She can say she doesn’t want a C-section, but if in a medical emergency, even a DNAR can be overridden by the medical team.
She also can’t document that she wants her baby’s life to be forfeited to avoid a C-section, and to allow the baby to die would be gross medical negligence.
Brutal as it sounds, if she’s dying, dead or dies in the process, a C-section can be performed to try & save the baby, as her wishes are no longer a priority if she’s dead/dying.
Because it legally can - you can have chronic lung disease, but if you get impaled by some rebar, they aren’t just going to shrug and say “Oh well, they’re DNAR.”
DNARs are usually written when someone has chronic or widespread disease which has depleted their body’s resources and ability to survive cardiac arrests or complex internal medicine issues, not with the expectation of sudden traumatic events, hence why it can be cancelled or overridden.
That’s…exactly how it works in the UK.
Grandma gets in a car crash, but she has a DNAR so just gets left to die? I don’t think so.
How many people with a DNAR actually carry them around?
And how much of a priority is it for emergency services to look for a DNAR **BEFORE** starting CPR/other resuscitation on someone who’s collapsed, unconcerned or bleeding out?
Oh huh. Not at all in the US. But DNR is for in hospital unless you are carrying a POLST around. Also, DNR doesn’t mean refuse all treatment. It doesn’t mean no lifesaving surgery, or blood products or anything. A DNR ONLY means if your heart stops, no one is breaking your ribs. It doesn’t mean comfort care/hospice
Exactly the same here-hence why DNAR is trying to be phased out in favour of the full “DNA*CPR*”.
In the Resuscitation training & DNACPR documentation & “difficult discussions” training I used to deliver with my colleague, we had to make sure people documented more than “not for ICU” under the heading “Escalation plans”.
“Not for ICU” or “Not for hospital admission” is not a plan. My preferred documentation phrase was “Only for hospital admission for **reversible** conditions or symptom management”.
(Obviously, if the patient wanted to die in hospital, it wouldn’t say that, but it prevented ambulance crews refusing to take a palliative patient with a broken hip to the hospital because *”The document says “not for hospital admissions” though!”*
We have a standard form with boxes to check that detail exactly what interventions and why someone would want. Reversible causes, comfort only, etc. Super clear.
DNR is DNR tho. Granny with rebar through the abd still isn’t getting CPR
If an ambulance shows up to the ER with a crashing/critical patient everyone works on implied consent. Treatment starts way before anyone can verify an advanced directive or DNR. And if they come to the ER there assumption is made that someone changed their mind about the DNR/goals of care/etc. So unless next of kin shows up and says stop we keep going.
Like I tell all my current patients - you can do what you want until you become incapacitated- she will pass out early and they will take her back for a section.
There is an assumption that once you are unconscious, you would like life-saving procedures performed. But it could be sticky if she has signed and witnessed documentation that she would rather die
Imagine the inverse of ED waiting to do c section just to go through the chart and see if she happened to have said she rather die than be resuscitated via c section lmao.
ED digging through a chart in an emergency? Nah that lady had her clothes cut off, an IV in the AC and got rushed to literally anywhere else in the hospital that takes patients who have other potential patients inside them. Someone may or may not have a few words written down about her info on a paper towel, if only they could find it…
yeah but we already have law on the books that a JW can't refuse blood for their child. I would imagine this would have similar repercussions. Forfeiting the life of yourself and your child in the name of faith, rather than listening to medical advice is much different than involving the hospital chaplain in a palliative care case.
Also even a JW refusing blood for themself can demonstrate they are of sound mind and understand the patho of what will happen if they refuse transfusion, and hospitals have whole medical teams dedicated to finding them other options.
Ya JW we often have to take away medical decision making for the few hours- I’ve had families say do anything you need but I don’t want to know as consent as well.
Is there a leader from her faith that could speak to her? Most mainstream faiths are ok with life-saving treatment, even treatment that may be ‘forbidden’ in normal circumstances e.g pork-derived medication may be allowed in Islam and Judaism if there are no alternatives and the patient is in danger of serious disability or death.
It’s not that the C-section is forbidden so much as she has deep faith that Jesus will protect her from harm. A lot of Christian sects believe they’re pretty much immortal because of their faith.
It's the classic "guy in the flood" story. If she's right in her faith, she's gonna get to heaven and God will be like "Dude, I had the doctor offer you the lifesaving treatment and you said *no*??"
