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Abortion/Termination - NOT A DEBATE

Posted Nov 09 2008 10:12pm
First and foremost: this post is not about a debate of whether abortion/termination of pregnancy is right or wrong. IF THERE ARE ANY NEGATIVE OR MEAN COMMENTS, THEY WILL BE DELETED.

Now that I have that said and out of the way.......

We have had some issues come up on L&D regarding abortions/terminations of pregnancy. We are trying to more clearly define what it is. We do not term 2nd trimester abortions on L&D as "abortions" per se, but rather as "elective terminations of pregnancy." We rarely do them on my L&D unit, but they are still done. Thus, we need a very clear cut policy/statement about them.

What we do now:
  • Each nurse signs a form stating either:
  1. I will take any termination patient.
  2. I will only take terminations if the mother's life is at risk.
  3. I will only take terminations for fetal anomalies incompatible with life.
  4. I will not take any terminations.
The majority of our nurses will do #1, 2 or 3. A few nurses have chosen #4.

In order to keep the peace and not open a debate, I will not state which number I signed.

Now, the issue at hand is - if a woman is inevitably going to deliver, and the fetus is non-viable (before 24 weeks), however, the fetus is still alive, is it a termination of pregnancy/abortion if the nurse needs to add medication to continue the natural course of the labor? (Pitocin, cytotec, prostin, etc)

This recently came up at work, and it's created a lot of arguments back and forth, on both sides of the issue.

On one side: it's being humane to add the medication, to keep the delivery process moving, when delivery is going to happen no matter if we intervene or not. (ex: fully dilated, membranes ruptured, fetal parts presenting, fetus still with a heart beat.) The woman could potentially become septic and very sick if we do not intervene. We're trying to prevent her from becoming sick, by not prolonging the inevitable.

On the other side: by adding an oxytocic medication, and the nurse having to physically administer the medication, this is now not an inevitable delivery caused by nature, but rather, it's now an elective termination of pregnancy. The nurse objects to giving the medication, because she feels that it goes against her moral standards to purposely aid in the delivery of a non-viable fetus, while the fetus still has a heart beat.

As you can see, we need improved clarity on what is and what is not a termination of pregnancy/elective abortion. We have tried to find a clear cut definition, but have not come up with something yet.

We do currently have a policy statement that further addresses the nurse's role in termination of pregnancy:
  • A nurse may not refuse to care for any patient if it is an emergency situation, even if the care rendered goes against any moral, religious, or personal belief system.
So, we are back to the issue again. When is care deemed emergency care? Who decides if it is an emergency or not? I can think of several situations where it can be argued either way - emergency or non-emergency.

(On another note: there will always be nurses on my unit who will care for a woman having a termination of pregnancy/elective abortion. I want to make it clear that someone, whoever can render the best care to her, will be assigned to that patient. Not having a nurse assigned to care for this particular patient is not the issue at hand.We have a large enough unit, with plenty of nursing staff available.)
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