....when you come in with vague complaints of pain and the entire staff knows immediately who you are because this is your millionth visit to L&D. You've had more pregnancies in the past several years than I can even keep track. You use L&D as your "prenatal care" for each of your pregnancies, and even shop around at different hospitals. Your urine drug screen comes back positive (no surprise), and you get angry when you don't get narcotics immediately upon your arrival.
Then you take off your monitor belts and leave because no one will take you seriously. You sign out against medical advice, refusing to even take the prescription offered for the antibiotic that you need for your legitimate infection that you chronically do not finish treatment for (and it keeps coming back.......)
And the cycle begins again, when you come back to us next week.
So, forgive my lack of empathy, ok?
20 comments:
Hallelujah!
... and somehow the visits keep getting paid for... I've heard that some states Medicaid is refusing to pay for excessive/unfounded visits... I wish they all would.
I wish that pregnant women with positive drug screens would get arrested for child endangerment.
I wish that pregnant women with positive drug screens would be offered services, understanding (if no empathy is available)and education about detox, counseling,drug treatment,and at the very least harm reduction....
Sarah -- no reason both can't happen, but in this case it sounds as though the patient is a repeat offender who has already been offered (and refused) services.
Drug abuse is a tricky thing, and I would say she should be offered those services each and every time, because you never know when she will accept. I have clients that I have worked with for years that have refused detox every time I offer. I always work with them on harm reduction strategies. I get people who I think will NEVER accept services, BUT I always give it my best shot, in a gentle non-confrontational way. People are ambivalent about change, but if you offer it they do accept when they're ready.
Guess it's the social worker in me. I always remind myself that it's their journey, and I sometimes get to, not lead them, but walk beside them and hold their hands. That means I don't judge for the choices they make, but am always there to support them and offer unconditional positive regard. I guess we all have our roles, and to some extent our job descriptions dictate that role, but I think that it's good to remember that just because she isn't accepting help now, that doesn't mean she will NEVER accept help.
Also I imagine that as nurses you are mandated reporters, which means someone is filing a report to whatever child services exists in your area. So hopefully she is still getting offered some services each time she shows up with a pos urine.
I guess I am just looking at this from a different corner,and offering my view from over here.
Sounds like rehab time.
I think the National Advocates for Pregnant Women are a good source of information about drug abuse and pregnancy.
Here Here!
mtfh, Great website. Thanks for that.
JoAnna, the problem with the suggestion to charge a pregnant woman with child endangerment is the slippery slope effect---where do you draw the line?
Would you have me charged because I ate blue cheese and deli meat throughout my pregnancy? Or would you charge my friend who still drank coffee every day that she was pregnant? You simply have to look no further than a mother in Tallahassee, Florida who was recently held against her will in the hospital by the State Attorney and her OB because she could/would not quit smoking.
The bottom line issue is this: autonomy. Granted, some people such as the one AYC described perfectly depicts the 90/10 rule. That is, 90% of your clients will be no problem and take up reasonable amounts of your time, whereas the other 10% cause most of the problems and eat up TONS of your time. We are all in control of the choices we make for ourselves and cannot control the choices that others make.
I think it is well within her rights for AYC to not have any empathy, but it is still her job (and the other nurses and staff) to do their best to hold up their end of the bargain in providing care. What the woman does with it is her choice.
One thing that strikes me, however, is that this woman obviously has some severe issues. The thing is, we ALL have issues. We just all wear them differently.
The slippery slope argument isn't too compelling to me. Of course, the world isn't black and white - reality is shades of grey. But this doesn't stop us from having laws which citizens must abide to or face consequences. Many would argue that the seatbelt laws were going to start us on a slippery slope to where we have no individual rights to make decisions (good or bad) for ourselves.
I think we (society) needs to take a clear stand on things. Either it's a mother's right to use illegal drugs during her pregnancy, or it is not her right. If it's her right - you can offer advice, but no legal interventions. If it isn't her right, then there needs to be legal ramifications.
I don't think we should dance around a very real issue just because we fear a theoretical "slippery slope". As thinking and rational people, I think we can all see there is a vast difference between a mother who is shooting heroin versus a mother who is eating blue cheese. Even if you take out the rational and thinking part, and purely look at the numbers, one is a serious risk to the child and the other is a statistically insignificant risk. Not to mention that one is illegal and the other is legal.
I don't claim to have the answers... but I think that hcp and the law does need to take a clear stand on issues that endanger children and not get bogged down with hypothetical slippery slopes.
*plunk* *plunk* That's just my two cents. :) Not sure if it made much sense.
I agree with the above poster about drugs... (personally I wouldn't mind if drugs were legalized in general... BUT it's different when you're pregnant):
I've never understood how a regular person can be arrested for so much as simply having paraphernalia but somehow you can be pregnant, *with the drug actually physically present in your blood*, on a drug screen, and not be arrested (or have some consequence)... to me that is twisted logic...
The logic is that if drug using mothers knew that the hospital would turn them in for drug use, they wouldn't go to the hospital for care. And as big as home birth seems to be, it is still a dangerous issue when you have no care whatsoever, and are possibly even less well than the average mother. Yes, these children will suffer for their mother's choices, but you do want to have the connection to help those mothers, however you can, because otherwise, both mother and child will suffer more.
I ate blue cheese today (and am 36 weeks pregnant). Guess I should be tossed in the slammer, eh?
The thing is that the woman in the scenario came to the hospital to get a fix, and then walked out AMA, without necessary medication, when she didn't get one. So the trip was essentially wasted and pointless anyway. At least a jail stay could have gotten her off the drugs on a temporary basis (she probably still would have refused antibiotics, but maybe she would have taken them at that point -- who knows?).
It's just frustrating to hear about women engaging in illegal and dangerous acts that are certainly harmful to their babies and knowing that they walked away to repeat the vicious cycle. I don't think there's a perfect answer.
A fetus isn't a child, and if you make that fetus a child - a legal person - then it's rights compete with its mother's. Who's rights take precedence? Is it the mother's rights? Or the fetus' rights?
What happens when the fetus' rights trump the mother's? Does not the mother lose full citizenship?
Would you reduce women to incubators? Like that woman in FL, strapped to a bed and involuntarily committed b/c she wouldn't quit smoking?
Or that woman a few years back arrested and taken to the hospital for a court-ordered c-section.
Who decides the fetus' best interests?
I know it's kind of beside the point of the interesting debate, but I think the lady in FL had a lot more to the story (like always); I believe her water was broken, among other things... I definitely don't think it was just a stop smoking thing...
Dianna, I guess you have a point.
On the other hand, my unit has mostly "casual" drug users, who are not addicts, and I wonder if the threat of actually having a consequence would deter them from using. I think for them, it would deter using more than deter from getting care... but yeah sketchy bet...
If a fetus isn't a child, then what am I pregnant with, a puppy?
Federal law (i.e., Connor's Law) would also disagree with you, as someone who murders a pregnant woman can be charged with two homicides. Thankfully, that law hasn't caused a rash of forced C-sections because it recognizes the humanity of an unborn child and the harm done to him/her.
@ Mitchsmom. There has been quite a bit of research about drug use and "consequences". No need to wonder. Imposing consequences such as jail, criminal charges, etc... on drug addicts makes little significant difference in their drug use. It does however cost a lot of money and lives. Resources that could be better allocated are wasted on punishing people who have a disease that needs TREATMENT, not punishment.
I have included a link to an interesting article (don't know how to embed it sorry) http://www.sciencemag.org/cgi/content/short/245/4921/939
Amen Sister! Just got off nights and had two of these lovelies last night!
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