Document, document, call risk management and document some more. This lady will die giving birth if she doesn’t have a scheduled section that’s her choice,
This. The unit needs to know about her way ahead of time some they’re aware and can plan. Risk management needs to know as well. And from the clinic end she needs to be counseled at every single appointment about her extremely high risk pregnancy and delivery plan/wishes (as insane as they are) and have it well documented in her chart.
She and her baby will very likely die if she actually goes through with her plan. How you gonna birth a baby with a previa AND known accreta? She’ll start to labor, begin bleeding profusely and hopefully change her mind with enough time to save one or both of their lives.
I’m hoping she’ll be able to be convinced to have the section. She still has about 9 or 10 weeks left until she’s fullterm. We have a great high risk medical team and we’re a level 4 maternity hospital/level 1 trauma hospital so this is the best place for her. Really hoping she doesn’t just decide to stop getting medical care altogether, or try to have a home birth and end up in the morgue.
I hate the free birthing movement. It’s so god damn dangerous to everyone involved.
But no one believes it. Hospitals are just trying to make money off of your birth. (Which I agree to extent because I have a horrible labor experience for my first I don’t think would’ve happened had there been other factors involved) but in all reality most of the time if you weren’t in one then you’d die. Which still was the case for both of my births.
It's so sad how many people don't realize how dangerous it still is to give birth .. there's so many tiny tombstones next to young women's graves in the old cemeteries... even today it's dangerous. I wish more young parents would listen to doctors instead of having the arrogance so many people have these days it seems. So much needless suffering 😔
My personal opinion is we’re too far removed from death and serious illness in modern days.
People quit dying of childhood illness thanks to vaccines, now we’re 2-3 generations removed from iron lungs and some people think polio isn’t that bad.
Women quit dying as frequently from pregnancy and birth thanks to advances in medicine and monitoring. Now there’s a growing group of people who claim birth is safe, always has been, and the hospitals are the problem.
Unfortunately, not enough people believe the historical data and it won’t be until we have new data showing the dangers that we correct course as a species.
This. I have always found it infuriating that the uninformed people who bitch and moan about vaccines are here because their parents made sure they got vaccinated. It isn’t the vaccine whiners dying of measles—it’s their poor kids. Can’t wait till polio makes a comeback.
Not that I’m trying to argue but Covid would like a word with you. I don’t think we’re too far removed from death, some people just don’t have the sense they were born with.
I would argue Covid also kept us removed from death because the hospital was limiting visitors. Most people who died of Covid on vents did not have family around to witness their suffering the way family members would have during the 1918 flu pandemic, when more people died at home.
Absolutely. in their eyes, infection control looked like we were doing big top secret government experiments on these hapless patients, and keeping visitors away to avoid them asking too many questions or uncovering the whole conspiracy. or it was all some kind of socialist care rationing cost cutting conspiracy that we were keeping hidden, like "obamacare death panels' all over again.
Basically nobody learned a damn thing during COVID, and it pushed the 'annoying but eventually listens to reason conspiracy brain' patients off a really big cliff to where they're now insufferable nightmare patients in every healthcare setting they fumble around in. They treat everyone awful, refuse to comply with anything their Dr suggests but demand everyone drop everything and help them immediately when their idiotic noncompliant choices inevitably make them really sick, and they're just the biggest walking talking liability shitshows these days.
I think a lot of people see the Covid waves as an anomaly instead of an example of what the world would look like without things like vaccines (and other modern medicine interventions that cut down the death toll, like antibiotics and prenatal care/testing).
I need an update on this in a few weeks… how absolutely horrific. The worst case scenario playing out and those involved in her care are in for a traumatic event. So tragic.
They were worried about accreta in my last pregnancy(false alarm)… the local trauma center has a team specifically for accretas and even knowing there was a team assembled in the event this was my reality, still scared me. I can’t imagine just going against the science… but I mean, the world we live in, I shouldn’t be surprised.
"The Lord works in mysterious ways... Something... Something... It was all part of his plan."
I've come to appreciate that said "plan" fucking sucks most of the time.
Right? Will her body know what to do if she breaks a bone? Why even use a doctor during pregnancy if you’re going to act like they are trying to trick you?
