Pitocin issue

[BuckRN]

Recently, I have had several upper level OB residents insisting that I increase pitocin on patients who are not changing despite adequate MVUs. They're response when I say that they are more than adequate is that baby is tolerating it just fine and that patient is not changing. The whole concept of saturating pit receptors and increasing the risk for post partum hemorrhage seems to be totally lost on them.

Also, I had a multip come in dilated to a 5. We AROM and put in an IUPC right away which is absurd to me. She was only contracting q5min and they were not super strong, but they didn't even wait 2 hours for her next check before ordering pit. I know for a fact multips can dilate to complete with very few contractions and hello...she came it already dilated to a 5! Does anyone else deal with these types of problems?

[lisheng]

Not too sure why she needed the IUPC. I would have just let her labor down. Doesn't happen at my hospital. No residents (maybe that's a good thing). Most of the attendings aren't so overzealous.

[mamagui]

This is not an uncommon practice in the medical-model of birth management. Overuse of pit is an unfortunate, but not uncommon, practice.

[queenanneslace, ADN, MSN, APRN, CNM]

I only know a little about this. Have you heard about the "Zero Birth Injury" campaign?

Part of this campaign included "care bundles" - some of which delineated safest practices for using Pitocin.

Once these bundles were used in the hospital - and implemented a majority of the time- cranking up the pit became virtually unheard of.

Oh and it turns out was safer for the patients, too.

http://www.modernhealthcare.com/article/20121204/NEWS/312049959

You might want to look into this. But this took an institution-wide policy change in order to happen.

[uRNmyway, ASN, RN]

Thanks for advocating for your patients on this issue! I really feel like most women are so unprepared and unfortunately, uneducated when it comes to delivering their child. Since most women can't afford to hire doulas, it's so great when nurses stand up for them and their baby!

When I had my daughter, I almost got into it pretty bad with one of my docs. I had meconium in my amniotic fluids, but since I was already dilated to 3cm when I came in, after only about 2-3 hours of active contractions, I refused pitocin. Baby's heart was doing fine, I had no temp, and nowhere near the 24 hours mark. My first doc totally agreed with my refusal, but 2 hours after my admission, at shift change, new doc comes in, looks at my chart, and asks the nurse, completely ignoring me, 'why is this woman not on pitocin yet?' I answered that I had refused it. Her response? 'You can't do that!' Ummm, yea, I can. I proceeded to inform her that I was a nurse, my baby's hr was fine, I was progressing just fine on my own (from 3 to 5 in the 2 hours since I had been admitted) and with no temp and nowhere near the 24 hour mark, I saw no need for it. She huffed out of the room, my nurse just stood there, not saying a word.

Now, had I known nothing at all about this stuff, I wouldn't have known to refuse. There was no one to advocate for me at bedside. I just wish my nurse had spoken up on my behalf.

[CNMidwife2Be]

Thanks for advocating for your patients on this issue! I really feel like most women are so unprepared and unfortunately uneducated when it comes to delivering their child. Since most women can't afford to hire doulas, it's so great when nurses stand up for them and their baby! When I had my daughter, I almost got into it pretty bad with one of my docs. I had meconium in my amniotic fluids, but since I was already dilated to 3cm when I came in, after only about 2-3 hours of active contractions, I refused pitocin. Baby's heart was doing fine, I had no temp, and nowhere near the 24 hours mark. My first doc totally agreed with my refusal, but 2 hours after my admission, at shift change, new doc comes in, looks at my chart, and asks the nurse, completely ignoring me, 'why is this woman not on pitocin yet?' I answered that I had refused it. Her response? 'You can't do that!' Ummm, yea, I can. I proceeded to inform her that I was a nurse, my baby's hr was fine, I was progressing just fine on my own (from 3 to 5 in the 2 hours since I had been admitted) and with no temp and nowhere near the 24 hour mark, I saw no need for it. She huffed out of the room, my nurse just stood there, not saying a word. Now, had I known nothing at all about this stuff, I wouldn't have known to refuse. There was no one to advocate for me at bedside. I just wish my nurse had spoken up on my behalf.[/quote']

Wow. You go girl. So sad that you can't just give birth though - you have to be an advocate for yourself too. And most women don't know that. What audacity... "You can't do that!" Classic example of why our system is such a mess.