My last few shifts at work have been a wide variety of patients. Inductions that go no where, inductions that take off super fast and precipitously deliver, pretermers, preeclamptics, c-sections. I think I've done it all in the last few shifts.
What bugs me are the inductions. These docs really dig for reasons to induce.
AMA (advanced maternal age) -- yep, let's induce her, even if she has no other medical or obstetrical problems. Just because we can.
Borderline BP's with a one time slightly elevated LDH? Induce her. Doesn't matter that her LDH is normal the next day, or that her BP's are better than mine. Let's induce labor anyway.
TOBP - Tired Of Being Pregnant. Gosh, I see this one more than I can count. Buck up sister. EVERY woman is tired of being pregnant at the end.
Hypothyroidism - someone please explain to me when this became an ACOG defined reason to induce? The last time I looked, it's not a reason. Especially when the woman is well controlled with medication, and her TSH/T3/T4 levels are all within normal limits.
BP's labile. Preeclampsia labs were worse one week ago then they are now. Multip patient has been hospitalized for several weeks on oral hypertensive meds. Let's section her. No, wait, let's induce her for vaginal delivery. No matter that she's 33 weeks. What's some time in the NICU?
Then again, we have some docs who refuse to induce for made up reasons. Case in point: we had a patient leave against medical advice because her doc refused to induce her. She had the TOBP syndrome at 39 weeks. Just walked out the door in a huff when her nurse was in with another patient.
That's one less bogus induction.
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I was induced. It kind of sucked. :-)
I had a great L&D nurse when I was being monitored in the hospital at 37 weeks with my first. I was not too keen on the idea of induction, but I was also hugely TOBP. I figured since I was already at the hospital I'd ask her about my chances as far as induction went.
She was *very* clear that considering my minimal dilation and effacement, we were looking at a long hard road should induction be necessary (it turned out it wasn't) and I'd be much better off to wait until I went into labor on my own.
I waited. Four and a half weeks later, Little Mr. Procrastination finally made his appearance :)
Bless that nurse... and you too!
Amen sister!
Then there are those pre-school vacation inductions... and pre-holiday inductions. Keep that census low when it is vacation time!! Makes me crazy.
Being someone that has had severe pe and partial hellp syndrome in the first pregnancy and severe PIH in the second, better to take baby as soon as you are able to than to have things turn for the worse. Bad labs a week ago only means that it WILL turn worse later on. Only cure for pe is delivery. I would rather my baby spend 2-3 weeks in the NICU at 33 weeks than to get severe pe and hellp or severe PIH again. The fact that she is on oral bp meds where she was hospitalized for several weeks says something. All it is doing is masking her bp. At some point those meds will not work anymore. She has had a baby before. What was her prior history. It's a good bet that she had PE before as that is the single highest risk factor for having PE. With a prior pe delivery, most docs don't take chances and let you get really sick. I know mine won't. I delivered my first with labs that were extremely scary (in fact when my current ob got my records after my second was born, he said I will be treating you much more aggressively next time than I did with S. I had excellent care with him where he watched me like a hawk!) My bp with the first baby delivered was 160-175/120-125. MY labs were ok with the second but bp on max bp meds of Aldomet and Procardia was 160-175/120-135. Scared the crap out of the nurses! I enjoy your blog, but I am a nut about PE/PIH/Eclampsia/HELLP. The other reasons were crap. But the PE one is a very valid reason. Things can change in hours. My first, I was fine although labs sucked and bp sucked. My dh left at 9pm. I crashed in l&d at 12 am. When he came in the next morning at 6 am I was covered in bruises, tubes, O2, and ivs everywhere. I had one iv with one bag on when he left. With my second, even though my bp was very high, baby was ok. I had a NST the day before she was born. I felt like crap but she was ok. The next day not even 24 hours later I had another NST at the peri's office. She had decels so I had an emergency induction that afternoon and she was delivered 8 hours later. If the labor had not have started immediately when starting pit, I would have had an emergency csection. That was per the nurse. It can change so quick that most drs have no tolerance for this.
I see the same thing. It's kinda sad that this must go on everywhere. We can always tell when one MD in particular is going on vacation based on how many inductions we have one week and then the next. There have been nights all of our rooms are full with elective or bogus inductions that we don't have room for 'real' labor patients and they end up delivering in our recovery room. And then there are nights we dont' have a room for an elective induction and she gets ticked that all of our rooms are full of people who went into labor on their own and thinks we should have saved her a room. Ah, gotta love it.
I had severe PE with my first, and was induced at 38 weeks. (And I got the evil epidural after 13 hours of no pain meds, too.)
With the second, as soon as my bp started up, I was on bedrest. At 37 weeks, everything went to Hell, and I was induced again. Both babies were nine-pounders, no complications for me or them.
The epidurals didn't even sow labor down -- in fact, both kids popped out about two hours after the needle.
Now, at 28 weeks, I'm starting to get nervous -- but my OB has already stated that it will probably be an induction.
Hell hath no fury like a TOBP woman scorned... LOL!!!
Most of the time our MD's are pretty good about only inducing for valid reasons (thank goodness b/c I would be going nuts otherwise). When TOBP ladies come in as labor checks, basically with some vague complaint and really just wanting to get induced and saying "can't you just induce if someone requests it?", I can confidently say "they are NOT going to induce you unless there is a medical reason to do so." And inside, I'm probably saying:
"IF they were to decide to do it for some reason, it would be scheduled by the MD's during an office visit, not right this moment at your request r/t TOBP. It's not a hotel that you can make a reservation for. There are actually women here who really need the nursing care that you are currently hogging for no real reason."