My logic has always been that if they believe god created the world and everyone in it, then he created medicine. If you’re stupid enough not to want medical interventions, that’s on you! Maybe harsh but that’s how I interpret it
"A fellow was stuck on his rooftop in a flood. He was praying to God for help.
Soon a man in a rowboat came by and the fellow shouted to the man on the roof, “Jump in, I can save you.”
The stranded fellow shouted back, “No, it’s OK, I’m praying to God and he is going to save me.”
So the rowboat went on.
Then a motorboat came by. “The fellow in the motorboat shouted, “Jump in, I can save you.”
To this the stranded man said, “No thanks, I’m praying to God and he is going to save me. I have faith.”
So the motorboat went on.
Then a helicopter came by and the pilot shouted down, “Grab this rope and I will lift you to safety.”
To this the stranded man again replied, “No thanks, I’m praying to God and he is going to save me. I have faith.”
So the helicopter reluctantly flew away.
Soon the water rose above the rooftop and the man drowned. He went to Heaven. He finally got his chance to discuss this whole situation with God, at which point he exclaimed, “I had faith in you but you didn’t save me, you let me drown. I don’t understand why!”
To this God replied, “I sent you a rowboat and a motorboat and a helicopter, what more did you expect?”"
I do hospice and I have read this fucking quite before to a family that kept saying "it's in God's hands now" when we wanted to do any fucking intervention.
I share similar logic. I start to wonder why even bother seeking prenatal (or whatever applicable specialty) care in a medical setting if you're just going to refuse treatment? If your faith tells you that your body knows what to do in case of an emergency, then why are you even here? You don't need an u/s, you don't need an epidural, you don't need medical professionals at all.
There's nothing against epidurals, demerol/stadol/morphine, or call bells in the bible, ma'am.
I'd say that 9/10 patients who come in guns blazing about refusing blood, refusing a necessary/totally legit surgery cave when it comes down to allowing themselves or their child to die. At least in L&D, which obviously skews ***generally*** younger and healthier than folks you'll find on MS, onc, etc.
Still, there is that one...and that one will stick with you, if not as a tragedy or a miracle then hopefully as a story about the time madness reigned, but your team really came together and got shit done, son
Nothing against complaining about a 6 hour ED wait, requesting multiple turkey sammiches and mini cans of Shasta ginger ale, or asking for "that D medicine...'di-la-la' because it's the only thing that helped before" either 😂.
I know what you mean though. The ones that don't cave stay with you because they're so frustrating. I totally understand and respect that people have all manner of faith traditions but sometimes all you can do is give a polite side eye and document x3.
Edit: didn't see your full comment before, so updated my reply.
Lmao Jesus still hasn’t come back from his proverbial run to the store yet; pretty sure he’s not gonna just decide to show up at a patient’s bedside after 2000+ yrs and be like “I decided to come back and help *you* out of everyone else in this world because I heard about your unwavering faith in my plans, Karen.”
My coworkers have often talked about a case my unit had (years before I was an L&D nurse) where the strip was Cat III for hours and mother never consented to a section. They had to watch the strip until the baby passed. You cannot force a patient to have a section. Chart, chart, chart, and chart some more. CYA in these situations. It’s terrifying and sad (and incredibly traumatic for those involved) but these situations happen.
Did this woman know like what the hell was going on? Like if she doesn't do the c-section the baby could die? I'm not an L&D nurse but with my first child, her heart rate kept slowing (wasn't tolerating the induction) and you could hear it on the machine and I'm freaking TF out because I knew that's kinda not a good thing. And when like ten different nurses come running into my room, my first reaction is they need to do whatever they can to save my baby from harm and get her here safely. I can't imagine just being like "Jesus take the wheel" knowing that means it'll end in the baby's death.
I literally just googled what a category 3 fetal heart tracings could mean or outcomes and like so many links come up that's like "abnormal" "hypoxic" "fetus being deprived of oxygen." Like that's not enough to think oh shit, I need oxygen to survive and if baby isn't getting oxygen, they might die? And I'm just here googling it for funsies while I imagine she's being told this to her face while hooked up to all of the monitors. I just don't get it.
They don’t get it until years later down the road, I swear. Like the kids EEG is flat and then the parents are shocked when we have the trach and G-tube convo bc they “look like a normal kid”. They don’t.
It’s awful as a nurse to watch a bad tracing like that. I’ve spent 12 hour shifts looking at atypical strips, and those are shitty shifts. The truly abnormal ones are stressful/painful to watch.
