when I had my first, I had NO IDEA what was going to happen. Sure, I'd read a little. Didn't get to attend childbirth classes--too expensive, and on a night that I worked. I had ran cross country in high school, was still very active; I figured the pain would be no problem. HOLY SHITE. I also had this vision that the two nurses assigned to me would be with me the entire time, knowing just what to do; rubbing my back, softly talking me through each contraction, walking with me, etc. HA! The ONE nurse that I had was running around like a chicken with her head cut off, as they were understaffed that day.
My expectations were totally unfair and unrealistic. I don't know how I managed a natural birth out of that one, but I did (probably because my labor was less than 5 hours...) My next birth I had a doula--it was awesome. I've worked as a doula before, too, and the nurses always comment how helpful it is. As a nurse, I love to have helpful, calm people at the bedside.
Anyway, I just wanted to throw the doula program suggestion out there. From the education point of view, it's almost too late by the time the patient enters the hospital. It shouldn't be the L&D nurse's job to educate a patient about natural childbirth, or much of ANYTHING to do with childbirth. That should have happened already--at the doctor's office, and at the childbirth classes, or the very least, at the preadmission clinic. Unless you get the docs to change how much time they spend with their patients, and what type of info they present, maybe a doula program would fill that gap.
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.
I agree, hydrate and sedate and send her home until active labor.
See our MDAs are VERY good at "reality checking". They tell the patients UP FRONT there is NO pain-free way to give birth and that they WILL feel the birth---and perhaps some pain as the baby comes out. They give them a quick down-and-dirty anatomy lesson about the nerves down low and how the epidural is not likely to cover those---but how that is a good thing----so they can PARTICIPATE in the delivery.
I am wondering if I can get a copy of this "down and dirty anatomy lesson". Sounds like it would be much more useful to memorize than my high school Shakespeare, as in
Pt- "How long will it take?"
Me- " Tommorrow and tomorrow and tomorrow creeps in this petty pace to the last syllable of recorded time..."
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
See our MDAs are VERY good at "reality checking". They tell the patients UP FRONT there is NO pain-free way to give birth and that they WILL feel the birth---and perhaps some pain as the baby comes out. They give them a quick down-and-dirty anatomy lesson about the nerves down low and how the epidural is not likely to cover those---but how that is a good thing----so they can PARTICIPATE in the delivery.
I am wondering if I can get a copy of this "down and dirty anatomy lesson". Sounds like it would be much more useful to memorize than my high school Shakespeare, as in
Pt- "How long will it take?"
Me- " Tommorrow and tomorrow and tomorrow creeps in this petty pace to the last syllable of recorded time..."
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
I agree with everyone else. She's not a good candidate for Pit or AROM with that cervix. (Why was she admitted in the first place?) You could therapeutic sleep her, but more than likely, at my facility, she would get a Vistaril and a wave goodbye.
from pain so the OB kept her with plans to possbily induce if she did not change on her own. Anyway, she has one of her 6/hr contractions when the Ob is in the room and looks directly at him and in all serious says "I didn't think this would hurt". He was kinda flabbergasted and said "you mean having a baby" and she said "yeah". I did my whole "that's why its called labor, its hard work speech" but she still expected a painless birth. Sometimes I wonder where this "pregnancy isn't uncomfortable/labor doesn't hurt" myth comes from. Even the stupid baby story which everyone seems to watch shows "some" pain. Anyway....
most likely).
vanillabloom
16 Posts
Yep...happened to me! A failed induction which ended up in c-section!