Haven't Really Been Around, but I am Upset!

[Tammy]

I am sorry I haven't been around, but adjusting to life as a single mom has been trying to say the least. I've been building my income on ebay and working on my first certification to become a Bradley Birth teacher...which brings me to my concern.
I went to my major training confrence this weekend in Orlando and it was lots of learning and I enjoyed every minute of it, but I also learned soooo much about drugs and how they effect the laboring mom and baby. I was so disturbed about this. Why? Becuase I was very overdrugged durning my labor with my son (the one I was dx PPCM with) With all the drugs I got, which was 4 different ones, it could have caused my heart failure.
Now I am looking at the possibilty that I was dx with PPCM when infact I don't have it at all! I am trying to obtain my records from the hospital so that I can review them myself.

Anyone else had alot of drugs durning their labor with their PPCM baby? Or maybe have any insight on this?

[momoftwoboys]

Tammi ~ Glad to see you on the boards! I've been thinking and wondering about you. As far as the drugs go, it was all natural for this little lady. I didn't have enough time to get anything. With my first it was about 4 hours from start to finish and with my second it was about 3 hours.

[margaretinva]

I received petossin (sp) and an epidural.

[melissamph]

Pitocin, epidural of fentynl and extra for pain as she was 10 pounds and 13 ozs vaginally! YIKES!

[SusanD]

I received lots of meds during labor, but I don't see myself as overdrugged. Had I not been induced (cervadil and pitocin) my blood pressure would have become worse and my daughter and I could have both become sick. Had I not received the mag sulfate, I would have probably had a seizure. Had I not received the epidural, I would have probably felt the C-section. Had I not received the pain meds after the C-section, I probably would have not been able to get up and walk and would have been at very high risk for a pulmonary embolism.

What is your definition of overdrugged ?

[SerenaWelsh]

First child was all natural, except for the labor stopping drugs I received starting at about 30 weeks. Can't remember what they were.
Second child had, I had terbutaline pump before the labor, pitocin, and an epidural. No heavy pain meds afterwards.
Third child I had epidural for the c-section and morphine, briefly, until they figured out I was allergic to it.

I'm thankful for each of the drugs I received, because they were all needed for the immediate situation. I've also wondered, though, if it didn't contribute to how bad I got. Will never know....

BUT...I have to say this...having delivered 3 kids, 3 different ways - NATURAL WAS EASIEST!

[NursCEO]

I have to be honest, that as a labor and delivery nurse, I am not fond of the bradley method and what they teach. I also feel as if I have a good grasp on why certain drugs are used and why we have to use so many in certain circumstances. As Susan wrote, I am also curious as to which drugs you had.

Personally, I had Mag Sulfate (probably would have seized if not), Pitocin (to get labor going, the only known cure for PIH is delivery). I had an epidural (fentanyl) with several reinjects because of a hot spot. I had lasix, vicodin, and probably more that I can't even remember.

I have never felt as if I was overdrugged, and might have even been underdrugged at times during my stay.

If I can help answer any questions about the kinds and specific types of drugs used in L&D please let me know.

Carrie

[mikeyandBellesmommy]

I had NO drugs during my labor with Belle until my c section. I feel if they woudl ave just let me have drugs I probably would have been able to have her easier and had ALOT less stress on my body, as I am 5' 0 and she was over 9lbs. I was in so much pain I couldn't even function and I was so tired and stressed, I think I should have had something..

As for preterm labor drugs I do think they MAY have an effect on the heart, as I have read they can cause high bp and palps etc.. My aunt ended up with severe pre e due to the preterm labor drugs!

I TOTALLY beilve in birthign the way you want, but I woudln't get my tooth pulled with no drugs, why wouldn't I subdue my labor pain.. that is JMO

[Tammy]

What is your definition of overdrugged ?


I went into labor at 37 weeks (according to the dr's calculations) and was going into hard labor when I arrived at the hospital at 5 cm. My water was broken before I got to the hospital. They gave me pit, demerol, epidural several times (due the back labor, when I get my records, I'll know how many times), spinal, and general. I hardly knew what was going on around me, was asleep for almost 24 hours, and really felt the effects of too many drugs.
Add this to the bags of IV fluid, which of course put too many fluids in my body.


I have to be honest, that as a labor and delivery nurse, I am not fond of the bradley method and what they teach. I also feel as if I have a good grasp on why certain drugs are used and why we have to use so many in certain circumstances.

I am curious to know what you don't like about the Bradley method. With my son's birth I feel if they had just left me alone, he would have been born in a few hours instead of 11 hours of hard back labor, 4 hours of pushing and then the c/section which landed my son in NICU.

