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.
I had a situation like this recently. It was (ironically) my first night on my own as charge.
The strip had been questionable for 2 hours then started looking even worse with no cervical change for 5 hours. She was having deep 60-second variables with some overshoots and veriability was all but gone.
The OB came in and the patient adamantly refused a C/S. She was a 3/2 from another country and very religious. So I found myself in the middle of phone calls with administrators, hospital attorneys, chief of staff, and ethics committee and to top it all off the OB kinda lost it and started crying and yelling.
Then the patient tried to get up and leave with an epidural no less. Lol it was a huge mess. I went in the room and convinced the patient to stay, explained and assured her that we wouldn't do anything without her consent. I told her that I just wanted to make sure she fully understood and that while we may keep on encouraging her to have a c/s that the choice was ultimately hers. I had the OB use the interpreter line just to make sure the patient understood everything and she still refused but at least didn't try to get out of bed anymore.
We did eventually convince her to consent. It was funny because right after she sighed the consent for a c/s the strip got much better. The patient ended up delivering lady partsly several hours later.
I think it varies from state to state and is largely based on abortion laws. In my state the cases I have seen presented at reviews show that either way you go your screwed.
In one case they tied the patient down and did a C/S. the docs and staff were charged with battery.
In another case the baby was born lady partsly and dead. The Ob was charged with manslaughter.
For me it's less a legal issue and a much separate issue from abortion. Yes the baby is at risk but this is a decision that also has to do with basic human rights and a person's right to decide what happens to their body. A C/S is a surgical procedure that carries physical as well as emotional and spiritual risks.
I think C/S is a wonderful technology and if my child were in distress I would want my wife to have a c/s and be dumbfounded if she refused. Despite that, I would never allow a patient (unless they were mentally unable to make a decision) to be forced into a C/S. It's not right to cut someone open without their consent regardless of the outcome.
Here is what I believe: I think it's so very important to form a trusting relationship with our patients and family members.
Exactly. They didn't tell her ANYthing that was going on. (I'd like to note here that I got my version of events from her, her mum who is a Social Worker, and her brother who is a medic) All she knew is that everyone was quietly freaking out. Turns out she abrupted. Everyone turned out fine, thank god, but it was just a bad communication situation.
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 Case Mgmt; Mat/Child, Critical Care.
Thanks for the links, Altalorraine. I was referencing post #17(also post #7, I think)....a current day (supposedly) forced c-section. I did see in the links about cases from back in the mid 80's time frame. I'm curious as to where in the US forced c-section is being or has been done in recent years.
Dayray, RN
700 Posts
I had a situation like this recently. It was (ironically) my first night on my own as charge.
The strip had been questionable for 2 hours then started looking even worse with no cervical change for 5 hours. She was having deep 60-second variables with some overshoots and veriability was all but gone.
The OB came in and the patient adamantly refused a C/S. She was a 3/2 from another country and very religious. So I found myself in the middle of phone calls with administrators, hospital attorneys, chief of staff, and ethics committee and to top it all off the OB kinda lost it and started crying and yelling.
Then the patient tried to get up and leave with an epidural no less. Lol it was a huge mess. I went in the room and convinced the patient to stay, explained and assured her that we wouldn't do anything without her consent. I told her that I just wanted to make sure she fully understood and that while we may keep on encouraging her to have a c/s that the choice was ultimately hers. I had the OB use the interpreter line just to make sure the patient understood everything and she still refused but at least didn't try to get out of bed anymore.
We did eventually convince her to consent. It was funny because right after she sighed the consent for a c/s the strip got much better. The patient ended up delivering lady partsly several hours later.
I think it varies from state to state and is largely based on abortion laws. In my state the cases I have seen presented at reviews show that either way you go your screwed.
In one case they tied the patient down and did a C/S. the docs and staff were charged with battery.
In another case the baby was born lady partsly and dead. The Ob was charged with manslaughter.
For me it's less a legal issue and a much separate issue from abortion. Yes the baby is at risk but this is a decision that also has to do with basic human rights and a person's right to decide what happens to their body. A C/S is a surgical procedure that carries physical as well as emotional and spiritual risks.
I think C/S is a wonderful technology and if my child were in distress I would want my wife to have a c/s and be dumbfounded if she refused. Despite that, I would never allow a patient (unless they were mentally unable to make a decision) to be forced into a C/S. It's not right to cut someone open without their consent regardless of the outcome.