File this under stupid, dangerous and malpractice.
I'm finding I have little time to write as fully as I would like about a blog post I stumbled across the other day which, for the first time in a while got me newly, thoroughly outraged. Fortunately the universe has good people like the Jills from Keyboard Revolutionary and Unnecessarean to do it for us.
I've spent a little time researching this "Pit to Distress" and have found, justly, that L&D nurses don't like it a helluva lot. I wouldn't either if I was the one being told to administer the doses when the only desired consequence (that I can see) is to stress a baby and clear the bed, probably due to a thoroughly iatrogenic 'emergency' cesarean for fetal distress. This also handily would allow OB residents to rack up another surgery before the end of a shift. I fervently hoped that this protocol is NEVER used on VBAC women. Sadly, many of the tales on nursing message boards discussing "pit to distress" were of VBAC mamas whose labors were augmented this way simply to ensure that their TOLAC (trials of labor after cesarean) failed, and quickly. What's the bet the women had NO idea that their labors were being forced to a frightening conclusion.
I have yet to figure out one single good, safe, clinical indication for this use of pitocin. Instead all I can come up with are the risks. The tale of woe outlined in N is for Nurse's post is notable for the eggregious malpractice on the part of the physician involved. Thank GOD the nurse quietly refused to augment a mother who may have been abrupting, was already (from the sound of it) in tachysystole, and had a babe with minimal variability (hallmarks of a babe already stressed and with low reserves). I just don't understand what it was that the Resident who made the order was thinking. ESPECIALLY given that it sounds as though the anesthesiology team was otherwise occupied. I really feel for (and am stupidly grateful to) the nurses who keep their patients safe when stupid stuff like this is in play. It must be tough going up against physicians who want to do dangerous things and want them, the nurses to basically run the show in their absense.
In the meantime counties in sunny Florida are enjoying (??) cesarean section rates of more than 50%. an outrage which defies logic and any rational explanation. This is not good practice, it's completely indefensible, I'd go so far as to posit that it's not even medicine. If I were a taxpayer in Florida I'd be calling my legislators daily and reaming them for allowing my public health and medicaid tax dollars to be spent this way. There is NO excuse for this. Physicians and hospitals in Florida should be ashamed of themselves.
Some other good media from the American Prospect. Turns out some smart economist out of Kentucky crunched the numbers and found that the US healthcare system could save $9 Billion a year if only 10% of American women enjoyed midwifery care and birth out of hospital. The majority of these savings would be made simply by reducing the cesarean section rates and their attendant complication rates. Bottom line: if you are planning a physician attended hospital birth your risk of a cesarean sits about 30% (or considerably more depending on your hospital, physician and geographic locale). Now, your average Certified Professional Midwife attending home births generally manage cesarean section rates of less than 10%. More and more legislators are asking "Huh. So what is it that you midwives do differently?"
Today all I want to do is point to the post which got me onto this topic and say " Well, among other things, that. We don't do that. Ever." Because not only is "pit to distress" unsafe, I think the case could be made that it also amounts to assault and battery on the mother involved, and reckless endangerment of the fetus.
I've spent a little time researching this "Pit to Distress" and have found, justly, that L&D nurses don't like it a helluva lot. I wouldn't either if I was the one being told to administer the doses when the only desired consequence (that I can see) is to stress a baby and clear the bed, probably due to a thoroughly iatrogenic 'emergency' cesarean for fetal distress. This also handily would allow OB residents to rack up another surgery before the end of a shift. I fervently hoped that this protocol is NEVER used on VBAC women. Sadly, many of the tales on nursing message boards discussing "pit to distress" were of VBAC mamas whose labors were augmented this way simply to ensure that their TOLAC (trials of labor after cesarean) failed, and quickly. What's the bet the women had NO idea that their labors were being forced to a frightening conclusion.
I have yet to figure out one single good, safe, clinical indication for this use of pitocin. Instead all I can come up with are the risks. The tale of woe outlined in N is for Nurse's post is notable for the eggregious malpractice on the part of the physician involved. Thank GOD the nurse quietly refused to augment a mother who may have been abrupting, was already (from the sound of it) in tachysystole, and had a babe with minimal variability (hallmarks of a babe already stressed and with low reserves). I just don't understand what it was that the Resident who made the order was thinking. ESPECIALLY given that it sounds as though the anesthesiology team was otherwise occupied. I really feel for (and am stupidly grateful to) the nurses who keep their patients safe when stupid stuff like this is in play. It must be tough going up against physicians who want to do dangerous things and want them, the nurses to basically run the show in their absense.
In the meantime counties in sunny Florida are enjoying (??) cesarean section rates of more than 50%. an outrage which defies logic and any rational explanation. This is not good practice, it's completely indefensible, I'd go so far as to posit that it's not even medicine. If I were a taxpayer in Florida I'd be calling my legislators daily and reaming them for allowing my public health and medicaid tax dollars to be spent this way. There is NO excuse for this. Physicians and hospitals in Florida should be ashamed of themselves.
Some other good media from the American Prospect. Turns out some smart economist out of Kentucky crunched the numbers and found that the US healthcare system could save $9 Billion a year if only 10% of American women enjoyed midwifery care and birth out of hospital. The majority of these savings would be made simply by reducing the cesarean section rates and their attendant complication rates. Bottom line: if you are planning a physician attended hospital birth your risk of a cesarean sits about 30% (or considerably more depending on your hospital, physician and geographic locale). Now, your average Certified Professional Midwife attending home births generally manage cesarean section rates of less than 10%. More and more legislators are asking "Huh. So what is it that you midwives do differently?"
Today all I want to do is point to the post which got me onto this topic and say " Well, among other things, that. We don't do that. Ever." Because not only is "pit to distress" unsafe, I think the case could be made that it also amounts to assault and battery on the mother involved, and reckless endangerment of the fetus.
posted by Louisa at 4:32 PM
3 Comments:
The Jills. haha. I like it! :)
Hey, I meant to come back and comment a long time ago. One of the highlights of the summer has been being called "the Jills."
Can I be considered interesting by proxy if I am associated with the other Jill? She's cool.
You're both cool.
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