I had a multip mom laboring beautifully and spontaneously. She progressed quickly to 10 cm dilated, and was fairly comfortable with her epidural. She had a history of short pushing stages, and the baby looked fabulous on the monitor.
The doc wants to teach the resident how to apply forceps.
(Umm, hello? You want to do what??)
When I heard this, I approached the doc and said to him "there is no medical reason why you need to apply forceps -- this is just a teaching time? Um, no."
He looked at me like he couldn't believe I would go up against him like that.
I stated the same thing again - "There is no medical indication for forceps. The baby is tracing beautifully on EFM. And the fetal head is presenting at the vaginal introitus. This patient is not a teaching patient to "practice" forceps on. Now, are you going to put some gloves on and come catch this baby, or what?"
End result? Spontaneous vaginal birth in under 2 minutes of maternal pushing. No forceps. No vaginal or perineal lacerations.
Now, I understand that there are times that residents need to learn new procedures, etc. However, this was totally NOT the right time, nor the right patient to do this.
And this was totally the wrong nurse to try to pull this crap on.
32 comments:
What the hell???? Excuse my language but that is totally unacceptable of the OB to even SUGGEST the use of forceps!!! It is a procedure with risks and definitely NOT to be done without medical indication. Thank goodness you had the guts to stand up to the doc and stopped them. You were TOTALLY in the right. I would have done the same thing. AND written them up. U.N.B.E.L.I.E.V.A.B.L.E.
I have heard horror stories but this one made my jaw drop. God save the women from some of those OBs out there.....
(you would love working with the OBs on the teaching video on my last post! :) ...no unnecessary tomfoolery there with them!)
Yes! I love it!
I don't mind teaching moments, but c'mon pick the right one!
This one should be listed under docs, "Let the patient do the work and just catch".
Too bad they need nurses to remind them of that.
You did a great job! Lucky patient to have you for her nurse. :)
That's insane. And, as much as I shouldn't be surprised, it makes me really sad that anybody would do something as invasive and potentially traumatic as a forceps delivery with absolutely no medical indication, which is even more clear with your patient's clinical profile.
Even if kiddo didn't look so good, have her push once...hello...
What is that OB teaching his resident about clinical decision making if he's just trying to look for opportunities to "practice?"
Good for you for being a strong patient advocate.
my last comment wasn't quite clear
When I said "have her push once" I meant baby would probably be half out with one push given her history and how low baby was, NOT "try pushing once then put on the forceps."
That would be nonsense.
Can I hazard a guess that this patient was not white, well-educated, privately insured, well-off, English-speaking, etc. etc.?
Yo go woman! Advocate extraordinaire!
I hope that when I deliver, I have nurses like you looking out for me. Do you have any general advice you would give to first time mothers before they give birth?
This makes me sick. The doctor was ready to treat the patient like a piece of meat. Not to mention cutting a huge episiotomy that would probably tear beyond that. Just so he can teach a resident how to play with a birth toy. Which he should know foreceps are not toys.
I feel violated on her behalf. Thank goodness you were there and had the stones to stand up to the doctor.
argh. I would have known this was wrong, would likely have not been able to speak up for myself in labor, and if my husband didn't fight for me, I would have had a rocky postpartum with him. I think I would have postpartum depression (or is it post traumatic stress or some other abuse reaction) to this knowing I did not need it in the past. This mulip sounds like me in that I used to, before they turned op, would have a very short pushing stage the same...and it really would have done damage emotionally as well as whatever physically. I also would have felt very sad for my baby if there was any extra damage to the face (even a bruise) or something. That doc is risking getting sued.
Blessings!
Dawn
How common is something like this?
Blessings!
Dawn
As someone who had a medically indicated forceps delivery and suffered the consequences (shoulder dystocia, baby with collapsed lung and APGAR of 3, episiotomy that required revision surgery 8 months later), I can't believe that this procedure would ever be used when not medically indicated. Aren't there enough opportunities to teach forceps use on patients with a medical indication? More importantly, if you're a patient in a teaching hospital, can you refuse being used as a teaching case in advance? I mean, being ready to push out a baby is hardly the time to have to fight Doctor Scissorhands
Yay for you!!! =)
Rock on! What is a multip? I keep seeing this term...
multiples? already had one child?
Rebecca - if I answered that, I'd be violating privacy rights. :-)
Jaclyn - great idea for a future post!
Type (little) a - exactamundo, my friend.
Dawn - I was also thinking of the postpartum difficulties she might face, not just physical, if he had put forceps on.
VNess - not enough opportunities, even in a big teaching hospital. Forceps are very rarely ever used. If we're going to teach residents something, how about how to deliver a vaginal breech? And yes, you can refuse to be a teaching patient - even if you are under the service of the residents. Everyone has a right to refuse care or procedures.
Abby - a multip is a multiporous woman - a woman who has given birth at least once before.
Well, all I can say is, thank God for you. !!!
