This doc makes me very uncomfortable . . .

MKFaizi · Aug 25, 2005

Sounds horrible. I thank God that a nurse midwife delivered my first child and a lovely Fillopino doctor in a one woman practice delivered my second. Both were perfect labors and deliveries -- no epidural. No drugs. No brute pushing on the fundus.

My husband -- now deceased -- would have cold cocked him. He was Pakistani and would have freaked out seeing a man do anything like that.

No wonder so many women recount horror stories of childbirth. I am certain that there must be many good male obstetricians who are wonderful at childbirth.

But darn. I don't think the dude should be allowed to be birthin' no babies.

No one should have to endure that.

MKFaizi · Aug 25, 2005

Cardiac One,

So why don't you get the Midwife degree and deliver babies? My nurse midwife was excellent. Perfect. Patient. Coached me in pushing. Gentle. Tolerant of my Pakistani husband. Very attentive. Very personal care.

I would have used her for the second birth but, unfortunately, by that time her practice had changed so that she was in with the doctors. That meant that she might not be the one to turn up at delivery time -- could have been any brute. She probably became too popular and could not possibly do all the deliveries.

It is a wonderful luxury to have one practitioner follow you all the way through your pregnancy AND deliver the baby. I did not want the usual cattle call. I did not want someone who would encourage me to have an epidural -- whether I needed one or not. I did not want someone overly medical. Pregnancy and childbirth are not diseases or medical emergencies. Pregnancy and childbirth are the elements of life. I would have resented suprapubic pressure from a brute, let alone fundal pressure. Childbirth -- under most circumstances is not a matter of extraction. It is a process that pretty well takes care of itself with little intervention.

Women tend to panic with the pain. I don't think a doctor in an urgent care mode helps that. You need a calming and soothing person.

Relaxation is very important. I feel so fortunate to have experienced two good and easy births -- no epidurals; nothing. When I was done, I was done. Nothing medical about it. I was free.

I realize your point about liability. Too bad. I cannot say enough good about nurse midwives or nurse practitioners.

USA987, MSN, RN, NP · Aug 25, 2005

We have this one doc with the group that gets all the unassigned pts and he does this in ALL of his deliveries: When he comes to deliver the baby, he puts a sterile drape on the mom's tummy, puts both his hands up there, and pulls on her fundus while she pushes. It freaks me out when he does this. What I want to know is, is this dangerous for the pt, or am I getting all worked up over nothing? Is this no more harmful than using a vacuum or cutting an epis? And I mean, this is a big, muscley guy and he really puts his back into it. It just makes me nervous, and I want to know if it is justified.
Thanks!

It sounds like you're describing fundal pressure...as Deb said, that's a big NO NO!!

Peaches N L&D · Aug 25, 2005

Oh my goodness, I heard a story where the Dr. did fundal pressure and the Mom later died due to internal hemmorage, he denied he had done fundal and when they did the autopsy they found the uterus had ruptured and there was massive bruising on the fundus, needless to say that Doc got hung out to dry! :bluecry1:

chuckc, BSN, RN · Aug 25, 2005

I am in nursing school now, but when I was a midwifery apprentice at a free standing birth center, I followed a patient who needed to be transferred in the second stage, not the hospital with our drs priveledges, due to their insurance, was there to support her. Some new OB, I thought maybe she was an intern, attended. She seemed so nervous and uptight, practically screaming when there were quick dip in baby HR during height of pushing, came right back to baseline. I just kept close to ear of mom, telling her how strong she was, etc. The Dr panics, grabs scissors and cuts with no anesthesia, says sorry got to. Vacuum extraction used, popped off 3-4 times. THen baby head is born, immediately she starts crying shoulder dystocia! Baby eased out next contraction. Then, After baby is born, she is so impatient about the placenta. I am not talking about a long time, I mean immediately she is fussing about it coming out. I am watching this woman thinking, OMG, she keeps pulling on that cord! Well, sure enough, she pulls the cord off the placenta. Then cries, OMG, sorry I've got to go in for placenta, not enought time for any meds. She reaches inside this womans uterus and is scraping with her hand extracting the placenta. What she is getting out in her hand looks like hamburger! I felt so sick, but kept to myself, trying to help this poor woman cope with it all. God, she was incredibly strong to endure what she did without so much as a wimper. Afterward, Dr kept talking about something must have been wrong with that cord/placenta, should send it to pathology. Of course at the end she decided not to. I know I only know a small drop of what you L&D nurses know. I am curious to hear your thoughts on this.

