Sensitive Subject: D&E in OR

[FlyOR]

This is my first post. I have been lurking for quite some time and I thank you all very much for the vast amount of information that is here.

This is where I learned that I want very much to be an OR nurse. I have shadowed, observed and considered the environment and I am hooked. So I am awaiting the results of an interview, but in my interview a subject that I never thought of came up. I should have thought of it, but I didn't.

This is a large community hospital. Apparently botched abortions can end up in the OR and of course it will require a scrub/ circulator. They are very clear that if I consent to work there, it will happen and I would have to perform the required role.

I don't want to offend or debate this, but I do need to know one thing.

Is the baby already dead or still alive during these incidents? I can be a woman's nurse if the deed is already done, but I can't participate.

My future is riding on this. I would be grateful for any information anyone would provide.

Thank you.

[SuesquatchRN, BSN, RN]

I don't really know. I guess my question is, "Is the woman's life riding on fixing the botched abortion?"

[FlyOR]

The women originate at the abortion provider but essentially lie about the length of their pregnancy and then there are complications that necessitate hospitalization and surgery.

This is uncomfortable stuff, I realize and apologize. I was just hoping for an OR nurse who has experienced this and can tell me what happens. I am new to healthcare and I guess I didn't expect an ethics dilemma this soon.

[SuesquatchRN, BSN, RN]

Every day is an ethics dilemma.

:)

[Elvish, BSN, DNP, RN, NP]

I understand your concern.

The cases that have come through my facility in recent memory have been cases where a woman went for an abortion, bled too much and was transported to the hospital. D&Es are at that point to remove fragments of placenta or the baby that are still inside and causing the uterus to be unable to contract. (= increased bleeding.) The few cases I've seen were not very pretty - moms went into DIC but fortunately all survived. So in these cases, no, the baby was no longer alive. And very fortunately, I can count the number of cases like this on one hand. I can't ever remember a case where we've done a D&E under these sorts of conditions in which the baby showed signs of life.

Perhaps other posters with different experiences can weigh in also.

[SteveNNP, MSN, NP]

In my experience, most hospitals during their hiring process allow you to specify which cases/procedures you cannot perform due to moral/ethical convictions. No one would hold you responsible to perform something you had stated you could not do.

I signed a form stating that I would take no part in any procedure that would end a life, whether unborn or other. I've never been in that situation, but was prepared if I ever was placed in one.

[RNmama05]

We get occasional transports from Catholic hospitals of patients with rupture and a live fetus at 16-20 weeks. Sometimes they're septic with ARDS (40% mortality in such cases). So yes, we do see live fetuses before termination.

[BlueRidgeHomeRN]

we get occasional transports from catholic hospitals of patients with rupture and a live fetus at 16-20 weeks. sometimes they're septic with ards (40% mortality in such cases). so yes, we do see live fetuses before termination.

just like to add that as a catholic nurse, the church does allow for a d&e, or even a termination if the physical life of the mom is in immenent danger. in case of a uterine rupture, or even in a severe utreatable cardiac failure (congenital on mom's part) that i witnessed, saving mom came first.

also, i worked at a state health department, and signed on hire that i would not councel a girl about abortion as an option. if a pt had a positive pregnancey test, i turned her over to a co-worker (unless she was clearly happy and wanted her pnv's and an ob intake appointment).

[FlyOR]

Thank you very much for the responses.

The hospital does have a method of which you can inform your manager of cases in which you have moral objections, however they stipulate that if there is no one else to do it, you would be expected to perform your role.

Not being ready for this, I am trying to figure out what this entails.

I would value any other information that anyone else would like to tell me.

Thanks.

[RNmama05]

just like to add that as a catholic nurse, the church does allow for a d&e, or even a termination if the physical life of the mom is in immenent danger. in case of a uterine rupture, or even in a severe utreatable cardiac failure (congenital on mom's part) that i witnessed, saving mom came first..

that's good to know. unfortunately, the definition of "imminent danger" does not include a ruptured 16 weeker who becomes septic later.

[FlyOR]

RNMAMA05

Thank you for your input. Would it be your judgment that this job

is simply incompatible for me? You seem to understand what I am asking and without knowing the particulars of the cases that happen, I am looking at a fine line here.

I am really devastated at the idea of not being able to take this job, but I also don't want to enter a situation that I should have made a judgment about, it wouldn't be fair to the patient, the OR and it would just postpone the decision to a possibly emergent situation.

If this is rare, if I could be reasonably sure that I would be dealing with a procedure where the fetus is already dead, or if I could simply not do this type of case. . . well you get the picture.

Thank you for any thoughts you have.

[RNmama05]

RNMAMA05

Thank you for your input. Would it be your judgment that this job

is simply incompatible for me?

At our hospital we do terminations for genetic reasons, even into the second trimester. We also get a lot of ruptured patients (previable) transported in from elsewhere, multiple gestations with some demises and others alive whose parents opt for termination, as well as severe preeclamptics prior to fetal viability who opt for termination.

These kinds of cases are not every-day cases, but they're not rare either. Usually a nurse who feel uncomfortable can find someone else to take the case; however, some days there are no other options. I think what you have to ask yourself is are you willing to give care to women who need care, even if that requires termination of a pregnancy with a living fetus?

Now, that being said, not all hospitals do what we do. We are a large urban teaching hospital. If you work at a smaller hospital many of the complex cases may be transported out. If you work at a Catholic hospital, this will probably not be an issue.

I would not give up on your career goals, but I would attempt to come to terms with the fact that in the healthcare setting, ethical issues will always be present- whether it is pregnancy termination, keeping a frail 90 year old on la vent because her family wants to, or honoring a person's decision to terminate life support.