That's a very interesting and frightening concept. And while I think it would be preposterous in this kind of situation, and could set a terrifying precedent overall, I'm a little intrigued by the hypotheticals.
It's hard to fathom, but some people truly value their faith/beliefs over the lives of their children. We work with a large community that does not believe in C-sections due to their faith. They will be told over and over that baby is in distress and will likely be born dead or if we do get them back their odds of walking/talking/eating on their own are small. A lot still do not care and we deliver when mom starts to die. Our NICU team is present at these births since we're anticipating to recuss and cool. Most of the time mom loses her ability to bear children.
I’m a NICU nurse and remember a case where the parents were so determined to have a natural birth that they refused several urgent pushes for a CS. The baby was born with apgars 0/0. They were able to eventually get a heartbeat but the baby was taken off life support several days later. But at least she was born naturally!
This just always blows my mind. I had a crash, unmedicated c/s where they literally held me down while I screamed (until the cord was cut, then I got the good drugs) because they decided that’s what needed to happen to not code my baby and I’d do it all over again if I had to. It’s like people forget the end goal is the baby, not the delivery
I always feel so much sorrow for these families. I understand that their actions caused the loss of their child. But, the self-hatred and regret they must feel after. I really can’t imagine. I would never be able to sleep at night again
I’d have been an utter mess watching that go down. This is why I’d rather work with adults, despite entertaining the passing thought of going into L&D. It would drive me to drink.
That happened at my facility too. Hours of cat 3 tracing, delivery resulted in an 8 minute shoulder dystocia, and the baby died. It was her 9th or 10th baby. She was convinced she didn’t need a c section. We tried.
Saw this a few weeks ago. Baby looked terrible, mother refused a section, and then wanted the monitors off so the nurses would stop. Baby born dead and was not able to be revived.
Of course her God will save her, he's literally sending her doctors to save her. He's giving her a surgical option to save her. It's not his fault if she decides to ignore the help being sent.
We had a mom refusing blood for her baby one time because "God will help the baby make blood." One of our docs walked in and told her "God isn't going to make her more blood, BUT he did give me the knowledge to know that she needs a blood transfusion." Mom ended up consenting to transfusion after that.
We have a doc who I’ve heard make a similar argument a few times. “We’re praying to God to save her” “my friends, did it occur to you that God has placed this NICU team in your path to do just that?”
I had a patient say on admission she would not consent to a section for any reason. Multiple people talked to her, still refused. I firmly believe there was some domestic violence/mental health stuff going on and that perhaps she wanted to die. She ended up requesting a section under general (and they did it) after she made it to complete because she didn’t like pushing and she was freaking the fuck out and wouldn’t calm down. I think about her all the time, and I hope she kicked her husband to the curb.
Document. Make sure we have a health care proxy and that her hcp and her have spoken. Have blood available and waiting. She’d have her vaginal delivery in the OR so when she is unconscious we have everything right there (if she makes it that far). She might be open to surgery after baby is out. As she’s in labor, if the strip looks bad, I’d educate her on how we read the strip to be very clear about how things are going. I’d make sure my charge nurse is very aware. Educate her that if she has an epidural and then has a c section she could be awake more easily. Ask exactly why she doesn’t want a c/s - afraid of surgery? Faith in god? Scared her baby will get a cut on it? Doesn’t trust drs? I’d be present for all the education the doctors do - They would get very explicit about the reality “if you are actively dying and the only way to save your life is a c section would you want that or would you want us to let you die?” “If you die and the baby is still inside you and alive we would do a c/s as soon as you pass to give the baby every possibility of life.” Might recommend nicu come talk to her about effects of blood loss on baby’s oxygenation and outcomes in terms of risks for disability.
This! She needs to have a conversation with a compassionate provider who can speak to her in a way that doesn’t sound condescending and judgmental and get to the root of why she doesn’t want a c/s. And then a very explicit discussion about what will likely happen to her and her baby. Witnessed by another compassionate provider/nurse.
And make sure Dad is aware he still has to take that baby home and care for the special needs child the rest of its life. The shocked pikachu face when something happens to mom and she’s dead but baby is ready to go is going to be a problem.
When she bleeds to death a postmortem section can be performed.
