What to do with this kind of patient?

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Specializes in OB.

The other night at work I had a 17 year old primip come in saying she was contracting every 5min. (She'd been in a few days earlier for this too). Nothing shows on the monitor and I palpate nothing when she says she's having a contraction. Her exam is 3-4cm and 80%, same as in the office previous day. When she came in she was pretty much crying, but after an hour she didnt change so I sent her home with vistaril and she was much calmer. I also gave her the standard advice about take a bath, drink plenty of water etc. etc.

Her mom called about 1/2 hr before change of shift, saying that her contractions were now 3 min apart and she was way more uncomfortable now. There wasnt much else I could say except come back. She showed up at change of shift so I didnt take care of her, but she was howling when she got up to our floor...however again no contractions on monitor or by palpation and no cervical change.

So my question is....what do you do with these pts.? How do you know if they just have no pain tolerance or if maybe there is something else going on...some medical issue or something?

I didnt get a chance to get her mom alone and ask more about her daughter, but she did have a friend there who kept rolling her eyes, so that gave me some insight.

I just feel bad and am not sure what to tell these people. She said if she keeps coming in here, she feels like we are going to hate her. Which of course I said no we aren't...but of course it's going to frustrate us and piss off our doctors...she's only 38 weeks. (And I would like to say here that I would rather she come in if she thinks she's in labor so please dont take my comment about frustration the wrong way).

So what do you guys do for these pts.?

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Specializes in Nurse Manager, Labor and Delivery.

These patients can be very frustrating. The boomerang visits exhaust everyone involved. I find that these types frequently are just plain exhausted, and then their pain perception is a bit skewed. I try to give them some sort of validation that their pain is real. I also think, a lot of times, that the patient is on the dehydrated side, and sometimes giving them some IV fluid makes them feel better. 3-4 cms 80% is nothing to sneeze at, even in a primip. Apparently her body is doing something with the pain she is having (though very SLOWLY) . Somehow you have to give control back to the patient, because they feel so out of control. I do wonder why she is having such pain (or her perception of pain). Where does she feel her pain most? Is it constant or coming and going? What is her family dynamic. Some young girls come in because there are issues at home, or they want the attention.

I do feel your pain. Sometimes elective inductions look good, eh?

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Specializes in LTC,Hospice/palliative care,acute care.

Babies having babies.....You have to have a license to drive-why not to pro-create? I work with 2 women who just became grandmothers.Both of their daughters took part in their high school graduation ceremonies while ready to drop at any minute. They had good prenatal care and participated in a program at the school so I can't say that lack of education was the problem.The last few months of their pregnancies they each must have run to the doc's office 2 or 3 times a week.And-when labor finally began they both were out of control (according to their mothers) Immaturity? I'd like to hear what the experinced l and d'ers say...I was scared when I had my son and I was 28-I can't imagine what I would have done if it happened when I was 17....

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
Babies having babies.....You have to have a license to drive-why not to pro-create? I work with 2 women who just became grandmothers.Both of their daughters took part in their high school graduation ceremonies while ready to drop at any minute. They had good prenatal care and participated in a program at the school so I can't say that lack of education was the problem.The last few months of their pregnancies they each must have run to the doc's office 2 or 3 times a week.And-when labor finally began they both were out of control (according to their mothers) Immaturity? I'd like to hear what the experinced l and d'ers say...I was scared when I had my son and I was 28-I can't imagine what I would have done if it happened when I was 17....

I know by today's standards 17 is young, but by historical standards 17 was a normal time to have a first baby. Maybe there's actually something wrong with our society that isn't properly instilling character, endurance and maturity in our young people? For 99.9% of human history it wasn't considered deviant or irresponsible to have a child at 17.

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Specializes in nursery, L and D.

I was 16 when I had my first, and I surely did not act like that. I read everything I could find about pregnancy and birth, and babies. I knew what I wanted for labor, I knew what to ask, what to do. I even asked what my ds APGARS were. Don't think it really is an age thing. I have had 40 y/o's come in with this type of behavior. The only thing to do is grin and bear it. Try to educate when they come in. Don't just brush them off, because they are "repeat offenders", they may have a UTI, maybe they have slipped a disc in their backs, who knows.

I think mostly they are scared, I do see this with first timers more often. And then after the babies are born, they call us in the nursery about twice a day, worried about the baby.

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Specializes in ED, ICU, Heme/Onc.
I know by today's standards 17 is young, but by historical standards 17 was a normal time to have a first baby. Maybe there's actually something wrong with our society that isn't properly instilling character, endurance and maturity in our young people? For 99.9% of human history it wasn't considered deviant or irresponsible to have a child at 17.

I agree with what you are saying, but our lifespan has significantly increased even in the past two generations, making it possible for our children to stay children longer. Even if they have adult reproductive systems and use them.... It was also the norm to be finished with your education at 14 and start a trade, and that isn't done anymore either. I agree that we should be instilling character, endurance and maturity into our young people, but not because we should be encouraging them to have children at 17. They may be better equiped if it does happen though.

Blee

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

That's true Blee, you have good points too.

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Can I politely ask we stay on topic here and not get into a teen mom debate.There are several threads around if you want to re visit them. I am interested in the OPs concern. Thank you. ;)

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Specializes in midwifery, NICU.

does not matter a jot whether the terrified woman is 44 or 14 yrs old. SHES the one carrying the wee life inside her...Shes the one feelin pain.....SHES scared and looking for some reassurance and comfort, and ALL the other things WE are paid to provide! This kind of patient may have been you or I, may be our daughters in the future..just needing that extra bit of care. I Know how busy things get, but every womans pregnancy/birth experience is unique to them, and they should NEVER be made feel like a millstone round the neck of stretched maternity services, just because we are pushed for time, she should not feel like a burden...SHE is just as important as the next labouring/pregnant/anxious mamma!

So, What to do with this "kind" of patient?? BE her support/her nurse/her comfort/her advocate....any of the other things we are paid to do, whilst being priviledged in sharing one of the most important and emotional times in a woman's life. Oh and as usual, cross your everything that it all turns out ok for her and her blessed wee one!!

Oh..and the "Friend" with the rolling eyes....I would roll HER and her wayward eyes right out of the building! SHES supposed to be a support for this wee girl whos scared and in pain!

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Specializes in midwifery, NICU.

OH, and shortstuff, 38-42 weeks is TERM, not ONLY 38 weeks.

And 3-4 cms, 80% effaced can hurt like billy-oh!

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I too have seen patients of all age groups present like this young girl. The best thing you can do for her is medicate her for the pain, try to walk her to stimulate her labor and get some cervical change. Early labor can be extremely uncomfortable for many women. At my hospital we would probably admit her and augment her labor. Most of our docs admit the patient at 4cm especially if they are that uncomfortable. Is it possible you weren't picking up her UCs? Did you palpate any UCs? If admitting the patient isn't an option, then maybe the doc would send her home with an Ambien to let her sleep.

PS: I had a 14 year old :bluecry1:in labor last week, she handled it like a champ. Pain is an individual thing, and we need to address somone that appears to be in excruciating pain like your young girl appeared to be.

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Specializes in OB.
OH, and shortstuff, 38-42 weeks is TERM, not ONLY 38 weeks.

And 3-4 cms, 80% effaced can hurt like billy-oh!

I know it's term...I was just thinking of how most primips go past their due date...though I hope she doesnt go that long..

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