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).
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!
Wee wee, oui oui, LOL. Sorry, couldn't resist. I love the word "wee" and the thought picture it evokes.
I don't know, OP, how to advise you. I guess you just have to not concern yourself with the family dynamic or the eye-roller, because what does any of it signify anyway and what can you really do about it, except to Social Work, which, for a teen mom, is probably routine to do already.
I'd say just focus on the patient, reassure her, do a complete and professional exam and assessment, and proceed according to established standards of care.
I think I'd have, at some point, gotten each person alone - pt, mom, and friend, and assessed them, too, just as you were inclined to do. It probably would have made me feel more knowledgeable about the case, although, as stated, I don't know that I'd have done anything differently.
Babies having babies.....You have to have a license to drive-why not to pro-create?
Excuse me, but would you mind attempting to be less judgemental? I had my son when I was 16 and I wasn't "out of control" or attention seeking. In fact, many of the nurses here were teenage mothers. I can't speak for them, but I certainly wasn't a baby.
Okay, enough with the debate. Fine.
In the OPs case, chorio might also be on the back of my mind. We've had PPROMs that were being induced at term-ish to lower the risk of chorio. Some did develop mild chorio at the time of the scheduled induction, and I have to say, those moms tended to, um, vocalize their pain more readily. I would think that an infected uterus would hurt more when it contracted than a healthy one. (not that this would be my main concern, but it would be there. And while this may have been assesed for, I've seen afebrile, non-tender women with non-tachy babies deliver with a uterus filled with pus.)
Also, as was mentioned, 3-4cm and 80% on a primip, while not something to get the Baby Table ready and gloving up for, does tell me that she was doing something there, ya know?
And as with a patient of ANY AGE (my pt avg. age range is from 17-45), I would consider a low pain threshold, and "issues" at home--lack of support, conflicts, other stresses that could make someone experience their pain more intensely compared to someone who had adequate coping mechanisms and a supportive homelife.
Hmmm ... prime, term, 3-4 cms, excruciating pain? I'm surprised she wasn't admitted and offered pain relief, if for no other reason to calm her down. Morphine sulfate or ambien to try to get her to sleep, or fentanyl (I hate nubain and stadol). Did you palpate her abdomen? If she's not contracting she should NOT be in this pain. She may be a drama queen and have no pain tolerance, but she's responding to something that does not sound too normal and a few other things need to be ruled out. UTI? STI? A complete pain assessment at minimum should be done, talking with her in private about sexual abuse is another. She may be a trauma survivor. She may be a drama queen with no pain tolerance, but as others have said, it's important to validate her pain. She's obviously feeling something, and she must have learned this behavior someplace. Yeah, I have a really hard time with these patients too when I'm triaging, that's why I run through these mental checklists, to get my feelings out of the way of giving my patient what she needs. Good luck!
Sometimes therapeutic rest is helpful in this situation. If Vistaril hasn't worked, try Morphine 10mg IM. The patient gets some pain relief whatever the cause and is usually able to get some sleep. Often the relaxation from this is enough to allow them to go into labor if that's what the body is trying to do, or to just stop things for a while if it isn't the onset of labor.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Therapeutic rest is the way to go, if you can the dr to do it. (especially on nightshift!!)
We use:
15 mg Nubain with 25 mg Phenergan, IM
OR
10mg Morphine and 25 mg Phenergan
then observe no less than 4 to 6 hours to see that mom/baby are ok.
this does one of two things:
Gives them rest, and sleep, whereupon they wake up in active labor
OR
Gives them rest and slows uterine activity enough to allow them to go home, sane, until active labor ensues.
I agree with all others who say generalizations based on age or other uncontrollable factors are not appropriate here. Treat the patient as you would your sister, mom, daughter, friend and you can't go wrong. That has been my saying for the 10 years I have been a nurse. Modeling this often benefits the "eye rollers" who accompany them, as well!
