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.
The keyword in my post that you're refering to is "personal".
I'm uncertain what you are trying to say Marie, but since you keep posting to correct me on this thread; would you care to offer an opinion, belief or experience on the topic of pts refusing a c/s?
If a woman has the choice to terminate the pregnancy she certainly has the choice to refuse treatment or c-section. I'll never understand why in the same hospital one woman has a legal abortion and another has CPS called on her because she refused a c-section and put the child's life in danger. I'm not making a statement for or against abortion here but if one type of choice is legal concerning the fetus, why not others? Let's please be consistent.
There are times that even thought the mother might refuse a c-section it can be done anyways. That would be determined by the emotional state of the patient. I have a friend that was a circulating RN in the OR and she had a mom who didn't want a c-section (it was emergent) because she didn't want a scar and they put her out and did a c-section anyway and it was justifiable becuase of her current emotional state at the time, and her irrational decision making.
There are times that even thought the mother might refuse a c-section it can be done anyways. That would be determined by the emotional state of the patient. I have a friend that was a circulating RN in the OR and she had a mom who didn't want a c-section (it was emergent) because she didn't want a scar and they put her out and did a c-section anyway and it was justifiable becuase of her current emotional state at the time, and her irrational decision making.
I would like to know the circumstances surrounding this case. I know of no situation other than a court order that would legally justify performing a c-section on a patient who has clearly refused one.
Who determined that her emotional state and irrational decision making justified forcing unwanted surgery upon her?
Specializes in Case Mgmt; Mat/Child, Critical Care.
I would like to know the circumstances surrounding this case. I know of no situation other than a court order that would legally justify performing a c-section on a patient who has clearly refused one.
Who determined that her emotional state and irrational decision making justified forcing unwanted surgery upon her?
I agree, when and where did this happen? I can't see that happenning either. Incidentally, I was, just recently, involved w/a case similar, need for c/s, mom refusing, etc. No way was the doc going forward without mom's consent. And we had everyone from base command to ethics to chaplain to risk mgmt, etc in that room....in and out all day....still didn't happen.
Whew, talk about the charting on that one....yikes!
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Also we need remember, just because they sign consent when they come in in labor (a sort of "just in case" thing) does not hold them to it, should they decide they do not want a csection after all.
poking my li'l head inHere's one of those annoying "my family member" stories that we all love so. My cousin was having kind of an ugly labor (brought on by too much pit, but that's a whole NOTHER story) and she heard the nurse tell the resident just outside the door that the attending was thinking about sectioning her. She turned to her mum and said "I don't want to have a C-section!" ('cause you know, no one really WANTS one) and the nurse and resident came running in and started with the "Your baby is going to DIE if you refuse this!" I realize this adds nothing germane to the discussion, but I just wanted to ask everyone to make sure a pt is really refusing before starting in on the doom and gloom.leaving now....
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
You bring to light an interesting point, Eliza.
Here is what I believe: I think it's so very important to form a trusting relationship with our patients and family members. This, IMO, begins in the midwives/doctors' offices and extends to the hospital and us nurses, as an obligation. I think if a patient and family TRUST their health care providers, a lot of the "doom and gloom" threats we hear of, would not be necessary or even occur, at all. And obviously judicious management of labor and continually keeping the patient/ family informed, are critical as well.
Clearly, I can't comment specifically on your loved one's case, but that is the way I see it in general, Eliza. Hope this helps.
Deirdre
23 Posts
Actually it seems to be about our opinions, beliefs and experience..or why post a "discussion" thread????