How do these pros forget that while they see births every day and it's (highly respected, highly paid) "work" for them, for the patient it's a once in a lifetime moment (even if you have more than one child, it's still a precious event like no other)? How do they lose the respect?
I'll never forget the chief of OB (my long-time OB had recently joined his practice and he was her operating partner ... all the OB's in that practice were paired up for surgery and because Chief was the senior lion, even though I was there as ~her~ patient, he ran the show) ... I'll never forget him holding court over me with two or three (about to graduate) students (it was the end of June) during my third c-section. All the back slapping and chit chatting like I wasn't even there. Like I was cut open in the middle of a cocktail party. He wasn't unfriendly, but we were in different worlds -- me at the pinnacle moment of what had been a two year plus journey to (what I thought was) my last child ... and him ... what? What was he thinking? Whenever he did think to acknowledge me, it was a bit canned and came off (in light of his behavior) insincere. I don't think he was a bad guy, they say he is a good doctor, but I marvel at the insensitivity -- his silly behavior, of all things, is what I remember most from my third birth. I was resigned to the repeat c, but it didn't have to be like that. I felt bad about it after -- it's not like you get a do over. Oh sure, I have perspective. Of all the things that can go wrong during childbirth, this is a non-issue. But it's still such a valid, important point that you raise for consideration here.
I probably should have said something, but I didn't have much hope that my lowly input would be well received. It was best just put behind.
I cannot imagine someone doing an unnecessary intervention ... let alone one that could complicate my recovery (!) and mark or injure my child ... not to mention alter that amazing moment for the worse ... merely for demonstration purposes. I shudder to think of it.
Where are their heads? Seriously? How do they get like this?
Another quick question: was this OB going to ask for the mother's consent for this procedure? Or did he think he could legally (and ethically) pull out the scissors and the salad tongues and just perform this procedure because she'd signed a blanket consent with the admissions papers? Are non-medically-indicated procedures even covered by such a blanket consent?
It seems like the hospital's legal dpt would want to know about one of their doctors engaging in practices that ask for lawsuits. Not to mention the ethics committee (if there is one).
Who "practices" using forceps on a laboring woman?? =/
SO glad you were there for that patient!
Rebecca: the same thought ran through my mind...after my experience in Palm Desert - doing a travel nurse stint...I blogged about it.
I find that it is much more common to use forceps in Canada as opposed to the USA...I only saw forceps used once in the 7 years I worked in the USA.
If I were a laboring mom, I would make darn sure to have a birth plan in the USA, at least at the hospitals I have worked at...they are needed.
Vness: In the hospitals I work in Canada, forceps are thoroughly discussed with the patient and choices are given...and as a mother you would have a right to say no... there are no consents signed for forceps.
Wow. There need to be more nurses like you. And less doctors like him. Super scary that a doctor would allow someone to "practice" something unnecessary on a laboring woman.
Wow, all I can say is thank goodness she had you as a nurse! It is just so sad to me that women are treated like this and if they don't have an advocate, are up a creek.
It makes me question what I would do as a doula in this situation. I guess I would ask mom and dad if they have any questions about what the doctor was about to do. Like was it medically indicated... what made the doctor feel it was indicated, could they try to push on their own for awhile first...
Uggh.
your awesome, nursing students more mentors like you to lead as an example. :)
I wish there are more nurses like you at the maternity ward! Awesome!
Hey! I know something rare and valuable this particular delivery could teach the resident:
How to sit on your hands and let effective maternal effort produce a healthy baby.
I wonder if the resident has ever had *that* opportunity before...
Cartoon Characters - I had a beautiful birth plan, every detail addressed... and no one looked at it, maybe a couple nurses. One of the OB's walked in and broke my water without asking my permission, which I addressed on my birth plan. I'm 20 weeks and I'll be driving 45 minutes to another hospital to have access to a midwife, even though I'm less than 10 blocks from a hospital here...
Thank God for nurses like you! Your patient was VERY blessed!
I totally agree! Congrats to you for standing strong!
That doc needed to be woken up a bit from his narrow-minded teaching bubble. It's far more rare for the resident to see such a smooth birth without interventions!!
As for the forceps, go for the dummy. That's what they're built for. Sheesh.
As an OB nurse 11 years ago at a teaching hospital, my partner and I would see the signs of the forceps outside the door of the multips who were pushing well and clearly needed no help. We would hide the forceps, drop them ont the floor as we opened them sterilely, be in mom's face and encourage her to push "as if your baby's life depended on it," Crazy that we felt the need to do that...
@Anonymous: That is pretty cool. :)
It reminds me of something I read in Barbara Harper's book, Gentle Birth Choices: "The use of water for labor has been linked with a significant decrease in episiotomies, almost eliminating them in hospitals where birth pools were used regularly. A funny thing started happening when the women in the water did not need an episiotomy. Providers realized they weren't necessary on women who weren't in the water, either. On one unit in England a few midwives started leaving the scissors out of the birth instrument packages on purpose or dropping them on the floor during a birth, so that none would be available (Harper, 2005, p. 87)."
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