When pt is refusing a C/S

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We had a pt yesterday, G5P4 non-compliant IDGD; last insulin injection 3 wks ago, last prenatal visit several weeks ago, term pg admitted in labor. Pt got to complete, but still at a 0 station. This strip looked like absolute crap - deep, wide variables following every contraction (at least her contractions were like 4 min apart) down to the 60's and then 40's :uhoh21: paired with a continually rising baseline and essentially no variablility. The pt was adamantly refusing a c/s because she had delivered her other babies "lady parts-lee" and wanted to deliver this baby "lady parts-lee" as well. She said the only way she would consent to a c/s was if the FH went down and stayed down. No amount of explanation by the MD or by her nurse of the possible repurcussions (sp?) of continuing to attempt a lady partsl delivery of this infant (profound neurologic injury, death, that kind of thing) would convince her that a c/s would be in the best interest of the baby. This strip continued on for a couple of hours; we all watched the strip in absolute horror ironically praying for a prolonged decel so we could get the baby out. What it finally took was another nurse going in to the pt's room, praying with the pt that God would help her to make the best decision for the baby and she FINALLY consented for the c/s. Baby weighed 10lbs 11oz, blood sugar 167, Apgars 1, 7, & 7, intubated and satting in the 60's, and to top it all off a cord gas of 7.0.

My question is, what is your recourse (besides documentation out the wazzoo) when this situation occurs? It is your responsibility to advocate for that baby - what if she had continued to refuse and the baby had not made it? Is it state mandated in what manner you can respond, or are there other regulations? Cannot two MD's sign that consent and go?

I'm just very deeply disturbed by the whole situation and refuse to accept that my hands would be tied if I had been that nurse.

Thanks for any input.

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Specializes in IMCU/Telemetry.

I'm not an L&D nurse, but I would think if she refused, she refused. But the responsibility is also hers. She can't come back later and say 'there is a problem with baby and it's your fault.' :stone

My question would be, if the baby is harmed/dies because of her refusal, could she be charged with child endangerment/negligence etc.

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I had a friend who refused a c-section and her baby died despite all the urging and warnings from doc and staff.

It is ultimately the woman's decision. As far as I know you can't override it.

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I think I remember some case in Utah? several years ago when a women refused a C/S because she didn't want a scar and docs knew that the baby (maybe it was twins, I can't remember) would most likely die as a result. Anyway, I think they got a court order. In an emergency situation, I would get AS MANY WITNESSES as possible to make and sign documentation- including the doctor of course. I would get a page full of signatures. Then I do believe she could be prosecuted later because abortion is illegal at that stage of pregnancy (duhhh...it's a little late now); and essentially that is what she was doing. As far as doing the surgery- like I said, a court order would be hard to get in time but I'm almost sure she could face legal issues later.

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I would love to hear more opinions or better still facts on this thread! If a pt came in stoned or drunk cps would get involved. If she were assaulted by her boyfriend and the baby died as a result he would be charged with murder(seen it) It is also illegal to murder your baby by abortion after 20 weeks. So how could it possibly be ok to refuse a c/s when the baby is dying????

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Specializes in Nurse Scientist-Research.

There was a case not long ago and the woman was charged with murder, but she was known to be mentally ill so I seem to remember they wound up dropping the charges. There were several threads here discussing it, this is one of them:

https://allnurses.com/forums/f86/charged-murder-refusing-c-section-60658.html

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I was a former L&D nurse, and though none happened at my hospital, I remember cases being presented at inservices where mothers refused C/S. In one, a mother was forced to undergo a C/S, literally held down with anesthesia knocking her out despite her refusal of the procedure, and the baby was found to not have been in any distress, as originally thought. The staff was charged with assault. This, I know, is an extreme case. I do think women should be held accountable if they choose to not pursue a C/S and the baby has problems as a result. But, there have been situations where the MD's were adamant a baby was in distress, the mother had a lady partsl birth despite staff's pleas, and the baby was fine. One thing I noticed in L&D was that all the OB's had different criteria as to who needed a C/S. One would allow a baby to decel for a longer period than another, before deciding to recommend C/S. It was based on their own comfort level as to what was going on. If it was decided a woman had to undergo it if a OB deemed it necessary, HOW exactly would you do it if a mother continued to refuse. I mean, how would you do it. Are you going to restrain a woman and just do it as she protests. Are you going to slip it in her IV as she lays there unaware of what is going on. I just don't see how you can make a C/S happen, while treating a patient in an ethical manner. I do believe she should be made accountable after the fact if something has happened to the baby due to her refusal.

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I would love to hear more opinions or better still facts on this thread! If a pt came in stoned or drunk cps would get involved. If she were assaulted by her boyfriend and the baby died as a result he would be charged with murder(seen it) It is also illegal to murder your baby by abortion after 20 weeks. So how could it possibly be ok to refuse a c/s when the baby is dying????

OK, well I know this is OT...but I just can't let this go...please remove it if you need to...but, it is *not* illegal to have an abortion after 20 weeks. Every day all over the country babies with Down syndrome are aborted up until 24 weeks. And I know someone IRL who was offered an abortion at 36 weeks (yes I said 36 weeks) when her baby was diagnosed with Down syndrome.

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

ANYone has the right to refuse anything at all. You may NOT assault patients by doing procedures upon them they refuse to have done!

But you ALWAYS get the physician involved and you always go through proper channels, ensuring AMA (against medical advice) papers/documents are signed and understood by the patient.

And you hope for the best, cause in the end, horrible consequences may result, a life may be lost (sadly), and what takes the cake, they can STILL SUE YOU.

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We have all pateints sign concents before we will even start an induction, and if they admit in labor we still have them sign a concent for c section, I have never had anyone refuse when you explain that the baby's life is in danger.

Interestingly enough we did have a mother who was commiting a late term abortion, 29 weeks or so. They were driving though our town and she was in such pain she stopped, explained she was taking medication and traveling to another state to complete this abortion. The baby delivered and needed lvl 2 nicu care. She refused to sign the concent to ship the infant, stating she was trying to abort the baby and didn't want it to live. Dr signed concent and baby shipped, did fine and was later adopted. Don't know what became of her as far as charges.

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OK, well I know this is OT...but I just can't let this go...please remove it if you need to...but, it is *not* illegal to have an abortion after 20 weeks. Every day all over the country babies with Down syndrome are aborted up until 24 weeks. And I know someone IRL who was offered an abortion at 36 weeks (yes I said 36 weeks) when her baby was diagnosed with Down syndrome.

thanks for that info-i was not referring to a termination for a legitimate reason although i do not believe that Downs is justification to terminate. But this thread is not about abortion, it is about refusing a c/s.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

(Nor is it really about anyone's personal beliefs on any subject...)

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