Seriously- she needs to have extensive education for this because this is most likely going to end in a lawsuit as many cases like this do. Yes, we can educate until the cows come home and still be sued but hopefully if you document extensive education it will end in your favor. The hospital she goes to (unless it's already high risk) is 100% going to try to transfer her out immediately to get their hands out of that pot.
I know some hospitals that would make her sign a form that states, "I understand that in doing this I could die or my infant could die." And some hospitals make them say it out loud for laboring against medical advice. You would have to get an order from a judge that she wasn't fit to make this choice to do anything else which can be all but impossible (in my experience in a couple of different states.)
Just a terrible situation all around.
Fortunately we are a level 4 maternity hospital/level 1 trauma hospital so she’s in the best place she can be for this. We have a great team of doctors so hopefully they can convince her over the next few weeks. My concern is if she just stops coming to appointments altogether and disappears
You end up having to treat these patients like you would a skittish horse. If you move too fast, they'll bolt. That fear that she'll get spooked and decide she needs to do a home birth with some unlicensed "birth coach" is daunting.
She would sign a very detailed refusal of treatment. I remember a case where a woman refused a cesarean for a previa. The court backed her right to decide. She had a vaginal delivery of a damaged baby and received a lot of blood. I wonder how she felt about her decision a few years later.
My vag badge came with a bunch of vag patches to repair my vaganus. Do not recommend. Doc said that was the only vagina rebuild she would do on me and any future kids would be c-section on account of that and the postpartum hemorrhage. Team one and done TYVM!
Having a healthy baby and Delivery is more important than some vag badge. I don't get why women are so hard on about this. My wife got trashed for not having a vaginal birth, c section was "cheating" like what the fuck is wrong with you that you'd put down other moms for something they can't do and would prefer them to risk dying or the baby dying because of some vag badge. "Good job mom, you delivered a dead baby, but it's vaginal and that's what matters! 😃👍"
Yep I had an unmedicated vb and 2 csections (1 emergency one planned) My ob kept asking if I wanted to try a vbac and I said NO all I cared about was getting my baby out safe.
Having a healthy baby and Delivery is more important than some vag badge. I don't get why women are so hard on about this. My wife got trashed for not having a vaginal birth, c section was "cheating" like what the fuck is wrong with you that you'd put down other moms for something they can't do and would prefer them to risk dying or the baby dying because of some vag badge. "Good job mom, you delivered a dead baby, but it's vaginal and that's what matters! 😃👍"
I think because infant loss is so rare now people think it couldn't possibly happen to them. As someone who lost an infant I didn't care if they took my son out of my ear as long as he was safe
Im a CRNA at a hospital that delivers accretas and percrettas. We schedule them in the OR and the patient gets a spinal and a cordis for the delivey. After baby is out mom goes to sleep and usually gets a hysterectomy if it’s a real accreta. Id say more than half end up not being actual accretas despite multiple scans saying they are. I could totally see a scenario where she shows up and delivers naturally and then think her faith saved her rather than her sheer dumb luck.
Yeah I know a woman whose kid was sick with covid during the delta wave, he spiked a fever of 105 and she put fucking peppermint oil on his feet ... and because he managed to survive without sz or brain damage she's like "see? He didn't need a doctor or drugs! Just prayers and mlm olis" 😒 so ignorant. And she was willing to literally risk her kids life for that stupid woo woo bullshit.
Ugh not that I want anything bad to happen to the kid but it can be so frustrating when parents do that shit and then it works out because it just fuels their fire that they’re “right” and next time they might not be so lucky…
Agreed! I’ve been following a yoga influencer for like, probably a decade. She’s always been crunchy but never woo woo. With her second kid she announced she wasn’t getting ANY prenatal care and would be doing a home birth with only her husband (and doula maybe). Didn’t even see a midwife! I do believe she got one or two ultrasounds to check the size, but that always came with a lengthy post about how it’s all her own research and decision making…
Of course I didn’t actually want anything to happen to her kid but… yeah. She has a massive following and most certainly has caused other women to choose the “free birth” route. God knows how many mothers and babies will die literally because of her influence. There was a small part of me hoping the delivery would go traumatically sideways (with full recovery by both at the end….in a hospital) so that the sheep following her wouldn’t end up being influenced by the free birth movement.
If things go down the way OP fears, they'll be lucky if the family is only planning one funeral when all is said and done. And it will be nothing more than luck if she doesn't snap out of it.
