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I had a pt who was a G2 P0 receiving cytotec overnight. Pt rec'd nubain at midnight around 4am was crying in pain, shaking and throwing up. Resident said to check pt and call her for an order for pain meds. I checked the pt. thought she was 5 and had another nurse check behind me because I am new and still not 100% comfortable with exams. She called her 6. Resident ok's order for an epidural, pt gets the epidural and is able to sleep. Resident comes in an hour later checks pt and says she is 1!!! Pt's dr comes in and finds out she is 1cm and pitches a fit in front of the pt and her mother and tells her it will be very difficult for her to deliver vag because she got the epidural so early! I was furious! I have had docs order an epidural on a pt who was ft because they were a "hard exam" Any thoughts?

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Specializes in Med/Surge, Psych, LTC, Home Health.

???? Interesting indeed. I'm not an OB nurse, but I didn't know that a mom could dilate to 5-6, then go back to a 1? And yourself AND a seasoned OB nurse checked the patient? Weird. I'm interested to hear from OB nurses.

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Never seen a cervix go from 5-6 back to 1.... Did you or the "seasoned RN" recheck the pt after the resident? I would trust a seasoned OB nurse before I would a resident! Don't know why it should make it any more difficult to deliver her lady partslly just becos she already had an epidural-just get her BOW ruptured, start the Pitocin and keep repositioning her, etc. (I take it she was being induced for a medical reason so sending her home was not an option?!)

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Specializes in Maternal - Child Health.

Since neither the resident nor attending bothered to come and assess the patient themselves prior to OK'ing the epidural, they have absolutely nothing to complain about. You and your co-worker did your best to provide accurate information, upon which they based their decision that an epidural was appropriate. If they question the accuracy of your assessment, they need to get out of bed and see the patient themselves.

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Specializes in Maternal - Child Health.
???? Interesting indeed. I'm not an OB nurse, but I didn't know that a mom could dilate to 5-6, then go back to a 1? And yourself AND a seasoned OB nurse checked the patient? Weird. I'm interested to hear from OB nurses.

You raise a good point! Was this truly a medically-necessary induction, in which the patient needed to be delivered for safety's sake? If so, a C-section, if ultimately necessary, would be justified. Or was it an ill-advised, unnecessary social induction? If it is the latter, the resident and attending may have some explaining to do.

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Specializes in L&D,Wound Care, SNC.

I agree with L&Doldtimer, I have had plenty of patients that received an epidural when they were 1 cm and delivered lady partslly no problem. Did you or the MD check her at some point after the resident? Was she in fact 1cm? Either way I wouldn't get too upset about it. I know I have misjudged dilation before, it takes time to learn.

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The pt was being induced for absent end diastolic flow and sga. Her doctor did check her this morning and confirmed she was one. The resident ruptured her and placed an iupc after her exam of 1cm. The pt didn't even need pit because she was contracting on her own every 1.5-2.5 mins and had adequate mvu's.

Honestly, I don't know what we were feeling during our check that we thought she was 5-6! To both of us she felt stretchy. I haven't done tons of vag exams, but I have usually been right on or off by 1cm from what my co-worker thought. The nurse that checked behind me has been on the floor for a year and said she was confident with her exams. We had 3 deliveries going on at the time, so the resident couldn't check her right then. The other rn and I thought for sure she was in transition with her shaking and vomiting!

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Specializes in Psychiatry.

I'm not a nurse or anything, but in Ina May Gaskin's Guide to Childbirth, she has a whole section on hom the cervix can actually regress due to various things. It has been documented for centuries.

This link touches on it briefly:

http://mothering.com/articles/pregnancy_birth/birth_preparation/sphincter-law.html

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Specializes in Nurse Manager, Labor and Delivery.

Gosh, where to start. The shaking can sometimes be from the cytotec. I have come across that when we use it for demises. As far as the cervix, I am wondering if it was posterior and you felt a lady partsl fold, which feels quite similar to a cervix...even to a few different nurses (I have been burned on that one myself). The epidural should not have made a big difference. They probably could've held off on rupturing her for a bit, to give her more time...but we know residents.

My real problem is that the doctor demeaned you in front of a patient and her family. This is just not acceptable.

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Specializes in ob; nicu.

My real problem is that the doctor demeaned you in front of a patient and her family. This is just not acceptable.

I agree. And I have had plenty of res. get dilitation way off. It's not your fault. We give epidurals at 1 cm if pt. is ruptured and has a good pattern. We usually pit them just to increase intensity. Plenty deliver vag. Sorry you had a bad day.:redbeathe

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I was shocked when a patient of mine went from 8cm to 4cm. (She had been checked by Dr, myself and another nurse - so she was certainly an 8). I was told that the cervix can swell and that is what makes the dilation regress. Atleast in her situation that was the case.

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

I have had many a patient receive an epidural at 1-2 cm and smoothly proceed to delivery lady partslly---- no problem. I have seen the reverse: Patients receiving "later" epidurals at 7 or 8 who had to have a c/s for FTP. It is not a matter of an epidural being placed too soon, often, but the patient being unable to relax and arresting progress, that made thigns a problem. Situations are more complicated than that----sometimes malpresentation or CPD is the issue, as we all know.

I agree also with the person pointing out that neither practioner bothering to assess the patient. They surely could have, if they were all that concerned.

Lessons can be learned in any situation, but not if we beat ourselves up too much about them. Let the patient be the focus ALWAYS, not one's own ego.

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