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Oh what a slippery slope

Posted Oct 17 2008 9:13pm
And I'm not talking about snow-capped mountains either.

I'm talking about the slippery slope of medical interventions.

I had a woman having her first baby - a scared woman, and not well educated - who was being induced. Why? Because she was a whopping 6 days past her due date.

Oh holy crap! Stop the presses! She's postdates!

No, not really doctor. She's only 6 days beyond her due date. That's technically not postdates yet.

Anyhow. She was induced. Lucky her. She had pitocin given with an unripe cervix, all day, and all evening. Why no cervical ripening agents instead? Because she was spontaneously contracting too often for a cervical ripening agent.

So. Pitocin all day. Very minimal cervical change. A whopping 1 cm when the current doctor now wants to place a foley bulb for mechanical cervical ripening (see previous post on this topic). She can't get the foley bulb in, due to patient discomfort. So, I talk to the doctor, and the patient, about "how about the pitocin gets shut off for the night, and see if her contractions space out?" In private, I tell the MD that I feel that there is no need to push her induction (and she agreed) - she didn't have ruptured membranes, she wasn't in active labor, she was negative for GBS, etc. The doctor agreed, but was wanting to instead --- get the woman an epidural, so she could place the darn foley bulb.

UGHHHHHHHHHHHHHHH!!!!!!!!

I told her, good move, let's just do a c-section for failure to progress right now, because that's where this is going to end up.

Long story short, she consulted with her attending physician (this was a resident), and he said yes, do the epidural, then the foley bulb. So that's what we did. I wasn't happy about it, knowing that we were going down the slippery slope of unnecessary medical interventions...........weeeeeeee! Here we go!!

Of course, baby has late decels after the epidural - and continued to do so off and on for a few hours, before the end of my shift. I ended up shutting off the pitocin. She was a whopping 1.5 cm when I left for the night.

....sigh....

I predict she will have a c-section by 8am.

We'll see how things go, when I go back to work tomorrow.

Labels: birth interventions, epidural, induction of labor, labor induction, pitocin, postdates

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