[SusanD]

I'm confused about your post. Your post sounds like all of the medications were given to you without your approval or consent. If that is the case, then I can see where you would have questions. I know at our hospital and at the hospital where I gave birth, you have to consent to everything and there were no drugs given without my knowledge and in the case of the epidural, my written consent. Also, I had to *request* the epidural. Did they give it to you without your requesting it ?

[Tammy]

They asked me if I wanted the demerol, which was the one injected in the IV, but after that, I don't honestly remember. I know they were given, but I believe my dh at the time requested them for me. Not sure. I dont remember signing any conset forms after the intial ones with admitting. And I have no idea what the papers were for that I did sign. I do know what I received all 4 drugs. Along with the pit, which was no means was asked if I even wanted it. Appearently it was hospital policy. But I dunno about that either, I am just assuming based on most hospitals giving pit when you walk in with spontantous ROM.

[SusanD]

That's interesting, Tammy....were you in a military hospital ? I can tell you (and hopefully Melissa will confirm) that most places don't put you on Pit for spontaneous ROM. I know for me, the PIT was hauled out only when I wasn't progressing. I most definitely had to request and consent to the epidural. Everyone I know had to request their epidural...mainly because there are so many women who indeed don't want an epidural and want a drug-free delivery.

[amyls]

My 3rd son, my PPCM baby was born emergency c-sect,

but my older 2 were born with the use of PIT as a last resort. my oldest I was in labor and not progressing, they tried breaking my water, they tried the pill to soften the uterus, nothing was working. After 20 hours of taking nothing, I did take a little pain medication, at 28 hours, I got an epidural because they thought he was going to have to be born with a c-sect. After the epidural, I was able to relax, after 32 hours, my son was born, with in 20 mins and 3 pushes and with no ill effects from the medicine, or epidural.
My 2nd son was born under PIT and an epidural too.

But again, the PIT was used as a last resort for both.

Did you have an epidural?? Because that is one sheet that YOU have to sign. There is no way you DH at the time could have. (even with my emergency c-sect, I had to sign before getting my spinal.)
I would look into that if you didn't.

amy

[melissamph]

I never heard of using Pitocin with Spontaneous Rupture of Membranes! Yikes! I think Epidurals are wonderful personally..........but not everyone would agree. It is an individual decision for sure.

[NursCEO]

Pitocin policy here is as follows... With Spontaneous ROM, pit is not started right away. Usually we do an exam to confirm rupture and dilitation, and then monitor for around two hours. If at the two hour mark, 1.the woman is contracting in a regular pattern regardless of cervical change our docs will let her continue without pit. 2. If the woman is contracting, not regularly, but is still changing her cervix, she will continue to labor without pit. 3. The woman is not contracting, has a very irregular pattern, and or is not changing her cervix,then pitocin is then discussed.

I will say it is always the patients choice. Some of our docs push it more than others, but most would be ok with continuing to wait for spontaneous labor to set in as long as the woman isn't running a fever. I think where a lot of people get confused is where we say labor. Labor in medical terms is cervical change, not just contractions.

Once a fever starts, or when a woman has been ruptured for > 18 hours, then we push iv Antibiotics, and they really attempt to get you to consent (verbally) to pit. Epidurals always require the signature of the patient.

With that said, I will be the first to say that I do believe that a lot of our patients don't really pay attention when they are signing their paperwork. I know that we present the epidural consent at the time of admission, along with all the other paper you sign to be admited. I think that when patients are listening to the whole presentation of legality, they get bored and just start signing. I always make sure my patients fully understand why and what they are signing.

The reason we present an epidural consent in advance is because it lets the women who know from the begining that they will be requesting an epidural get the consent over with. we do push for everyone to sign it because if there is an emergency, it is much easier to know that your patient consented earlier in the day, than to be running down the hall trying to get her to sign it.

If people really don't want to sign it, they don't have to. But before an Anesthesiologist will place an epidural, they check the chart for that consent!!

I also want to apologize if I offended you with my comment about not being a Bradley fan. I have a very medical mind, so, I am pro medicine and medical intervention. I will ALWAYS say that my favorite deliveries to attend are the natural ones (even though it wasn't for me).

My belief and my experiences are that most if not all Bradley pt's want no medical intervention at all. That is all good, but if that is the case, they shouldn't be delivering their baby at the hospital and fighting every policy and decision the MD's make. I think that having been the nurse, I have just seen many bad outcomes, and many close calls. I honestly, and whole heartly believe that our policies are set with the pt's and babies' best interest in mind.

I also believe that Bradley pt's don't intend to be difficult, but the nurses are always caught in the middle. We are our pt's advocates, and I have spoken up on my pt's behalf more than a few times, but we also work with the Docs day in and day out. It is a long hard day when you get an order from a doctor and then when you go to carry it out, the pt refuses, so then you call the doctor and they come to the bedside, and work out a plan, and then if later in the day the pt decides not to be monitored or to go for a walk out of the unit, or whatever, it starts all over again and we are still in the middle trying our best to please both sides.

