Refusing "Hospital Protocal"

smk1, LPN · Oct 3, 2007

WOW, I guess I wasn't as difficult as I thought as a laboring mom. I don't see what the huge deal is about letting them put in a saline lock. The very fact that you are in the hospital at all for the birth takes away the "completely natural" idea so what is the harm in taking a brief safety precaution? It will make the staff happy, you won't have to hear about it every hour and you won't have to sign a million pieces of paper signing away your legal rights in case of emergency. I know not everyone feels the way I do, but it seems like such a minor thing to worry about. When you are on the precipice of bringing a new life into the world...well it just seems like you should have other things going on to worry about. Honestly the way people want to skirt the rules everywhere they go just astounds me. If I want complete control over my labor and delivery, then I have no right going into a facility and telling the specialists how to do their job while still retaining the right to seek legal recourse if something goes wrong. Stay home and hire a midwife. Then you can do whatever you want. Why is that concept so hard? and another thing, why show up at the hospital when you are in the first stage labor if you don't want the staff to do anything? Stay home until you know things are moving a lot faster, instead of showing up hours and hours before any real movement is going on and fighting with the nurses who have accepted a legal responsibility to monitor your safe progress and that of the baby. The issue of why these safeguards are in place and whether they are truly appropriate and necessary is a whole separate issue. If the standard or policy of the hospital is saline lock, monitoring etc... then that is what needs to happen with a minimum of fuss or another facility that will suit your needs should be found. A hospital is not Burger King.

CEG · Oct 3, 2007

A hospital is not Burger King.

The thing is, health care IS Burger King. I have the legal right to have it my way. And health care providers have the moral and ethical obligation to give it to me my way.

Some reasons to give birth in a hospital when you want a natural delivery: concern over PPH, family concern over safety, lack of homebirth providers, GBS pos and desire treatment, "everyone goes to the hospital," might want pain relief and the biggie: lack of insurance coverage for homebirth.

If I went to the ER with a heart attack and they hooked me up to a monitor and said "This monitor will make it more likely that you will have a heart surgery that you don't need. Use of this heart monitor has not been shown to improve outcomes. There is another way I could monitor you that is just as effective without the potential problems but I choose not to do that because I am more comfortable with this way." Would you walk or run to another ER? Because that is essentially what you are saying to a low risk patient. It isn't a matter of trying to be difficult, but of making informed health choices. And often it's hard for a patient to find out beforehand what a hospital's policies are. Even on hospital tours women often get vague or misleading answers about policies, how long their baby will be in the nursery, etc.

Mrs.S · Oct 3, 2007

Do what you will, with what you have. Those of you with less than 10 yrs experience, talk to the hand...Oz I respect your opinions, but must remind you that they are just that. Its amazing how many of you truly believe that medicine is a cospiracy, yet you entered the field, I guess to change the world. Fewer and fewer states in the US are recognizing midwifery, why? Because it is a proven fact that risks are higher AT HOME, no matter how "low risk" you start out. But I bet this group preaching natural birth is the same no deodorant wearing, tree hugging, imagery using "nurses" that never should have gotten a license to begin with, since medical professionals are all evil anyway. I will continue to cover my orifice, and help patients seek restitution when you don't. Protocols (with ALL "o"s) are developed BASED ON SCIENTIFIC EVIDENCE...and if you don't know this, then you have never been an administrator. You can't just "write" a protocol because you want to. You sound like a bunch of ADNs that were LPNs and wanted higher pay, and never learned the theory. FYI Cochrane has been discredited by AWHONN time and time again, try using more than one source all of the time. But there are always people out there everywhere who find someone that believes what they believe and then quote them all day. Yes labor * there is NO "u" in the word * is a natural process, and people have been doing it forever unaided, but remember if everyone believed that, then you wouldn't have a job...so why did you choose nursing if intervention is actually interfering? You can stand and hold someones hand for free, and without a degree. It has always amazed me how nurses always think they know better than the doctors. Go back to the herb farm, rub some oil on peoples feet, hand out magnetic bracelets, and do the profession a favor and let your license lapse.

As far as I know, AWHONN doesn't support continuous fetal monitoring in labor for women who are low risk. Policy for normal labor patients at my hospital includes neither continuous EFM nor saline lock. If it did, I would have no problem providing education, documenting patient's refusal, and moving on. That's just my job. Nobody's preaching natural birth here.

