Does this make sense?
Patient #1 comes in with spontaneous rupture of membranes. She's a multip, contracting every 3 minutes, mildly uncomfortable. The nurse doesn't check her.
Patient #2 comes inwith spontaneous ROM. She's a multip who is VBACing (has had three vag deliveries prior to the section). She's not contracting or complaining of any pain. She's been ruptured for 5 hours. The same nurse checks her.
Does anyone see the illogic behind this? Why wouldn't you check the patient who was contracting regularly and leave the VBAC (especially want expectant management for her!) unchecked since she isn't contracting!!!!!
Please put me out of my misery. I had a temper tantrum about it at the nurses station. One of the nurses tried to use the "well the docs want to know" logic with me. I promptly replied that the nurses ought to friggin know how to approach midwife patients. After all, I've had this very discussion with this nurse (the one who checked the one patient and not the other) in the past. AND we midwives have been at this hospital for quite some time (several years) now - you ought to have it figured out by now.
I'm becoming increasingly unhappy with the behavior and care I see from some of the staff. I had a revelation tonight. Perhaps I shouldn't be doing hospital birth anymore. Perhaps I need to be a homebirth midwife! Too bad that's not feasible in the state I live in.
5 comments:
If you're at the hospital (you, the midiwife) why would the nurse need to do a cervical exam at all? I always defer to the midwife/doc if they are in-house. Unless, if the woman presents and appears to be very close to delivery. Then I check her myself so I know if I need to stat page the provider to the bedside!
I was not present at the time either patient was in triage. And some of the nurses check patients in general, even if we are there. Seems silly unless I am tied up.
Our MD's (we don't have midwives) would yell at us for calling withOUT checking just about everyone... (unless they are preterm and r/o rupture or previa, of course)...
The MD's generally expect us to check the patients even if they are sitting at the nurse's station playing video games. They usually don't go in a room unless someone needs ROM or delivery.
...but yeah, of the two I would have picked #1.
Did the nurse ever tell you her reasoning?
Never spoke with her - I didn't find out there was an exam on #2 until after shift change.
i wouldn't have checked either of them.... Unless #1 was REALLY uncomfortable...why not just let her labor without a VE? Keep the fingers outta there as much as possible...that is my way of thinking. #2 I wouldn't have done a VE either...same reason...increased chance of infection with increase of VEs and u can bet there will be a lot of VEs with both by the time they deliver. It just isn't natural. And by the way, yes I am a L&D RN with 15 yrs high risk obstetrics....but I guess in canada we do it the more natural way....in fact i know we do it more relaxed here...I was trained in the USA and it took some adjustment when i moved back to canada....
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