Refusing "Hospital Protocal"

eden · Jul 14, 2007

Is there any way you could present evidence based practice to your OB's to get policy changed.

crissrn27, RN · Jul 14, 2007

Is there any way you could present evidence based practice to your OB's to get policy changed.

I gave up, lol, thats why the move to the new hospital. The funny thing is that most of our OBs are fairly new, and young. Weird.

OzMW · Sep 17, 2007

What happens if a woman refuses what a hospital considers "protocal'? What if she flat out refuses to have an I.V., amniotomy, EFM, ect.?

More importantly one should be asking why the 'protocols' aren't evidence based:o:o Women have every right to refuse anything in a hospital, anything...and I would actively encourage any woman in my care who was unsure or uninformed about routine stuff that occurs during labour to not have it until it was explained to her or she informed herself. :angryfire

My favourite saying: When you plan to intervene or do something to a woman in labour take a quick minute to consider if what you are about to do is an improvement on what nature is doing, if so then go right ahead, if not, don't do it and that includes non evidence based protocols written by bloody obs.

Elvish, BSN, DNP, RN, NP · Sep 18, 2007

Oz, I love your use of the word 'bloody.' Obviously it doesn't mean the same thing here as in Oz, but I love how you use it, and I enjoy reading your posts. We muck around with the birth process far too often. My next wee one will be born at home if there is any way under the sun to make that happen.

OzMW · Sep 19, 2007

Oz, I love your use of the word 'bloody.' Obviously it doesn't mean the same thing here as in Oz, but I love how you use it, and I enjoy reading your posts. We muck around with the birth process far too often. My next wee one will be born at home if there is any way under the sun to make that happen.

Good for you and I'm not suprised!!

You know the trouble is that midwives in Australia think that we stuff around in the birth process too much here!! Maybe a trip to the US is warranted! Hee Hee.... :idea:

cassioo, RN · Sep 19, 2007

We have an OB who still wants enemas because he's scared he'll see a little poop for the 2 minutes he's there to catch I've been known to tell his patients you have the right to refuse. As it's been said document anything that any patient does that's against P&P and that you've informed them what the protocol is. Our big one is patients want to go smoke which you can't do on Mag or PCA or Pit or..... so they go anyway off goes their medication I can't restrain them.

OzMW · Sep 19, 2007

Someone needs to tell him if hes scared of poo then hes in the wrong job.

Mary Cronk a midwife in the UK tells an interesting story about her experiences many years ago with obs demanding women be given ememas on admission. She refused to do it (because there is no evidence to support it has any benefit). So she would ring the ob at home and tell him she was refusing on the basis that it was a pointless procedure; and if he required his patient to have an enema, he needed to come in and do it himself! Funnily enough, he stopped ordering them after awile!

Elvish, BSN, DNP, RN, NP · Sep 20, 2007

That is HYSTERICAL, Oz. That's one thing I've never seen our OBs order, very thankfully. The closes thing I had was a pt take a bunch of castor oil once trying to bring on labor...all she got was a bad case of the runs and some killer cramps.

cassioo, RN · Sep 20, 2007

He very seldom has a chance to have anything to do with the poo because he just comes in to catch so it's cleaned up all an enema does is cause a bigger mess in the end.

at your cervix · Sep 21, 2007

What happens if a woman refuses what a hospital considers "protocal'? What if she flat out refuses to have an I.V., amniotomy, EFM, ect.?

I agree with what everyone else is saying....if it's not harmful to the patient or the baby, no biggie. If it is harmful or potentially harmful, I have them sign an AMA form and document very extensively the teaching that I have done. For example, I had a patient once that came in and wanted to use the Bradley Method-fine, no problem there. She was however very unprepared, I think she just thought the Bradley Methond meant no medication. She literally screamed at the top of her lungs for eleven hours straight-she didn't even stop screaming between contractions!! We had to move patients to rooms in the med-surg department because they were complaining about her and they couldn't sleep. She refused an IV, she refused ANY monitoring, not even intermittent or fetoscope. At one point her husband asked me "is everything OK?" I had to give him the honest answer-"I am assuming so but since you won't let me do any monitoring, I can't be sure." He then actually said to me "well, I don't mean the baby, I don't care about the baby, I mean with my wife." I had this patient sign an AMA form and I documented that conversation as well!

But I do have another question....is amniotomy standard procedure in your hospital????????

NPinWCH · Sep 21, 2007

Routinely, for an admit already in labor: No. Sometimes the docs will use AROM as the first step in a postdate induction with a favorable cervix and every once in awhile a doc will AROM to speed things along, but our docs usually just wait until it breaks on its own.

It's one thing they are pretty good about it and as the one OB always says, "I ain't gonna go courtin' no trouble."

cassioo, RN · Sep 22, 2007

ours go courting trouble because the do AROM some at 1 cm because he can and another usually starts pit about 7am and will break water when his are 4cm you can't convince them that it really only speeds things up on average 30 minutes again they don't have time to wait or they can intervene and put internal monitors in...but again we have the majority induced or augmented...hopefully they are changing some with more info on late preterm.