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Re: Labor definitionFrom: Betsy Hyde (elishyde@mindspring.com)Fri Jul 18 19:34:40 2003
On Friday, July 18, 2003, at 06:57 PM, Anna Meenan, MD wrote:
> Oh, Betsy, could you tell your story again? You know the one I mean. lol, sure. I'm on a different computer now, so some of the minor details may be different, but the message is the same. Muslim woman, 2nd baby. First birth was pretty rapid....4 or 5 hours, more or less. Doesn't matter...it was fast. Routine cervical exams at term revealed advanced cervical dilatation. I think she was 5 or so the first check. She wanted to have the baby, but her husband wanted no interventions, and she did not want to have a disagreement with him, so she went home. Came back the next day, was 6 or 7 or so. Same story. Wouldn't go to hospital. Came back the next day, 8 or 9 or so. I am rapidly becoming psychotic over this, and do the whole risks/benefits/alternatives thing for about the 3rd time. Unattended delivery at home etc. No deal. I send her out to walk for a couple hours. She comes back almost fully. No contractions. She is beside herself. I am beside myself. Her husband will not allow any intervention, and she will not consent to anything against the wishes of her husband. It is rapidly becoming a very bad day. I do convince them to go to the labor floor for observation. Silly me, I am convinced she will SROM and the baby will fall out. Ha! She is there for 24 hours, fully dilated, not contracting. I am there for 24 hours watching nothing happen. Her husband, who is a law student BTW (how could I have forgotten to mention that sweet little detail...now the lawyers lurking on the list will probably turn me into the HIPAA police) would sit on the couch and glare at me whenever I checked her. "I know that sometimes people 'accidentally' have ruptured membranes when they do exams. If that happens you will be sued for battery" (or was it assault? battery, I think. Lynne, Marilyn, help me out here.) I don't even know why I bothered to check her...did I think she was going to shrink? Did I think the baby was going to be crowning? I don't know what I was thinking, actually. But after 24 hours I wanted to do *something*! Whenever he left the room to eat or urinate, she would cry bitter tears...just wanted to have the baby, but she couldn't go against her husband's wishes, and would not consent to AROM. They finally got so that the sister in law would come whenever he left. The SIL was against interventions as well. She'd glare at me, too. I don't know about your hospitals these days, but the hospital and the labor floor nurses really frown at women just hanging out for days on the labor floor without any attempt to get them delivered. So now they are glaring at me, too. After a day of patiently sitting, watching, waiting, reading a lot of books and old journals and getting glared at from all sides I, too, get tired of this. I make my umpteenth call to risk management. I explain the case, and tell the CNM/JD head of risk management that I am going to send her home. She thinks that is a reasonable plan, given that I have, by now, written about 10 pages of notes, documenting each word out of my mouth. So....I sent home a multip w/ hx fast labor after being fully dilated x 24 hours. She ruptured membranes a few days later, had painful contractions, and delivered about 2-3 hours later. They don't call it labor for nothin'
-- Betsy Hyde CNM Branford, CT
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