Hoping that Thanksgiving was enjoyed by ALL!
My Thanksgiving was pretty AMAZING! Nothing like family, friends, good food, and gratitude!
In my line of work, there is NEVER a dull moment. Having done this for 11+ years, I’ve developed the patience of JOB as a lot of what I do involves waiting…..babies come in THEIR own time.
Recently, while on call and waiting for a patient to deliver, I had an interesting exchange with a few of the nurses on the night float team. The topic, annoying things OBGYNs do. We arrived at this topic of conversation as I had previously been answering questions posed to me by them…queries ranging from why I chose a career in obstetrics and gynecology to why I did or didn’t do certain things in my own practice.
I am ALWAYS open to such dialogue as the relationship between an OBGYN and Labor and Delivery nurse is dynamic and intricate indeed. The Labor and Delivery nurse is a major advocate for the patient and oft times serves as the frontline for the physician with regard to what is going on with the “mom to be”. In an effort to continue my own growth, and make strides toward being the best physician I can be, their input is invaluable.
After a lot of laughs, here is a part of what I came away with…..granted I had to narrow this list down as it was LOOOOOOONNNNNG!
Top 5 Things OB Docs Do That Drive Labor and Delivery Nurses Crazy!
What’s that thing you do with your hands when a mom is about to deliver? Vaginal Stretching? What does it accomplish and could you please NOT do it! I was recently asked about this. You know, sometimes when a mom is preparing to deliver, an OB will have their hands/fingers in the patient’s vagina stretching, pulling, etc. I don’t personally do this as I am VERY hands off when it comes to delivery. I like to let baby do most of that stretching. I also think all this “extra” activity increases the risk of trauma, inflammation, etc to the vagina. Less is more. My response to the nurses on this one was to ask physicians who do this why they do it. I for one, would be interested in the response. Babies do most if not all of the work for you…..they make their own room/space to get out of the vagina. Try doing this maneuver; i.e., the vaginal stretching, on someone without an epidural….YIKES!!!!! That can’t feel good.
Having patients PUSH as soon as they are complete….even when they don’t yet have the urge to PUSH! A nurse recently inquired, “when you take a dump, do you push before you have the urge?” Point well taken. What I can tell you is that while I am an advocate of allowing the patient to “labor down”, recently, the literature has questioned the benefit of this and whether or not it provides a true advantage.
The notion that physicians don’t give patients a fair chance for a vaginal delivery and are too quick to move to c-section. I actually hear this a lot. Patients being sectioned to accommodate a physicians schedule. While I hate to think that this still happens, it does. Obstetrics and Gynecology is a TEAM approach. Inquiries regarding decisions directly affecting delivery or route of delivery are NOT off limits. This is where the advocacy piece of what nurses do comes in. Most labor and delivery nurses are NOT push-overs. They’ve got your back! I, personally, am ALWAYS open to questions regarding my management of patients. Make sure you as the patient are kept in the loop.
Physicians ordering them to increase the Pitocin when the patient seems to be having regular uterine contractions. Briefly, Pitocin is a medication used to induce or augment labor. It typically is given through an I.V and causes uterine contractions. By definition, labor is uterine contractions that cause cervical change. There are numerous reasons a physician would ask a nurse to increase the Pitocin rate, whether it be because contractions have spaced out and are no longer occurring “regularly”, to the contractions aren’t strong enough to cause cervical change……Worse case scenario, the nurse does not feel safe increasing the rate(perhaps because contractions are already occurring frequently and there is concern for over stimulating the uterus which could then lead to things like non-reassuring fetal heart tones or increased risk of uterine rupture)of the medication and asks the physician to come and evaluate the patient. I always tell nurses that I work with, you can always ask the physician to come in and personally assess the situation. Another example of where advocacy comes in. The labor and delivery nurse, ALWAYS, has the patient’s safety as the priority.
Physicians that are not “nice” to them or respectful of their contribution to the team. I LOVE my labor and delivery nurses. Their contribution is invaluable! I have had the pleasure and privilege of working with some AMAZING nurses; some of whom have been active in their profession for longer than I’ve been practicing. Have learned a TON from a lot of them. While I can only affect my own behavior and hope that my example inspires others, I simply follow the golden rule regarding my interactions with them; “Treat them as you want to be treated”. I learned early on, that if you don’t, they can TRULY make your life miserable.
To all the labor and delivery nurses I’ve worked with over the years, this post is for you. For those of you that are out there in this particular field on your grind, I see you. I feel you. I thank you.
Hoping this blog post provides value to your day!
Until next time,
Look Better. Feel Better. Be Better.
Dr. Angela