FWIW I do have a BSN, never worked as an LPN, always wear deodorant. I do hug trees. BTW I could draw a few stereotypical conclusions about a couple posters here too, based on screen names alone, but I prefer not to.

CEG · Oct 3, 2007

Do what you will, with what you have. Those of you with less than 10 yrs experience, talk to the hand...Oz I respect your opinions, but must remind you that they are just that. Its amazing how many of you truly believe that medicine is a cospiracy, yet you entered the field, I guess to change the world. Fewer and fewer states in the US are recognizing midwifery, why? Because it is a proven fact that risks are higher AT HOME, no matter how "low risk" you start out. But I bet this group preaching natural birth is the same no deodorant wearing, tree hugging, imagery using "nurses" that never should have gotten a license to begin with, since medical professionals are all evil anyway. I will continue to cover my orifice, and help patients seek restitution when you don't. Protocols (with ALL "o"s) are developed BASED ON SCIENTIFIC EVIDENCE...and if you don't know this, then you have never been an administrator. You can't just "write" a protocol because you want to. You sound like a bunch of ADNs that were LPNs and wanted higher pay, and never learned the theory. FYI Cochrane has been discredited by AWHONN time and time again, try using more than one source all of the time. But there are always people out there everywhere who find someone that believes what they believe and then quote them all day. Yes labor * there is NO "u" in the word * is a natural process, and people have been doing it forever unaided, but remember if everyone believed that, then you wouldn't have a job...so why did you choose nursing if intervention is actually interfering? You can stand and hold someones hand for free, and without a degree. It has always amazed me how nurses always think they know better than the doctors. Go back to the herb farm, rub some oil on peoples feet, hand out magnetic bracelets, and do the profession a favor and let your license lapse.

No to derail, but to clear up some inaccuracies that are here. First of all, in English speaking countries other than the US the "U" is a more popular letter- as in "labour." So you may want to get a little perspective on that.

Secondly, not only does AWHONN not recommend continuous fetal monitoring for low risk patients, it specifically teaches in its certification classes that IA is just as effective without the drawbacks of CFM. It is also not a "proven fact" that risks are higher at home. In fact it is proven that morbidity and mortality are DECREASED at home for low risk women.

Conchrane has never been "discredited" by AWHONN. Cochrane is a database containing many thousands of studies from a wide range of sources. Cochrane is not "a source" but a database. Cochrane also publishes reviews and analyses of studies to provide perspective on what the different research is saying. Conchrane is widely regarded as the go-to source for current publications.

Protocols are not all based on scientific evidence. Or in many cases are based on outdated evidence. If people refuse to change their practices when new evidence is available they are doing their patients a great disservice.

I chose nursing because I like to work with people, enjoy providing patient education, and I enjoy science. I chose midwifery because I like supporting women in labor, I like providing prenatal care and education, and I wanted to advance my education. Not because I wanted to impose interventions on people.

BTW, nurse-midwifery is recognized in all 50 states. The number of births attended by CNMs has been rising every year since 1980. Direct-entry midwives are recognized in 22 states and the number has been growing over the last few years.

Elvish, BSN, DNP, RN, NP · Oct 3, 2007

I won't belabour (yes, with a 'u') the UK/Aussie/NZ/Canadian spelling vs USA spelling. That's already been pointed out.

Those of you with less than 10 yrs experience, talk to the hand.

But I WILL take offense at the rest of your post. I do have less than 10 years experience, but we all start somewhere. And this is a discussion forum, so you and I and everybody else have to be adults here and be prepared for people to disagree nicely.

Its amazing how many of you truly believe that medicine is a cospiracy, yet you entered the field,

I did not enter medicine. I entered nursing. Doctors practice medicine.

Fewer and fewer states in the US are recognizing midwifery, why? Because it is a proven fact that risks are higher AT HOME.

I think it's already been said, but CNMs are licensed in all states. And where is the proof that risks are higher at home? If you have a low risk (as previous posters says -- defined by WHO, not by me) pregnancy, then where exactly is the risk higher for a home birth? You get in your car and drive to work, or the bank, or the store, or school. Now THAT'S something risky.

