I have finally have gotten a position in L&D. I had worked towards this position for many years now and somehow during my interview a question was raised and I was blindsided. I was asked if I would have a problem participating in late term terminations.... up to 26wks. How had I not realized this was a very real part of L&D? I worked with OB patients for 5yrs (MD office) and had also done my senior preceptorship in L&D, but somehow this never entered my mind. The interviewer proceeded to go into graphic detail about the procedure and needless to say the obvious reason why we could not comply if the patient requested footprints.
Wow... it's been a few months since and I'm still struggling with this.
I feel compassion for the mother who has to make the heart breaking decision to terminate because of medical/genetic/congenital reasons ect.
I struggle with the elective late termination because I just can not wrap my head around it. In one room I have a mother destroyed at the thought of losing her 25 weeker and in the other another patient as she stated is just "Getting rid of it".
Where is the line between our nursing duties and ethics.
Thanks so much for any response. I know this is a very touchy subject.
Every person has their own beliefs and principles. If you think you cannot do it, I would suggest to find an employer elsewhere. Afterall, you wouldn't want to be in a situation wherein you will be forced to do a thing that you didn't like and then later on emotionally suffer. I'm sorry you're going through this, but I hope you'll find a job that suits you well.
To be honest, there are patients who do things that we do not agree with. But try not to be judgmental. It is not your place to tell the patient what they are doing is morally wrong. You may or may not know the reason behind the patient's actions. If you are uncomfortable taking care of a patient that is terminating their pregnancy, then refuse that assiignment.
I don't think she was judging anyone. I think she is having a hard time figuring it out personally. And I hope she will refuse to be a part of anything that causes her such consternation. Just as pharmacists can refuse to dispense certain meds, so a nurse has a right to not have to nurse patients for whom she might not be able to give good nursing care.
BTW, for those of us who believe that a fetus, especially one who is recognizable as a human being, is truly alive and truly has a soul or spirit, it is not possible not to have severe emotional and physical reactions to being in a situation where we are helping to murder a living being. I have never been in that situation but can imagine pretty easily and all too well how I would think and feel about it. Even if I understood that the child had a severe congenital condition that was not compatible with life, I'd react, I know, and in that sort of case, I think AB is not so very wrong.
Even nurses have ethics and morals. It is up to us as professionals to determine if we can participate in the procedures that the unit or hospital provide. We need to do this BEFORE we accept employment.
To the original poster - I sincerely hope that if you are so torn up by this, that you look for another position. Our careers aren't worth losing our morals and/or ethics.
Well, I would say that it depends on how much the OP is faced with it.
If it's a routine issue at her facility, then of course, that is going to put a hardship on the other staff if she has to "pass off" to another nurse.
But if it's something that's not common, then I think as compassionate co-workers, professionals can understand that no matter what "side" you are on, that we can agree to disagree and trade off assignments.
If I worked with someone that was hard-core pro-life, and if it was a first trimester elective (I know that these aren't usually done in a hospital, but I'm just drawing an example)...I would have no issue assistant at all and would do so for someone that just couldn't...but where I have limitations of my own, if a co-worker "traded" assignments with me...then I would feel obligated to probably help him/her out a little extra that shift b/c even the emotional aspect of the situation needs to be considered for your nurse co-worker, even if they agree to do it.
To the best of my knowledge, second trimester a/b is far more stringently regulated than first, as it should be, and abortions when the fetus is close to or at viability are exceedingly rare.
Where is the OP applying? Dr. Mengele's Hospital of Horrors?
I work at a big teaching hospital and we don't ever do elective terminations (meaning mom's life or health in danger). Period. It is possible to find a hospital that does not do them.
On occasion, however, we do have to deliver babies that we know will have little if any chance of survival because they are so early (21-22 weeks), but if we don't deliver, mom will die. Peds comes to the delivery, but I've never seen them be at all aggressive. No point, really, as lung surfactant doesn't get produced til around 23-24 weeks.
Very distinctly I remember taking care of a lady in this very situation. 22+ weeks, and she's already preeclamptic. We admitted her, trying to buy her some time but she quickly declared herself. Her BP was through the roof and her platelets took a nose dive. There was really no choice. They delivered the baby, no resuscitation. Mom's life is precious too.
A friend recently terminated a pregnancy in early 2nd trimester - her baby had bilat renal agenesis. Incompatible w/ extrauterine life. She and her husband weighed the options, and decided to be induced and deliver, knowing that her baby would die. Would I have done the same thing in her shoes? I don't think I would have, but I pray I never ever have to find out.
My point here is that a termination is not a termination is not a termination. There are varying degrees, and even if the facility you work at doesn't do elective ab's (no health/life issues involved), you will almost certainly have to deal with some aspect of it.
At my place, we also get women post-ab with complications. Retained placenta, excessive bleeding, sepsis, you get the picture. Not all the time, but it does happen.
I'm not saying any of this to discourage you. You are well within your rights as an employee to say you aren't comfortable caring for a pt during a termination. You would very likely not be the first nor the last, and good employers will respect your convictions. I just want you to be aware that there are many shades of gray even in what seems to be a very hot-button issue for many.
I know that this thread is not an abortion debate, but I agree, I could not participate in late term abortions regardless of the reason.
