This doc makes me very uncomfortable . . .

SmilingBluEyes · Aug 25, 2005

Here is a start from the Journal of Maternal-Child-Nursing

Fundal Pressure During the Second Stage of Labor: Clinical Perspectives and Risk Management Issues.

MCN, American Journal of Maternal Child Nursing. 26(2):64-71, March/April 2001.

Simpson, Kathleen Rice PhD, RNC, FAAN; Knox, G. Eric MD

Abstract:

The role of fundal pressure during the second stage of labor is controversial and can result in clinical disagreements between nurses and physicians. Clearly the time for resolution of this issue is not when there is a physician request at the bedside in front of the patient. A prospectively agreed upon plan specifying how this request will be addressed is ideal. In order to develop this plan, risks, benefits, and alternative approaches to the use of fundal pressure should be reviewed by an interdisciplinary perinatal team. Much of the data about maternal-fetal injuries related to fundal pressure are not published for medical-legal reasons; however, anecdotal reports suggest that these risks exist. Unfortunately, it is therefore difficult to quantify with any degree of accuracy the exact number of maternal-fetal injuries that are directly related to use of fundal pressure to shorten an otherwise normal second stage of labor. However, there is enough evidence to suggest that if injury does occur when fundal pressure is used, there are significant medical-legal implications for the health care providers involved. This article will review what is currently known about fundal pressure including risks, benefits, and alternative approaches. In that context, suggestions will be offered for a safe approach to managing the second stage of labor.

You will have to find the journal and article either online, or in your library------I don't subscribe to it, but I know my manager does. Ask around, you may find it......

another you can purchase:

Common Areas of Litigation Related to Care During Labor and Birth: Recommendations to Promote Patient Safety and Decrease Risk Exposure

Kathleen Rice Simpson, PhD, RNC, FAAN

G Eric Knox, MD

$6.95 Journal of Perinatal and Neonatal Nursing

April/June 2003

Volume 17 Number 2

Pages 110 - 125

SAMPLE:

Reducing the risk of liability exposure and avoiding preventable injuries to mothers and infants during labor and birth can be relatively easy when all members of the perinatal care team (nurses, nurse-midwives, and physicians) agree to follow two basic tenets of clinical practice: use applicable evidence and/or published standards and guidelines as the foundation for care and whenever a clinical choice is presented, choose patient safety rather than production. Adhering to these two principles could theoretically eliminate the need for extensive and overly detailed policy and procedure manuals. Most clinicians feel the need to have some written guidelines for practice. A summary of the most common foci of professional perinatal liability claims together with the most current applicable evidence and published standards and guidelines from professional associations and regulatory agencies is provided. The purpose is to provide a framework for reviewing existing institutional protocols and/or developing future policies and guidelines that decrease professional liability exposure and minimize the risk of iatrogenic injury to mothers and infants.

(the above is an abstract only)

******************************************************

I will search my AWHONN journals (I get JOGNN and Lifelines) and they get MCN at work and see what I can come up with for you ....

I also subscribe to a perinatal listserve where the subject has been discussed before and you can search, once you subscribe too:

Here is the address:

http://listserv.acsu.buffalo.edu/archives/pnatalrn.html

anyhow there is a start in your research.

Hope this helps....

deb

BETSRN · Aug 28, 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!

You know what? I think I would take this problem to your hospital's risk manager. This is a huge liability. Some hospitals do a "risk assessment" and it can change a physician's practice (which is a good thing). I know my friend's hospital did that with their OB's and things improved a bit.

Also, how about the other docs in this group? Are they aware of this guy's practice? Probably not, as usually there are not two docs in a room for a vag birth. They only see each other or work together in the OR. Maybe you could bring it up with one or more of these other partners: especially if a lot of you are uncomfortable.

BETSRN · Aug 28, 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.

Scary story. This doc sounds most incompetant! NO excuse for it.