But I bet this group preaching natural birth is the same no deodorant wearing, tree hugging, imagery using "nurses" that never should have gotten a license to begin with

Pardon? That is a REALLY judgemental thing to say about people you have never met before. And so what if I don't do all that? What does that have to do with my competency as a nurse? And why should you care? I passed the same NCLEX as everybody else. And if you think I shouldn't have gotten my license as a nurse, maybe you should go back and read some of my posts; you might see that I may not know everything but I do know something. If you'd like to know something else, I didn't have my son circumcised, I nursed him for over a year, and he DOES have all his vaccines up to date.

You sound like a bunch of ADNs that were LPNs and wanted higher pay, and never learned the theory.

Actually, I graduated with a BSN from one of the top 10 nursing schools in the nation. But I hope there are some LPNs out there who are offended. I work with one who's been on my floor for 33 years and has forgotten more then most of us know.

Go back to the herb farm, rub some oil on peoples feet, hand out magnetic bracelets, and do the profession a favor and let your license lapse.

Don't really even want to dignify it with a response. :madface:

I am extremely offended by your tone toward people who do not agree with you. I'm not asking you to agree with me, but I am asking that you disagree respectfully.

*puts on Birkies and heads back to commune*

(takes tongue out of cheek as well)

OzMW · Oct 3, 2007

Do what you will, with what you have. Those of you with less than 10 yrs experience, talk to the hand...Oz I respect your opinions, but must remind you that they are just that. Its amazing how many of you truly believe that medicine is a cospiracy, yet you entered the field, I guess to change the world. Fewer and fewer states in the US are recognizing midwifery, why? Because it is a proven fact that risks are higher AT HOME, no matter how "low risk" you start out. But I bet this group preaching natural birth is the same no deodorant wearing, tree hugging, imagery using "nurses" that never should have gotten a license to begin with, since medical professionals are all evil anyway. I will continue to cover my orifice, and help patients seek restitution when you don't. Protocols (with ALL "o"s) are developed BASED ON SCIENTIFIC EVIDENCE...and if you don't know this, then you have never been an administrator. You can't just "write" a protocol because you want to. You sound like a bunch of ADNs that were LPNs and wanted higher pay, and never learned the theory. FYI Cochrane has been discredited by AWHONN time and time again, try using more than one source all of the time. But there are always people out there everywhere who find someone that believes what they believe and then quote them all day. Yes labor * there is NO "u" in the word * is a natural process, and people have been doing it forever unaided, but remember if everyone believed that, then you wouldn't have a job...so why did you choose nursing if intervention is actually interfering? You can stand and hold someones hand for free, and without a degree. It has always amazed me how nurses always think they know better than the doctors. Go back to the herb farm, rub some oil on peoples feet, hand out magnetic bracelets, and do the profession a favor and let your license lapse.

Gee I'm not sure where to start! The words judgmental & narrow mindedness come to mind. Hippies!! I love how those who promote interventive birth practices call those who don't hippies! It's hilarious and does nothing for the argument.

It also seems strange that your professional body discredits Cochrane. I read their journals, (along with many OTHERS) and it seems they are quite willing to publish papers whose authors reference Cochrane Reviews.

As for continuous EFM, whether you believe Cochrane or not may I refer you to the many other professional bodies around the world who promote IA for low risk women: RCM,RCOG, SCOG, RANZCOG, ACM, FIGO NZCOM CMBC. And that's based on evidence.

Protocols should be evidence based! Show me evidence that proves that EFM for low risk women is effective, or that routine IVs in labour is beneficial? Back your claims up with references. I s'pose you gals see benefits in routine episiotomy too.

And as for the spelling lesson! Here's some for you: in my part of the world foetal has an O, haemorrhage has an A, oesophagus has an O.

But seriously lets start backing up our claims with evidence heh!

beckinben, CNM · Oct 3, 2007

I have an idea. (Warning, I was up all night at a very lovely, low-intervention hospital birth with intermittent auscultation and no pain medications, so I hope this makes sense).

