Re: Labor definition
From: Anna Meenan, MD (annam@uic.edu)
Sat Jul 19 14:16:22 2003
Got to thinking about this one some more and decided it would be
interesting to pose the question to the group: How would you have
handled this case?
--
Anna Meenan, MD
P.S. My own inclination would probably be to park her on L&D with
residents in-house and go about my business until something happened,
but then I actually HAVE an in-house resident (2, in fact), and most of
my pt's live >30 miles from the hospital. If I had the presence of mind
to think about it (which I probably wouldn't under such stress), I might
suggest quietly to the mom that she do some nipple stimulation whenever
her hubby was out of the room. Otherwise I guess she would just sit
there until utilization review decided to intervene and then I would get
them, risk management, and the Dad together in a room and tell them to
call me when they had reached a mutually acceptable decision.
Anna Meenan, MD
At Fri, 18 Jul 2003, Betsy Hyde wrote:
>
>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
>
