Compassion...

In clinical recently I had an experience that made me question (again) if I could ever work in the hospital as a L&D nurse. My preceptor and I started our day with a couple in very early labor. In fact, they probably wouldn't even be at the hospital, but the mother had SROM early that morning and was GBS positive. Per the hospital protocol, a GBS+ mother has IV antibiotics every 4 hours in labor. It’s unfortunate that primips are told to come in right away because usually with a primip you have plenty of time to get in a round of antibiotics before the birth even if they stay home until they are in active labor. Any time you come in early to the hospital your labor will be fucked with-- that you can count on. If you decide you want a hospital birth, my advice to you is to go to the hospital when you are cookin' with gas, check your own cervix before you go in. It blows my mind that people go in, scared they will be sent home (which they pretty much never do so don't worry about that) when they could check their own cervix-- its your cervix dammit!!!!

I spoke with the couple while working on their admission paperwork and they told me they were interested in having a natural birth. The mother stated she was having some back pain, so I asked my preceptor if we could take off the monitor for awhile so the mother could move around. Of course this is never something a nurse would offer, someone would have to insist on it and they only way the will take it off is if everything is going perfect so far and there are no interventions yet.

These parents seemed unable to cope with contractions and did not seem prepared with any coping strategies. I am not suprised as I sat through the birth class offered at the hospital and its absolutely ridiculous. I made some suggestions about positions, but it seemed to me that they were not confident in there abilities, nor did the mother seem able to follow her body through the contractions. The nurse suggested getting out of bed and put a chux on the chair and said "you can sit there." Well, you may as well be strapped to the monitor because sitting up in a chair is not going to do any good! This is where a good child birth class can be very helpful, so parents have tools they feel confident in to deal with pain. This poor woman was fighting every contraction, hyperventilating, curling her toes and trying to stay in control. Its so sad, I feel there is nothing I can do at this point.

Eventually the mother took some Stadol and slept for awhile. The husband thought this would be a good time to run home to take care of their dogs. He probably did not understand the importance of his presence as my nurse and I did not spend much time doing labor support. Why that is, I don't know. We only had one patient! We could have sat in the room doing charting or been a little more encouraging, but basically nurses stay in the nurses station until 2nd stage.

The Stadol began wearing off and the doctor told us to start Pitocin at 2 by 4 every 30 minutes. I overheard the medical resident state that this order was “obnoxious.” I was glad somebody thought that was ridiculous. It makes me laugh when I see these fat, old OBs; give me a break, why are you doing this work?! You don't give a shit about women or birth or babies! This doc is the same one that nurses can tell when he checks someone when they are in the hall because women scream. Really nice... why isn't he confronted about that? That's assualt if you ask me. The whole thing is just disgusting.

This protocol was very intense for the mother and it was obvious that no one could have a natural birth with that level of Pitocin. She appeared to be in a great deal of pain and will probably not remember that day fondly even though its supposed to be one of the happiest days of a woman’s life. I have seen many natural births, but I have rarely seen anyone in this much pain especially so early in the dilation phase of labor (2-3 cm). I mean, this woman was suffering. This wasn't "pain with a purpose" this was inflicting an unnatural level of pain that the body would not be able to create on its own. The contractions were every 2-3 min. lasting 60-90 seconds and they were beyond intense, they were torture. She was grabbing the bed, holding her breath, trying to escape the pain. She was sobbing. It was horrible. And then we left the room. We went to the nurses station and paged the anesthesiologist as there is no other option at that point. I could here her sobbing and screaming from the nurses station and she was all alone. I should have stood up to my nurse and said I'm going to stay in there with her until her husband comes back, but it just didn't feel like an option. When I have stepped up and done that in the past nurses get offended like I am overstepping my bounds as a student.

My nurse and I switched to postpartum and last I had heard our patient had not progressed much past 3 centimeters dilation and the baby was beginning to have decels. Some of the nurses were calling her a c-section early in the day and that prophecy looked to be self-fulfilling. It is so unfortunate that she would probably be an “emergency” c-section for fetal distress that the doctor most likely caused by his aggressive labor management. And then they will say "thank you, thank you doctor for saving our baby."

I find the level of compassion in the physicians, nurses, and residents to be disheartening. My preceptor and I sat in the nurses’ station and paged the anesthesiologist to get an epidural right away as this seems to be the only option at this point. I don’t know if turning the Pitocin down is an option. The resident sitting in the nurses’ station seemed concerned about our patient and I said to her “it’s pretty intense and her husband isn’t here right now, he had to run home.” She turned to me and said “so,” in a way that made me think that she had never experienced pain like that, nor did she have any empathy. Compassion and empathy are very valuable qualities to have in health care providers and these skills seems undervalued in comparison to technical skills or getting a patient “delivered” as fast as possible. What happened to the nurse being the patient advocate!

I could not agree to such a high dosage of Pitocin causing more pain for the patient and more risk. If a patient has some negative consequences from the oxytocin management who is to blame, the doctor that ordered it or the nurse that carried the order out? In school it seems that we have learned we always have to double check what a doctor orders because if we give what they order and its incorrect then our license is on the line. As a nurse I wonder if you are able to question or disagree with a doctor. These are all questions I would have to answer before becoming a labor and delivery nurse.