cardiacRN2006, ADN, RN · Aug 25, 2005

I am in nursing school now, but when I was a midwifery apprentice at a free standing birth center, I followed a patient who needed to be transferred in the second stage, not the hospital with our drs priveledges, due to their insurance, was there to support her. Some new OB, I thought maybe she was an intern, attended. She seemed so nervous and uptight, practically screaming when there were quick dip in baby HR during height of pushing, came right back to baseline. I just kept close to ear of mom, telling her how strong she was, etc. The Dr panics, grabs scissors and cuts with no anesthesia, says sorry got to. Vacuum extraction used, popped off 3-4 times. THen baby head is born, immediately she starts crying shoulder dystocia! Baby eased out next contraction. Then, After baby is born, she is so impatient about the placenta. I am not talking about a long time, I mean immediately she is fussing about it coming out. I am watching this woman thinking, OMG, she keeps pulling on that cord! Well, sure enough, she pulls the cord off the placenta. Then cries, OMG, sorry I've got to go in for placenta, not enought time for any meds. She reaches inside this womans uterus and is scraping with her hand extracting the placenta. What she is getting out in her hand looks like hamburger! I felt so sick, but kept to myself, trying to help this poor woman cope with it all. God, she was incredibly strong to endure what she did without so much as a wimper. Afterward, Dr kept talking about something must have been wrong with that cord/placenta, should send it to pathology. Of course at the end she decided not to. I know I only know a small drop of what you L&D nurses know. I am curious to hear your thoughts on this.

That is terrible. This is probably the EXACT reason why she choose a midwife to begin with.

sddlnscp · Aug 25, 2005

Goodness! I just wanted to add a positive note to all the scary OB docs out there. I had a male OB doc who delivered both of my babies and he was absolutely incredible! He was wonderful throughout my entire pregnancy, both times, and he was absolutely teriffic during the delivery. Of course, I had the world's best nurses both times too, so I was really lucky, but I did want you to know there are some great docs out there too. Mine did specific massage techniques right before the birth of the baby and kept me well lubricated which helped with an easy delivery - with my first child, I only needed one tiny, itty-bitty stitch and with my second, absolutely nothing! After I had my second child, I was ready to get up and run a marathon I felt so good - I had a completely natural child-birth and because my Doc was so wonderful, no tearing or complications of any type, it was great. After seeing some of the posts on here, I am extremely greatful I found him when I did because I wouldn't want to go through child birth with anybody else.

SmilingBluEyes · Aug 25, 2005

Oh yes, it must be said: MOST of the docs are AMAZING care providers. I have the privelege of working with a great group, for the most part.

Understand: There are some from the "old school" of OB who do things, well, the "old way"---ones who are not staying current or using evidence-based practices.

Your obligation is to the patient. You can take action by:

.Refusing to assist/perform in fundal pressure in a pregnant woman

.Documenting clearly, through your occurence reporting system and/or Risk Managers, the date/time/names/specifics of each situation

.Talking to your manager about your concerns

.Requesting this physicians' practices be discussed at Perinatal/OB committee meetings (the hospitals all have them, they just go by different names).

You do have the obligation, now that you have seen it, to 'take it up the chain"......Don't fail in doing so, dont' be afraid to. It's so important. You have a good eye and it's VERY hard as a new nurse to "blow the whistle" Believe me, I know. I was called before the OB committee 6 months out of school for a write-up I did on a dr who did dangerous things one night. It was so scary----so hard to do. But it was worth it....the specific practice was sanctioned and stopped. It was worth it, in the end, even tho the guy threatened me w/my job.

You have to do the right thing! Be strong!

RaeT,RN · Aug 25, 2005

Blu, and everyone else, thank you so much for your responses. Yes, I am a new nurse, but that fundal pressure did NOT look right to me - maybe this is one of those gut things that I didn't think I would get until I was more experienced? I know how things work, and I'm sure if one of those cases ever went to court, I would be right beside this doc in court. And what is my job, ultimately?????? TO ADVOCATE FOR MY PATIENTS. (This is also the doc that told one of our other new nurses to keep increasing her pit until she got her MVU's to 300. Yeah, you read that right. A good thing several experienced nurses were like, "Whoa!!!!! Your baby is going to start showing that pretty quick!!!!! TURN IT OFF.") And the thing is, this guy is young, too (well, younger.) I will make a written statement for my NM when I go talk to her. Should our chief of OB medicine also get a copy? I am friendly with the inappropriate doctor, but I am not willing to risk the health of my pts to save our rapport. I realize that I am also liable.

Thank you, thank you, thank you!

SmilingBluEyes · Aug 25, 2005

This guy is a COWBOY, read: DANGEROUS w/all capitals.

I would realllllly be wary around this guy. Sounds like the scary dude I mentioned in my other post-----thank GOODNESS he is no longer doing OB.....

But not cause of my reports, he hung himself eventually. He was one SCARY dr.

This one sounds like him----watch him and report anything you KNOW is wrong. Good luck......

Regarding the occurence/variance: make SURE your Risk managers and your manager get this. Leave it to your MANAGER to ensure the Chief of OB gets it.....make SURE he/she is involved in the whole process and not blindsided. Also be sure when things like that are going on, you are elevating your concerns to your charge nurse and the house supervisor. Involve as many people in the "chain" as you can....! It is critical. GOOD luck and way to go.

SmilingBluEyes · Aug 25, 2005

I think your observations and caring are to be commended, Rae. WELL-DONE!

RaeT,RN · Aug 25, 2005

Any suggestions as to where I can find lit on it? Not that I think they will blow me off, but I just want to make sure I really know what I am talking about. . .