When pt is refusing a C/S

The keyword in my post that you're refering to is "personal".

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?

this is not an abortion debate thread, please be aware.

would you care to offer an opinion, belief or experience on the topic of pts refusing a c/s?

Alright then.

Our OBs get a consent for all pts. for a c-section, in case of emergencies.

The pt. has the right to refuse, whether i personally agree with it or not, luckily where i work, there is zero history of anyone refusing.

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!

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....

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.

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.