RaeT,RN · Aug 28, 2005

Well, ladies, what I've decided to do first is to go to our clinical nurse specialist, who is very well published within AWHONN and get her behind me so to speak. I want to know if something has been said before about this guy because I've heard at least two other nurses mention him doing it. I want to go about this as the concerned, curious new grad and she is my best resource for current nursing practice and AWHONN and our hospital guidelines. Then she will tell me I'm sure to go to my NM, but then I can have AWONN and hospital guidelines behind me for sure so that change can be brought about. Plus, our clinical nurse specialist does NOT play around and I feel more confident that she will handle this kind of thing with more agression than my NM; sadly my NM is kind of scattered and I do not have a lot of confidence in her.

I do not know if the other two docs in this group know that he continually does this in his deliveries or not; those docs are very good and I respect them trememdously.

I am back on the floor tomorrow, and I will update you all on how it turns out.

**RosesrReder, BSN, MSN, RN** · Aug 28, 2005

If he is truly putting pressure on---really pulling, report this to your manager (if he/she does not know it already---and perhaps this needs to be elevated to your perinatal committee); this is very ill-advised oldschool methodology. AND IT IS VERY DANGEROUS.

Definetly agree. I am so sorry for your situation.

MKFaizi · Sep 1, 2005

Replying to the post from Chuck:

This woman was a physician? For real? Not some psycho off the streets?

I mean, my grandma -- no offense to my grandma -- wonderful woman -- could have done a far better job delivering that poor baby than that so called doctor. My grandma at the age of ninety five could have done a better job than that so called doctor.

Thank God, I am past child bearing age. If I ever have grandchildren coming into the world, I am going to advise them to get a nurse midwife or somebody.

Such barbarism. Childbirth should be -- SHOULD BE -- and can very well be - a good experience. It should never be a tale of horror.

I am disgusted by the tales in this thread. If I was pregnant and reading this, I reckon I would go on out to a field and have my baby by myself. I mean, darn.

Does anyone ever attempt to advocate for a peaceful, non-medical childbirth?

Does Lamaze still exist?

SmilingBluEyes · Sep 1, 2005

Does anyone ever attempt to advocate for a peaceful, non-medical childbirth?
Does Lamaze still exist?

oh Yes we do. Thank you for asking.......I have one recommendation:

Please take the opportunity to read our threads here, and you will see many threads that discuss our advocacy for our patients as nurses.

Thanks and welcome!

mamallama · Sep 1, 2005

Replying to the post from Chuck:
Does anyone ever attempt to advocate for a peaceful, non-medical childbirth?
Does Lamaze still exist?

LOTS of nurses advocate for this. The last hospital I worked in had a wonderful group of nurses, midwives, and physicians who worked together to provide a safe birth while honoring the woman's wishes. We provided tons of labor support, utilized positioning, breathing, massage, music, water, etc.

I gave birth in that facility last October. Had a beautiful labor. Had an intermittent IV only for antibiotics (I was GBS Pos). Otherwise, I walked, showered, rested. Had a beautiful, peaceful, unmedicated birth in a dimly lit room with my husband, mother-in-law, and 5 year old present. My son was put to breast immediately and we cuddled as long as we wished. Yes, this was in a hospital and attended by a (male) OB. :balloons:

chuckc, BSN, RN · Sep 2, 2005

Scary story. This doc sounds most incompetant! NO excuse for it.

Yes, it is a scary story. I forgot to put in one other horrid detail in that story. THe OB stitched her episiotomy halfway while waiting for the placenta! In quite a hurry i would say. Imagine how much pain that added to the already horrid scraping off of the placenta with no anesthesia.....

I want to add that I worked with a male OB/GYN and loved him, he taught me so much. I love midwives and OBs alike, just not this one...... :uhoh3:

AggieNurse2B · Sep 13, 2005

I had the world's best OB with both of my pregnancies, too, and I wouldn't dream of going to anyone else. In fact, in the middle of my last pregnancy, he moved about an hour and 15 minutes away, and I treked it up there just so I could have him as my dr. I'm on the "c-section plan," but he's amazing...Right up to giving me his cell phone number in case I need something. No need to call the answering service.

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.