But it doesn't matter, she will come back tomorrow and try again, hoping for another result (btw, another nurse is going to tell you the exact same thing so you might as well not bother). But the nurses will have to do all the same work, all over again, every time you show back up. On our unit we have to do almost the same amount of work and charting for a labor check as for a regular admit and discharge.
Oh, and don't forget, the TOBP will have the nerve to get mad when she can't just get up and leave after 10 minutes when she realizes that she isn't going to get the on-the-spot induction that she hoped for. Sorry, but yep, we have to get a reactive strip. Even if baby is sleeping and we have to wait for him to wake up. Yep, we have to do the same papers. Yep, same computer questions. Yep.
We are a busy, understaffed unit and I just think it's a little selfish, even if the person is very very very TOBP, to take up valuable time and resources that sick and laboring patients need more than the TOBP moms-to-be. Just remember it when *you* are here laboring and your nurse can't help you as much as she would like to because she has to go deal with the next TOBP "labor check".
Do I actually act like that when this person comes in? Of course not. Would I say this about a person who really needs to be labor checked or has a problem? Of course not. But if you have a healthy pregnancy and are just TOBP, please let your baby cook. Your birth is probably going to go better and your baby will probably do better too.
AYC, you are my dream L&D nurse! I love ya! Also congrats on your weight loss.
What, you didn't have any inductions for "you're late" (40 weeks 1 day) or "your baby is so huge a vaginal delivery would kill you both"?
You are right, they do dig for reasons. I'm getting tired of it having gone through it 3 times (and successfully avoided induction!).
Love your blog--great insight!
I'll be back to visit again,
Anna
My OB wanted to induce me at 39 weeks, began discussing this when I was about 12 weeks. I have fast babies after being at the hospital for 2 hours (plenty of time in my opinion). She wanted to do it basically so I could arrange child care and get to the hospital in plenty of time. Ugh. She knows how I am and this time she's not even mentioned induction. I did hear in the hallway an interesting exchange at the OB's office while waiting for my appointment. A nurse or receptionist said, "the hospital called and cannot do your induction for the 18th, they will be able to though on the 25th." My OB said, "well, I'm going with what was originally said to me and I don't care what they say." It was funny because she's always so kind, I had not heard her angry before. She likes inductions, so women have to speak up for themselves with her if they don't want one...
Dawn
sounds like the ob docs in my local hospital...
we will be inducing because... because... the weather is turning bad?
LOL
For the record, I didn't just "show up" at the hospital TOBP for a labor check hoping for an induction. I had been at a normal OB appointment when my OB couldn't find my son's heartbeat. I had an extended BH contraction, and once it eased off they were finally able to find his heartbeat again. However, my doctor did want me at the hospital for some extended monitoring after that situation.
I was scared out of my mind, and on one level I was wondering if the child wouldn't be more safe outside my body where I could easily verify he was alive. Fortunately his strip was fine and we were dismissed to go home. But that's where my interest in induction at 37 weeks came from.
I have to say that I am very, very distressed at the lack of empathy and compassion I am seeing in the L&D blogosphere.
Between nurses and midwives being markedly anti-pain relief (as if you're less of a woman or mother if you don't "buck up and take the pain" and go natural) and openly disdaining women who are "tired of being pregnant," birth is becoming something to dread.
Nurses have a degree of power over a laboring woman. They're looked to as advocates; comfort- and care-givers. This means ADVOCATING and comforting the patient, even if she makes choices you don't agree with or would not choose.
There is a degree of absolute trust that a woman must have in her L&D nurse; after reading a number of midwife and L&D nurse blogs, I am not trusting the words or actions of any single one of you.
Just lately, the term "birth rape" is fashionable. I'd consider an L&D nurse who is so openly negative on pain relief, cesareans (when needed), and necessary inductions to be a potential "birth raper." Belittling the pain or the medical choices of your patients betrays a contempt for them, which shines through in your blogs and your behaviors.
Congratulations -- y'all have managed to make me even more anxious of an experience that is supposed to be one of the best of my life.
I know this is schadenfreude-licous of me... but who wants to bet that anon at 6:47 has a scheduled c/s... or the very least an "emergency" one?
I know... I'm a bad, bad person.
People are defensive of their birth expereinces. I'm not a nurse, but a mother of three. When my first birth didn't go as well as I liked, I educated myself. My first was with an epidural, and I paid the consequences for it. Simply I didn't enjoy having my baby.
The second and third I prepared myself for the birthing experience. Our bodies were designed to birth. No drugs. No nothing. It was great to be able to have my baby immediately after birth and to get up and pee too.
My first labor my water broke and I went from 3-10 in an hour.
My second I was overdo one day and my doc was going out of town for a conference.
My cervix was 3 centimeters and I was 80% effaced for weeks.
B/c of my history of precipitous labor after water breaking and the fact that I lived 30 min from the hospital in good traffic and he was leaving he decided to induce by breaking my water. I did not want pitocin, but the baby was so low that not much in the way of water happened so they gave me a touch of pitocin (as the nurse put it) and I was off. 3-10 and had a baby in 1 hour!
I dont know if it was right or wrong, but it went well and quick.
I defintely did not want to deliver at home or in a car and she came out quick, a push and a half!
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