I had my first at 30. I was told that labor takes a long time the first time, but I still remember thinking that when the contractions are 5 min apart, i NEED to be at the hospital, regardless of dilation, etc. I had this fear that if I wasnt there, things might spiral out of control, something might be wrong with the baby, something might happen and I wouldnt know what to do. THe pain was like no other I had ever felt and it scared me. I wanted some reassurance. Maybe I acted more mature because I was, but I was in the same boat as the 17 yo.
With my second baby, I didnt set foot in the unit until I was 8 cm.
Now that I work in OB, I just always keep in mind that until you have been there once, you just dont know and could be scared. I work with other nurses who are the eye rollers and piss and moan when a primip acts "inappropriately" I just step up and say " i will take her" and she becomes my assignment for the day. Thank heavens that 11 years ago when I was the scared primip, someone did the same for me.
Specializes in LTC,Hospice/palliative care,acute care.
Excuse me, but would you mind attempting to be less judgemental? I had my son when I was 16 and I wasn't "out of control" or attention seeking. In fact, many of the nurses here were teenage mothers. I can't speak for them, but I certainly wasn't a baby.
Okay, enough with the debate. Fine.
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Just my opinion which I am entitled to-I believe any one can have a baby but not everyone is a good mother.I'm sure there are many good young mothers (13,14 to 17,18) successfully raising happy healthy children.I happen to know parenting is hard work and I think children deserve to start out with out having the odds stacked against them.I believe that parenting should be prepared for and there is not much excuse for an "whoops" babies today.IMHO that's the best case scenario.. I've worked peds,I've cared for kids in that age range and they could be very challenging.Are you telling me that this immaturity is often NOT a problem in L and D? Doesn't fear cause pain to escalate? I'm not saying that this was only this patients problem-I wouldn't know but I tend to believe that a large portion of these patients present some unique problems. Just like any peds patient can...Lets forgo judgments AND defensiveness and talk about it...
I've worked peds,I've cared for kids in that age range and they could be very challenging.Are you telling me that this immaturity is often NOT a problem in L and D? Doesn't fear cause pain to escalate? I'm not saying that this was only this patients problem-I wouldn't know but I tend to believe that a large portion of these patients present some unique problems. Just like any peds patient can...Lets forgo judgments AND defensiveness and talk about it...
When you say "babies having babies", you are judging. Period. I'm not going to argue that with you.
I think immaturity, stress, bad home life, ignorance, uneducation, past experiences, etc definitely effect pain perception. (If you read my previous post, you'll see that I stated that quite clearly. I also said that this rings true for pts of all ages.) Perhaps dealing with crap from judgemental nurses and other medical staff, teachers, preachers, neighbors, students at school, family, etc, in regards to their pregnancy adds to this stress over the course of 9mos.
It would be interesting to get the family/friend out of the room so you could have a private conversation with the young mom. You might find out what's really buggin her. If she calms down when she's alone, maybe it's for attention.
Maybe she's coming in hoping to convince doc to just induce her and get the pregnancy over with.
I agree that other causes for the pain need to be ruled out.
Too bad you can't inject some saline into her IV and tell her it's a narcotic just to see her response.
I wasn't suggesting it to be cruel - just to see if she was faking. If she calms down and says the pain is gone, then she was faking. If she says she still hurts, then it's probably real.
TrudyRN
1,343 Posts
Wee wee, oui oui, LOL. Sorry, couldn't resist. I love the word "wee" and the thought picture it evokes.
I don't know, OP, how to advise you. I guess you just have to not concern yourself with the family dynamic or the eye-roller, because what does any of it signify anyway and what can you really do about it, except to Social Work, which, for a teen mom, is probably routine to do already.
I'd say just focus on the patient, reassure her, do a complete and professional exam and assessment, and proceed according to established standards of care.
I think I'd have, at some point, gotten each person alone - pt, mom, and friend, and assessed them, too, just as you were inclined to do. It probably would have made me feel more knowledgeable about the case, although, as stated, I don't know that I'd have done anything differently.