I firmly believe in a woman's right to choose, but with limitations...my reasoning is not so much a moral one but an ethical one as an advocate for the fetus...I feel that a fetus at around 3 months gestation, can begin to detect pain...so it's for that reason, not the fact of the termination itself, is why I am against the procedure and could never participate in one.
Even for genetic disorders, even for rape or incest, because at the end of the day, in late-term abortions, you still have the same thing...a fetus that can detect pain and would go through God knows what type of suffering.
I just couldn't.
I am sure that people have seen the story on TLC regarding Julie, the baby born with the worst case of Treacher Collins syndrome known to medical history...that baby is the perfect example of why heroic efforts to "save" the baby need to be seriously reconsidered by some parents. That child has known nothing but surgery and pain in her lifetime...she can't even cry...and has to take very heavy doses of pain medications because of the tolerance she has developed to anesthetics in her young life.
If you look her up on YouTube...you will see the video shortly after her birth that they don't dare put on television.
Without heroic efforts after her birth, she would have died on her own, and if you have ever seen the video, you would quickly understand why it probably would have been best for all involved. Losing a child, I can just imagine, would be horrific...but what they have to see that baby go through every day, to me, would be worse than any death.
They had no idea what was really wrong with her, and her anatomy appears to be unique.
I couldn't watch anything on You Tube regarding her (and her name is Juliana Wetmore) because the thumbnails on the side had some really grisly things on them. Not to mention some of the cruel, horrible comments people put on there! I sure hope her parents never see them.
If you can't or won't work with patients that *choose* to terminate for whatever reason, then you should look to a Catholic hospital to work L&D.
Parents who *choose* to end a pregnancy where the child is doomed to die during birth or will be in horrific pain during it's entire life (however long or short that may be) should not be villified and require compassionate, competent care, even if we would have *chosen* differently. The people I knew who had to do this, did not make the decision lightly, that child had a name & a nursery already - and siblings and grandparents. A wanted, loved child, who was not going to live past birth (acephaly).
If you *choose* to be against abortion, then are exercising your right to choose.
Blee
Some Catholic hospitals are doing D&C's, some of which are abortions. I know because I have heard the surgeons and patients talking.
Specializes in Infusion Nursing, Home Health Infusion.
Can you make a religious objection? I believe that hospitals allow for that. I choose to work at a Catholic hospital b/c I too saw too many things during nursing school that ultimately began to shape my views on this issue.
Specializes in A little of this & a little of that.
I'm still finding it hard to envision where you work that all this is such an issue. In spite of what "pro-life" advocates say, abortion after 20 weeks is highly regulated in the US and elective termination in the 3rd trimester is illegal in something like 46 states. Abortion numbers are at the lowest point since abortions became legal.
The Alan Guttmacher Institute indicates that only 1% of abortions are performed at 21 weeks plus. In real numbers that is approximately 11,848 abortions. In 1997 the Alan Guttmacher Institute said that approximately four one-hundredths of one percent (.04%) are performed in the third trimester or after viability. In real numbers that would be approximately 474 abortions performed in the third trimester out of over 1 million abortions overall.
I don't get the "obvious reason" parents can't have a footprint if they want it. Most of the late term abortions are the "induced stillbirth" type and the baby is delivered intact. Many institutions performing late abortions for people with medical reasons, treat it as a stillbirth would be treated and parents are even given the option of seeing and holding the baby just as they would for a natural stillbirth.
It really seems to me that you could be struggling so much because of 1) a cruel interviewer and 2) a patient that you had early on that was a rarity. Using 2nd & 3rd trimester abortion as birth control is highly dangerous to the woman due to increased risks of complications. The general public, like most posters here, views these later abortions differently than the early 1st trimester.
My suggestions to you would be: 1) use this experience to get yourself a job in a hospital that doesn't do late elctive terminations 2) look to your co-workers. Hopefully some of them are having the same reaction you are, see how they cope. They can also tell you how common this type of patient really is. 3) seek out factual information about late abortions, it may make you feel better. I still think your interviewer (nurse-manager?) may have been giving you anti-abortion rhetoric not truth. 4) check out what your state's actual law is. Killing a baby which may be viable for convenience is not legal in any state. There may be action you can take (like a "whistleblower") to stop this if it's what's really going on there. 5) while talking to your co-workers you should be able to find out who would be willing to switch if you get a patient like that again.
Most important - 6) If you get stuck with that kind of patient again, try thinking of it like this - if she didn't have access to the procedure in a hospital and tried to "get rid of it" herself or illegally, she would only end up in your care if she was lucky enough to not die in the process and she would be a much more acutely ill patient. Try to think not so much of the life that was lost but of the life that was saved because she had access to a hospital with caring nurses like you.
I stand by my belief that OB/GYN patients who are not having babies are best cared for in med-surg. That works out better for everyone except the docs.
rn4ever?
686 Posts
Every person has their own beliefs and principles. If you think you cannot do it, I would suggest to find an employer elsewhere. Afterall, you wouldn't want to be in a situation wherein you will be forced to do a thing that you didn't like and then later on emotionally suffer. I'm sorry you're going through this, but I hope you'll find a job that suits you well.