Refusing "Hospital Protocal"

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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.?

Specializes in OB.

all right, my 2 cents (again), here is proof if it is proof you want. fyi midwifery is absofrigginlutely not legal in all 50 states, midwifery is not even recognized in even close to all 50 states. direct-entry midwifery state-by-state legal status

now on to continuous efm, (big deep breath) does it improve maternal outcomes? no, and that is where the confusion on this board is coming from. again, too much "in your face", lets grow up and learn from eachother....women!. we in the "states" go with what we know and learned from and many of your (oz) organizations are foreign to us (no pun intended). what continuous efm does do is improve neonatal outcomes, undisputed, and i can reference reference reference...blackwell synergy - j obst gyn neonat nurs, volume 33 issue 5 page 550-553, se

there are so many, like i said before, you can always find what you are looking for if you just look, no matter which side you are on. my problems with the cochrane library is that it reports the stats that support what the study is searching for, example : "the childbirth connection's systematic review found 15 outcomes where assisted lady partsl delivery introduced excess risk compared with spontaneous lady partsl birth." how man did they find that it didn't??? it never says. there is information everywhere, and we must all continue to search for it, and through it. but there is no steadfast rule. life is unpredictable, and there is nothing wrong with planning for the what ifs, just like there is nothing wrong with ignoring them. i think the original poster asked about refusal of protocol, and this is what galls me. i can't go to a garage and say i want you to change my tires, but i want you to do it blindfolded and with your hands behind your back. think they'd kick me out? yes, but we can't. women come to the hospital because they know something could go wrong, but they want you to make sure that it doesn't using their rules. people keep saying that insurance does not pay for a home birth, well my question is, why is there a charge? if you can go it alone, then do. statistics obiously show that you dont even need the midwife. hubby can breathe with you, you can prance around in your jammies or lie in your own tub, and then obviously when its time (i love the words expulsive contractions), push your own kid out. so why are there charges? i get in a wad when i hear people say insurance wont pay for me to do it my way, you know why? because its not safe: gail's midwifery, homebirth & birth center birth web what this page states is that doctors have a higher mortality rate, well duh...they have all the high risk patients. if you had a hospital that did just low risk deliveries, they'd have awesome c/s rates, i've worked at one before and our c/s rate was 11%, no lie, we didn't even do vbacs. but the unexpected happens, and when you are stacked with only low risk patients, your numbers appear better, i have a study that i'm trying to locate, this was part of my thesis, thats proves that midwifery and home births have the highest infant mortality and injury rates than any hospital when only low risk births are considered. and it makes sense, if i only drove one day a week, only at 8pm, and at 30 mph, i doubt i'd ever get killed in a wreck. but you have to count all accidents, no matter the causes, and say how unsafe it is to even drive. okay i'm rambling, us old people do that from time to time, so wake up now, i am done.

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Specializes in OB.

Anybody elses arms tired from beating this dead horse??? Where's my Ben Gay, or is that too hippie of me....maybe I'll take an Advil instead.

:deadhorse:banghead:

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all right, my 2 cents (again), here is proof if it is proof you want. fyi midwifery is absofrigginlutely not legal in all 50 states, midwifery is not even recognized in even close to all 50 states. direct-entry midwifery state-by-state legal status

last i looked, i am a midwife. seems like that's what the m in cnm stands for, at least. and i can legally practice in every single state (were i to get a license in each and every one of those states ;) of course). i can even legally prescribe in every single state.

now, i have been told on occasion that i am not a real midwife. but not by people with your perspective on birth.:lol2:

now my random thoughts:

you do realize that the jognn article you linked to completely argues against the use of continuous fetal monitoring, right? nothing in there about improved neonatal outcomes justifying the use of cfm. and, yes, improved neonatal outcomes with cfm use is very much disputed.

cochrane and childbirth connection are two separate entities. cochrane does list all data, both ways, and comes to a conclusion. sometimes, the conclusion is there is not enough data to go one way or the other. just because you don't agree with the conclusion does not make it biased towards a specific outcome.

another random thought - the home birth study that you are looking for has been refuted over and over again and is almost a classic on how not to do research.

and i have to say, i learn so much from my counterparts in the uk and nz. their use of evidence rather puts us here in the states to shame. they have a lot to teach us, if we'd let go of "what we learned" long enough to open our minds to something new. take a look at the link ozmw put up - i'll be reading that one in my spare time. (all 200+ pages of it).

