September 2, 2008

Honesty (or lack thereof) in L&D

What an odd night last night was. It seems lately I've had quite a few patients not want to answer questions or be honest with me. They choose to stay quiet when they don't want to admit to whatever. And usually people have no problem telling me things, like the positions they find work nicely when pregnant, or that they checked there own cervix. But not lately. I had a 21 week patient last week who was high on something and wouldn't make eye contact, or admit she'd taken something. But she gave me a urine sample, so I don't know why she was hiding it. And last night, I walked out of my midnight elective induction's room to drop my consent forms off at the desk, only to find an ER RN with a patient in a stretcher. Now, they don't do that. Usually our scrub tech gets the patient, or if they think they are about to deliver, we go a-runnin' with a precip kit. But, here is this patient on a stretcher and the RN says "Dr. So-and-so said she's 6cm and 100% effaced." I thought "Sh*t, hol* f@#king hell, if she's laboring, where's her belly?" She did not even look pregnant laying on that stretcher. She was a teenager who just told her mom last week she was pregnant, and her dad found out the night before. So, yeah, they were a bit stressed. The patient really was uncooperative, too. She couldn't say when her last period was, or even how long she'd been feeling the baby move. I was just trying to get some idea of how far along she was because judging by her belly, she wasn't term. There was a doc there when she came in so he evaluated her, and couldn't get a straight answer. So he did a sono - very little fluid, approx. 32 week baby, 4cm, 100% effaced, ruptured for who knows how long. We got her admitted, got her an epidural and I proceeded to ask her all the routine admit stuff, like are you going to breast or formula feed? Circumcision? Pediatrician? etc? She said she did not plan on adoption, but she seemed irritated that I was asking her about these things. I did finally tell her gently that she had to start thinking about these things because in a few hours, she'd be a mother of a newborn baby. I also had our charge nurse who had her 1st baby at 17 go in and talk to her because I thought that might help this poor girl. She did seem to open up after that when she realized we really weren't judging her. We just wanted to make sure they were set up with everything they need. Her family was very supportive. I hope everything turns out for her and her baby. We were a bit concerned about how healthy the baby will be based on not knowing how far along she really is, how long she's been ruptured, whether or not she had oligohydramnios (too little fluid), or if the baby has any anomalies, etc. She was 10cm and at a +1 station, not pushing, but laboring down ( letting the uterus push the baby down farther, per Doc's orders) a bit when I left. I'll have to check in on her the next time I work to see how it went


AwkwardMoments said...


Jody said...

Wow how sad huh?

Yeah I find patients tend to be Very open with the stuff like "yeah I smoked pot during my pregnancy, but I quit 2 weeks ago!!"


Kim said...

What a night! I have really enjoyed reading your blog and would like to exchange links. Kim at OB Nurse

Taking Heart said...

What hurts me the most... is when I triage them, and try to gently talk some sense into them, or even to inspire them to love their baby enough to stop... and then they come back a month later abrupting. Kills me. I know it's just wishful thinking to think I can get through to them... but maybe someday there will be just one that turns it around. (probably not)

Love your blog, added you to my blogroll.

Jaimie said...

I finally got my tag done!