??? Trial of contractions

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One of our docs that we frequently want to strangle is pulling a new one, even for him. One of his patients, having her final repeat C-section wants to know what labor feels like. So he is having her come in several hours early and will order pitocin so she can have a "trial of contractions" prior to her scheduled c-section. !!!! Upon being questioned about it, he is justifying it by saying the contractions will thin the lower uterine segment......less bleeding yadda yadda. He justifies everything he does. If I were the night nurse, I would flatly refuse to administer this pitocin......he can do it himself and document. Talk about waste of time and potential to expose Mom and babe to risks. Its all about $$$$ with him..........give the patients what they want.....epidurals before actual labor.......hysters in their 20s..........don't get me started.:angryfire

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Specializes in Nurse Manager, Labor and Delivery.

Are you kidding me?

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Specializes in OB/GYN.

It is absolutely contraindicated to use pitocin to induce labor in a mom with previous c-sections. If she had just 1 prior section and was trying for a VBAC it's ok to augment with pit but never to induce. What is he thinking?

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Specializes in OB.

Why physicians like this are legally able to practice absolutely baffles me. Maternity care in the U.S. is in crisis, largely because of practitioners like this who play God with women's bodies without scientific evidence to back up the reasoning for their crazy interventions.

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Specializes in L&D telephone triage.

I would not start the Pit. He can if he wants the responsibility. Talk with your nurse manager and corporate legal department.. Also, review your policy and procedure.

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That's the craziest thing I've ever heard. Too bad the patient can't be told to just no show for her section... wait until she goes into labor... she can experience it. Then she can show up and get her section.

I'd like to go to this doctor and tell him I'd like to experience being high. Maybe he could put me in the hospital and dope me up real good on fentanyl or something.

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

Amen to not starting the pitocin and knowing policy and procedures regarding TOLAC (which is what this would be, really!) This sounds about as crazy as anything I have ever heard of. And, really dangerous also.

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I plan on bringing the subject up with our manager at a staff meeting. Our risk manager is on vacation this week. The doc is pals with the chief of OB ( they assist one another's C-sections and hysters ).....so I wouldnt' expect a response from him. This doc will act like WE are out of line should we question him. I wouldn't wish a complication on a patient except to say that HE would deserve it. :angryfire

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I brought up the subject of starting pitocin on a scheduled section soley so the patient can feel contractions at our staff meeting. Turns out the manager of our floor sees nothing wrong with this !!!!!! Call it a trial of labor she said. Oh my. I am glad I am not on that day as there would really be a ruckus as I would flatly refuse to expose a patient to a medication needlessly. Unbelievable.

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Specializes in Maternal - Child Health.

I encourage you to contact your hospital Risk Manager and legal team and ask them to run this by your hospital's malpractice carrier.

Is there a Chief of OB you could go to? I have occasionally called in the chief of service when we had an attending physician doing questionable and risky things. Fortunately, they were usually able to prevail upon the "offending" physician to "rethink" his approach. In one case involving a pediatrician's inappropriate treatment of a sick newborn, the chief of peds simply took over the patient's care.

I would also contact my personal carrier for suggestions on how to respond if I were to be assigned this patient.

Good luck!

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Well, our little doc and his whacky patient ( 24 years old and uneducated about any possiblity of potential problems ) got their way. She was a scheduled section who wanted to know what labor felt like. Ended up with a spineless night nurse who got her up to 8 mu of pitocin before her surgery. Turns out she had 16 hours of labor prior to her first section "but couldn't remember it". What kind of physician gives in to this nonsense ?? I and a handful of other nurses are the only ones who see the folly and potential for problems with this.........not to mention the waste of time and $$$$$$$$$. The patient was on her cell the whole time even with contx q 3-4 minutes so what was the point except the physician gave in to keep a patient happy so she wouldn't go elsewhere and he would lose a fee. Our nurse manager basically laughed at me when I brought up the concerns I had ( I am twice her age, so of course I am an old fuddy duddy ) GRRRRRRRRR I end a lot of my posts with the same refrain..........can't wait to retire. Although I have to say, a much younger friend of mine in her 30's called me today to say she applied for a position in endoscopy to get away from all this same stuff happening in another facility. A job we once loved has turned into one we honestly can not tolerate. :cry:

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Specializes in Maternal - Child Health.

I guess the obvious question is this: If patient and doc were so hell bent on a "trial of contractions" why didn't he just wait until she went into labor naturally to section her? I assume one of 2 reasons. Either they didn't want to give up the convenience of a 9am scheduled C-section, or he truly believed it too dangerous for her to contract in an uncontrolled setting. Neither reason justifies this ridiculous charade of a "trial of contractions."

I would have a really hard time not contacting the case management department of her insurance company. I know you can't do that, but wouldn't it be satisfying?

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