I would love to discuss this more with you and I don't ever want to upset people on this board. Afterall, we are all here for one reason.

Sorry to be so long winded.

Carrie

[Tammy]

Carrie, Thanks so much for you insight. And everyone else too! I still have alot to lern about what happened with me.
While I feel that the hospital didn't take as good as care of me as I think they should have, I also take some responsibilty in it with not being as educated as I should have been. That is why I am wanting my records from that birth.
I dont recall ever being ask about the pit and I was going into active labor at 5cm when I got there. So I know I was in labor, I never had Braxton kicks either. My ROM was definatly "like a dam broke" no small leak here. :)


Once a fever starts, or when a woman has been ruptured for > 18 hours, then we push iv Antibiotics, and they really attempt to get you to consent (verbally) to pit. Epidurals always require the signature of the patient.

I can understand why a hospital is fearful of infections, etc with ROM, and why they would want to start pit and/or antibiotics, but I also see that most of that is from putting "things" up inside the vaginia. Such as vaginal exams, EFM, etc. Each time something enters the vaginia it increases the chance of infection. If nothing is ever inserted, then the chance of infection should be min.

Not trying to start an argurement or anything, I truely like to see a different point of view from the medical standpoint. It will help me learn how to work with the medical staff and teach my students how to do the same.

With that said, I will be the first to say that I do believe that a lot of our patients don't really pay attention when they are signing their paperwork.

I can totally see that!


The reason we present an epidural consent in advance ..... because if there is an emergency, it is much easier to know that your patient consented earlier in the day, than to be running down the hall trying to get her to sign it.

This I can agree with. I was working with one of my doula clients and she was refusing to sign it at all. She saw it as compling and losing her goals. I am still new to it, so I wasn't sure how to compromise with her to let her know for sure that just because she signed it doesn't mean she would have it. The medical staff explained the same thing. But on a side note, she also had an anesthesiologist with a bad attitude come in so it didn't help either.


I also want to apologize if I offended you with my comment about not being a Bradley fan.

No offense taken! :) I was truely curious as to why.

While the Bradley method does advocate natural birth, it no way says nothing at all, even with emergancies. We are taught that we are to leave nature alone and only have intervention if there is a problem. Medical advancement of today is wonderful, but in the bradley ways, we believe that it is overused.
It is wonderful for truely life saving times, but when and how to use it isn't too clear cut and dry.
There have been some students that tend to take it overboard and go to far upsetting the medical staff. I am sorry that you may have had to deal with those couples, but it isn't what we are taught to teach our students.

I honestly, and whole heartly believe that our policies are set with the pt's and babies' best interest in mind.

This is great! That is exactly what we are wanting. :) But there are no one size fits all policies, and very little bending. But I also see from a hospital standpoint that it's hard to please everyone and it's alot of extra work to please everyone. Especially when I hear how shorthanded the nurse staff in most areas.

I have to say that nurses are under appricated and under paid just like teachers. I dont believe most nurses are trying to undermind and make things difficult for their patients. I also belive that nurses on the whole know the patients better than the dr's. But also they have to find a way to stay within the dr's orders. It's got to be difficult job to balance at times!

I love natural childbirth since I myself have been able to do with it my daughter. So of course I am on this side of the fence. But I also really want and know how to work with the staff so that my students will be able to get their wishes without upsetting the medical staff.

Most couples still use the hospital because of different reasons. I myself because of being high risk, dx with PPCM, which I am frustrated with at the moment. But I would truely love to homebirth. I know it wont happen for me though!
Some couples just think they are better at a hospital, especailly first time moms. It's also imprinted in our minds before we understand where babies ceom from. Mommies come home with babies from the hospital. Maybe the couple wasnt able to find a midwife at a birth clinic. Who knows?

Sorry to be so long winded. (Me too!)

[SusanD]

I *love* that we can discuss things on this board in a rational, thoughtful way. And, in honor of Nurses Week, I wanted to let you know also that salaries for RN's have never been higher and I can honestly say I don't think we are underpaid anymore ! I don't know if I want us to give up our image of the hardworking underdogs, :) but I want people to know that for the most part we are well-compensated professionals. Sure, there are some lower paying RN jobs out there, but those are usually better hours, less crazy type of jobs. The PRN rates at my hospital are *wonderful* and even before I went PRN, I received a market adjustment which pretty much amounted to a 6.00/hr raise....almost overnight !

You and Carrie had a very insightful conversation here ... I learned a lot from reading your posts. Thanks so much !