Let's make home birth and birth center birth legal and available in all states. Let's make midwifery by CNMs and CPMs legal and available in all states, without need for an MD to sign off on every move they make. Then, those who want to give birth without all the fuss and bother of the hospital rules, and all the intervention in the hospital setting, can get out of the hospital and quit annoying those who find their anti-continuous monitoring, anti-no food in labor, anti-IV attitudes annoying. (And those of us to attend those horrible low-intervention hospital births can have a better setting to work in). And those who want the safety and security that they feel in the hospital setting can still choose to have that (although I think they should pay a little more for all the technology and interventions that have not been shown to improve outcomes).

To each their own. But if I had to take sides - I go with my sister midwife. :lol2:

smk1, LPN · Oct 3, 2007

see below

smk1, LPN · Oct 4, 2007

The thing is, health care IS Burger King. I have the legal right to have it my way. And health care providers have the moral and ethical obligation to give it to me my way. QUOTE]
I just can't agree with this statement. You only have the legal right to have it your way if the hospital, and licensed staff who are bound by their practice acts and boards have agreed to accomodate your wishes and they are within the standards of care. Morally and ethically they have an obligation to inform you of the risks to any procedure and the consequences of your medical decisions, but they also do not have to treat you unless you present as an emergency. A provider cannot force an individual to consent to medical procedures, but neither can a patient force the provider or hospital to ignore their professional judgement on what is safe. When such an impasse is reached. The patient is free to seek care that is better suited to their desires elsewhere.

beckinben, CNM · Oct 4, 2007

Morally and ethically they have an obligation to inform you of the risks to any procedure and the consequences of your medical decisions, but they also do not have to treat you unless you present as an emergency.

Or in labor.

Hospitals are required to care for women in active labor - it is considered an "emergency" under EMTALA. Read more about it here - http://www.emedicine.com/emerg/topic737.htm

CEG · Oct 4, 2007

The thing is, health care IS Burger King. I have the legal right to have it my way. And health care providers have the moral and ethical obligation to give it to me my way. QUOTE]
I just can't agree with this statement. You only have the legal right to have it your way if the hospital, and licensed staff who are bound by their practice acts and boards have agreed to accomodate your wishes and they are within the standards of care. Morally and ethically they have an obligation to inform you of the risks to any procedure and the consequences of your medical decisions, but they also do not have to treat you unless you present as an emergency. A provider cannot force an individual to consent to medical procedures, but neither can a patient force the provider or hospital to ignore their professional judgement on what is safe. When such an impasse is reached. The patient is free to seek care that is better suited to their desires elsewhere.
Labor is covered under EMTALA. And just like in an emergency situation, a woman in labor has the right to choose the treatment she feels medically appropriate. And it absolutely DOES NOT matter what a provider or hospital feels is an appropriate treatment, it is up to the patient. Period. No Matter What. Autonomy ring a bell?

OzMW · Oct 4, 2007

WOW, I guess I wasn't as difficult as I thought as a laboring mom. I don't see what the huge deal is about letting them put in a saline lock. The very fact that you are in the hospital at all for the birth takes away the "completely natural" idea so what is the harm in taking a brief safety precaution? .

Read alittle more widely and you will inform yourself of the physiology of labour, hormones ring a bell, do they teach that in nursing school? Then read abit further about the interplay of hormones and how this effects progress in labour and possibly increases the chances of fetal distress.......AND then put it all together and you will understand a) why poking and prodding women in labour isn't good and B) why women who have medicalized birth more often fail to progress or get chopped because of fetal distress. Much of this stuff is based on animal research and some older studies on birth physiology. And no it's not just the hairy arm pitted hippies who get into this stuff, this is such common sense.......and for that fact all women having IVs in labour, as I have said before is abig CROCK, non evidence based bull **** that does NOTHING but make lawyers and non clinical administrators happy. There are places on this earth (hospitals I'm talking about) who DON'T put ivs in every labouring woman, they don't do EFM on every labouring woman, they ENCOURAGE women to eat and drink and mobilise, and they also encourage staff to be respectful and quiet around women. And women and babies are not dropping dead left right and centre! Can anyone give me an example where a woman has sued because they didn't get a bloody IV in labour and they bled etc??? Anyone could be involved in a multi trauma, we don't all run around with IV access JUST IN CASE. We put them in when they are REQUIRED!!!! Sorry this is really starting to get my blood pressure raised!:uhoh21::uhoh21::uhoh21::uhoh21: :down: :down: :down: