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 Midwifery.
THAT is what is called bullying darlin'.

In any language

Not quite sure what you are on about? I made a reference to bullying earlier (of women), but this is SMK1s post that you quote. And as we have already worked out our misunderstandings like big grown up girls this comment seems to be irrelevant or just maybe stirring up the proverbial !

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Specializes in Community, OB, Nursery.

I for one think this is a discussion that is long overdue, at least here in my neck of the woods.

Women have been taught for generations now that their bodies can't give birth without technology, and it is time to stop that. Women's bodies know what to do and it is high time we honor that. I do not knock women's choice to have their babies in the hospital; at the very least it is job security for me. BUT, people do NOT need to knock others' choice to give birth at home, esp when it has NOT been proven unsafe.

I don't see anyone advocating stupid stuff like natural birth if you have a complete previa or a home birth if you are going into HELLP. What I do see is people advocating that healthy women be allowed to trust their bodies and their instincts during labor. That they be allowed to eat and drink. That they be allowed to push in whatever position they want. That they take responsibility for those decisions. Whether that's in a hospital, a birth center, or at home is a distantly secondary issue.

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What stage of labor though?

The definition of labor in EMTALA is "the process of childbirth beginning with the latent or early phases of labor and continuing through the delivery of the placenta"

Also note:"a woman experiencing contractions is in true labor unless a physician, certified nurse-midwife, or other qualified medical person acting within his or her scope of practice as defined in hospital medical staff bylaws and State law, certifies that, after a reasonable time of observation, the woman is in false labor."

If I decide she's in labor, she stays. The standard definition of labor is uterine contractions producing cervical change. That's what I use. If someone comes in for evaluation, we are obligated to care for her until/unless we are sure she is not in labor. Hospitals can't kick women out who don't want to comply to their protocols who are in labor.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

we have an amazingly passionate, engaging and informative discussion here. let us please not muddy the waters with thinly-veiled insults and innuendo. if you can't keep it respectful, please keep it out of this thread and this site. thank you and enjoy this timely discussion.

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we have an amazingly passionate, engaging and informative discussion here. let us please not muddy the waters with thinly-veiled insults and innuendo. if you can't keep it respectful, please keep it out of this thread and this site. thank you and enjoy this timely discussion.

thanks for coming back and keeping us in line, sbe :)

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Judgmental much? I guess I'll run back to my no continuous EFM, no routine NS loks, tertiary care center, that does both low and risk risk deliveries, less then 20% section rate (with great outcomes) teaching hospital and tell them they've been doing things entirely wrong.:icon_roll

I for one, have a BscN, have never worked as an LPN (and am incensed on the behalf of LPN's) wear deoderant and am not a tree hugger. I simply look at evidence and practice the way it has been suggested is most effective. Since the US has a very high section rate (with more mortality/morbidity relating to their high section rate) even that should tell you that something is wrong with how you use continuous EFM as a crutch.

I have said time and time again, it can be very useful but IA has been shown to have similar outcomes but with a lower section rate, so why knock it? I use both IA and EFM in practice and both have their uses, depending on the situation.

I have a question for those who rely on CEFM. What do you do when a pt wants to labour in the tub?? What kind of monitoring do you use? I'm genuinely curious.

ETA: yes we monitor our high risk (mag sulphate, HELLP, preterm ect) much different then our low risk moms, but we still have a less the 20% section rate. Also the incidence of TTN goes up with moms who have sections so you cannot stipulate that there are NO more adverse outcomes for babies who are born via section vs those born lady partslly.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Generally, for low risk women who labor in a tub or elsewhere, we use only intermittent monitoring. Some units have sophisticated tele that works all over the unit for ambulatory purposes, and even in water conditions, too. Clearly, it's a choice of the patient, not just the doctor/midwife. Sadly, most of the women who labor where I am want their epidural "yesterday". This is true so many places. Those who want natural labor experiences, we try to accomodate as much as possible.

I will ask again, KEEP IT POLITE please. We can argue our points without attacking others. Let's try to do so, in order the thread not have to be closed. Thanks!!!

PS where I am, our c/s rate is also under 20% without all the fancy doo-dads like tele, etc. But just barely.

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Specializes in Midwifery.
Since the US has a very high section rate (with more mortality/morbidity relating to their high section rate) even that should tell you that something is wrong with how you use continuous EFM as a crutch. .

Well said Eden.;);)

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Specializes in Midwifery.
Generally, for low risk women who labor in a tub or elsewhere, we use only intermittent monitoring. Some units have sophisticated tele that works all over the unit for ambulatory purposes, and even in water conditions, too. Clearly, it's a choice of the patient, not just the doctor/midwife. Sadly, most of the women who labor where I am want their epidural "yesterday". This is true so many places. Those who want natural labor experiences, we try to accomodate as much as possible.

I will ask again, KEEP IT POLITE please. We can argue our points without attacking others. Let's try to do so, in order the thread not have to be closed. Thanks!!!

PS where I am, our c/s rate is also under 20% without all the fancy doo-dads like tele, etc. But just barely.

Thats very impressive! How do you manage second stage with your epidurals? Am very impressed with such a low section rate and so many epidurals!! What are your secrets...do tell:D:smokin::bow:

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Thats very impressive! How do you manage second stage with your epidurals? Am very impressed with such a low section rate and so many epidurals!! What are your secrets...do tell:D:smokin::bow:

My hospital has an 80%+ epidural rate, and a c/s rate between 17-20% (we do VBACs). My secret is to labor down, labor down, labor down until she feels an urge to push. Best thing ever. I'm trying to introduce side-lying as a pushing position, but I get resistance from both the staff and the moms. I personally think it is a function of the media always showing women birthing on their backs. :o My unmedicated moms almost all birth hands/knees.

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Specializes in Midwifery.
My hospital has an 80%+ epidural rate, and a c/s rate between 17-20% (we do VBACs). My secret is to labor down, labor down, labor down until she feels an urge to push. Best thing ever. I'm trying to introduce side-lying as a pushing position, but I get resistance from both the staff and the moms. I personally think it is a function of the media always showing women birthing on their backs. :o My unmedicated moms almost all birth hands/knees.

Well done! So how long would you leave a primip before you start her pushing? Do you wait for how ever long it takes for the head to decend?

:bow::bow::bowingpur:bowingpur...to all you fab people working hard to give women the best outcomes!!!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Thats very impressive! How do you manage second stage with your epidurals? Am very impressed with such a low section rate and so many epidurals!! What are your secrets...do tell:D:smokin::bow:

Well to me, anyhow, that is somewhat easy. (like Beckinben said). Simply put, we let them "labor down" as much as humanly possible. This works the majority of the time. Why have a mom push when baby is of a high station and there is no urge? Usually, when baby reaches a very low station, mom feels pressure and pushes very well with each contraction. Also I don't let them languish in labor on their backs. I warn them ahead of time, I will "turn them like pancakes" as much as they and their babies can tolerate." If a baby is OP, especially, they will spend a LOT of time turning and off their backs! I keep them I have no problem having them push on their sides, either. This works great to turn a stubborn OP or transverse presentation, as we know.

Experience taught me well what works (most of the time).

Again, it is knowing how to do things (and with some MDs, you have to fudge or cajole a bit) in order to let nature take as much of her course as possible w/an epidural. Also I must give our MDAs (anesthesia providers) Kudos. They have perfected their art a lot. Women often have great labor epidurals whereby they feel pressure but not pain and push VERY effectively and well---and go on to have joyful lady partsl births with minimal perineal trauma. Our MDs rarely, if ever, cut episiotomies on anyone. Most tears are minor and require minimal intervention.

It's a combination of education and experience ---as well as great communication among providers (nurses, MDs) and TRUST among all above, including our patient----that is the key, if you ask me, to success in many labor situations. I work hard to foster trust with my patients/families and the MDs and it has served me well.

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