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Specializes in Midwifery.

now on to continuous efm, (big deep breath) does it improve maternal outcomes? no, and that is where the confusion on this board is coming from. again, too much "in your face", lets grow up and learn from each other....women!. we in the "states" go with what we know and learned from and many of your (oz) organizations are foreign to us (no pun intended). what continuous efm does do is improve neonatal outcomes, undisputed, and i can reference reference reference...blackwell synergy - j obst gyn neonat nurs, volume 33 issue 5 page 550-553, se

d.

ob/gyn..no one has said that in certain circumstances to some women efm hasn't made a difference, we've all seen the saves haven't we! but my counter argument is how many women are rushed to theatre with non reassuring ctgs, and are delivered of completely well happy babies??? far more in my experience. and of course we say that's ok coz we got em out before it got too bad! we've all done it.

now the paper you quoted...hmm..here are some snippets from ms priddy's well presented argument:

"..continuous electronic fetal monitoring, as it is applied in contemporary north american obstetric practice, does not stand up to the rules of logic or the application of empirical evidence."

and she goes on:

"this in turn made it possible to visually evaluate fetal response to contractions. it was assumed that the use of continuous monitoring held the promise of improving birth outcomes. after 30 years, it is clear that this is not the case."

priddy goes onto to explain why efm was introduced and why it doesn't do what it was meant to do.

"however, in the face of mounting evidence against the efficacy of continuous efm, we must ask ourselves how we can defend its ongoing application."

she then goes onto to cite the cochrane review on continuous efm saying:

"nine research studies including 18,561 subjects show that there is no significant benefit to the use of efm, but there are significantly more operative deliveries associated with its use thacker, stroup & chang, 2001)."

she also discusses belief systems which is really interesting stuff...thank you for me reminding me of this paper...i am happy to read anything that informs me about my practice and helps me improve the care i provide women and babies. and it's ok if its from the other side of the world!

reference:

priddy, k.d. (2004). "is there logic behind fetal monitoring?." jognn. 33(5), 550-553.

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Hey those sources listed where British and New Zealand, and Austrilian

from both midwifery and OB Evidence based is drawing from all apporite areas even outside your own health care system

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Specializes in Midwifery.
Anybody elses arms tired from beating this dead horse??? :deadhorse:banghead:

This is the exact reason why CS rates are skyrocketing world wide...no one wants to flog the horse! It ain't dead in my opinion. Sorry! I welcome this sort of debate because WE can all benefit it from it, but especially women!

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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

What stage of labor though?

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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:

If you are a nurse then you went through nursing school and know full well what is taught. When you have to resort to putting down the education of others then I know you really can't plead your case very well. If you put in an IV like a cattle prod then perhaps "you" shouldn't be the one "poking and prodding" anyone. Let's not get into a pissing match. If the evidence does not support the practice of saline locking and fetal monitoring as a standard of care, and it is a huge issue to the patient population where you work, then the nurse managers need to have a meeting with the powers that be to get that policy changed so that it is not a hassle to the patients or the staff. If there isn't any evidence to back it up then it shouldn't be a big deal to change the policy. If your BP is going up over this issue, then I have to ask what are you doing to change things?

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Specializes in Midwifery.
If you are a nurse then you went through nursing school and know full well what is taught. When you have to resort to putting down the education of others then I know you really can't plead your case very well. If you put in an IV like a cattle prod then perhaps "you" shouldn't be the one "poking and prodding" anyone. Let's not get into a pissing match. If the evidence does not support the practice of saline locking and fetal monitoring as a standard of care, and it is a huge issue to the patient population where you work, then the nurse managers need to have a meeting with the powers that be to get that policy changed so that it is not a hassle to the patients or the staff. If there isn't any evidence to back it up then it shouldn't be a big deal to change the policy. If your BP is going up over this issue, then I have to ask what are you doing to change things?

Apologies SMK1, as you will see I am from another country. And when I went to nursing school no I wasn't taught those things, when I went onto to do midwifery it was touched on. So I actually have bugger all clue as to what you are taught in your training. And I completely agree with you that it should all be pretty simple to change, but unfortunately there are many many factors that make it pretty difficult really! As you can see there are vastly different ideas even here about labour care. Should be simple but it ain't!

So what I am doing to change stuff...well thankfully we don't have CEFM on all women, nor do we place ivs unless there is a risk factor and then they are only the cannula. But we have our own set of battles that continue and continue, and I pretty much try and make a difference one birth at a time really...

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You know what, I need to apologize OZ. I didn't even consider the possibility that you are not from the U.S. (you would think the OZ part of your screen name would have clued me in, but it is late and I am tired). I am guilty of being very culture-centric. Sorry about that. In any case good discussion.

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Specializes in Midwifery.
You know what, I need to apologize OZ. I didn't even consider the possibility that you are not from the U.S. (you would think the OZ part of your screen name would have clued me in, but it is late and I am tired). I am guilty of being very culture-centric. Sorry about that. In any case good discussion.

Apology accepted! Go to bed and sleep well!;) And i must apologise too for being pigheaded when it comes to this stuff, I am abit passionate about good care really!

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Specializes in OB.

If your BP is going up over this issue, then I have to ask what are you doing to change things?

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R.N. Student Senior Year Baby!

THAT is what is called bullying darlin'.

In any language

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