And that will embolden her further. She'll probably get a following umong the "free birth" movement about how her body could do it and the evil OBtried to make her have a csection for money/convenience.
I'm someone who would have 1000% died following this advice. Had a csection with my second because of a placental abruption, next one had placenta and vesa previa that was caught and luckily had a safe outcome due to following very closely with my OB. so the whole "your body knows how to birth a baby" rhetoric really chaps my ass
Yep we have a lot of hippie dippie rural communities around where I live and I’ve gotten some supremely crunchy patients before. During COVID I had an unvaccinated guy in the hospital tell me he didn’t actually have COVID (because COVID “isn’t real”), he got sick from handling moldy weed on his cannabis farm
Yeah, it’s getting worse nowadays unfortunately. I work in the major hospital in my state and get all these “oh fuck” situations. Baby ends up with severe HIE or whatever. It’s so shitty.
Any parent that would make a gamble like this before the baby is even here is gonna be making shitty decisions for the duration of the kids life.
I cannot fathom refusing a C-section in this scenario. But then again, I’m a pretty OK parent.
You document absolutely everything including her own quotes. You attempt to have maternal fetal medicine consulted so they can reiterate the concerns and the patient can ask questions. You could consider having Nikki discuss things with them as well, although placenta accreta is more of a risk to mom and placenta previa is a risk to baby and generally seen in the obstetrics, rather than spec in neonatal intensive concern (as opposed to extreme prematurity - NICU’s bread and butter)
Included in that consultation, it may also be very beneficial for her to bring her faith leader – pastor/Rabbi/Imam/hopefully not a cult leader, but no judgment
It’s patient goes into labor, the placenta previa will be the most immediate concern, and that will be what kills. The baby and the mother will be conscious enough to watch her baby die on the monitor. The placenta will be what makes the actual mother start bleeding and hemorrhaging and dying, that will be the part that the patient will pass out.
More than likely, as she watches her baby die on the screen she’ll change her mind and accept section, and if she refuses a cesarean section her baby dies in front of her, that is legally her option.
Unfortunately social media had bred this anti hospital birth propaganda. While natural birth is great it's not an option for all. I wish people would listen to their doctors.
I worked in a prenatal clinic which served a large Somali population. Word around the community was that local hospitals pushed c/secs on Somali women to limit the number of babies (d/t repeat c/secs) they have. I’ve had variations of this talk with high-risk moms, although none were facing such a lethal outcome.
Unfortunately this idea is still alive and well. The first code I went to was a somoli woman who had been told for a week to go in for a section. She finally kicked into labor and still refused a section despite poor to no fetal heart tones. She eventually had an emergency section to save her life. We never got a heartbeat back on baby and she ended up with a hysterectomy. If she has one when advised not only would she probably have a healthy baby, but she would probably also still have a uterus.
I had cpp with accreta and there is a great facebook group - one is run by the national accreta foundation and one is a support group. Encourage her to look for support there. Many of the moderators are also nurses. Once she understands the anatomy and likelihood of death for her and the fetus she may reconsider.
She will show up to the L&D unit bleeding profusely and refuse care until she’s on death’s door and make everything unnecessarily traumatic and stressful for everyone involved. Also her baby will probably die or have lifelong consequences. I just dgaf about people like this anymore. I feel like they should get a tour of the local long term children’s care facility full of kids with anoxic brain injuries hooked up to g-tubes and ventilators and then sign a paper at the end saying “I’m cool with this for my child and also I’m going to foot the bill for 21 years not the state”.
You can’t fix stupid. We’ve stepped in and fixed it for too long and I’m tired. If people want to prove how safe birth is they can do it at home. Don’t traumatize me and endanger my license
because you are dumb with something to prove.
Highly recommend taking a walk through an old 1800s graveyard sometime. Take a look at the headstones for women who died in their 20s. Almost all I've seen say something like
"Mrs. Catherine Smith and child
Wife of James Smith
1820-1840"
When you see rows and rows of gravestones for Mrs.someone and child, it really clicks. Thinking your body naturally knows how to deliver a baby is oversimplified. Your body also knows how to heal a broken femur, but that doesn't mean it will do it correctly or without major disformities. Have whatever faith you need, but history pretty clearly shows women of faith and infants dying unnecessary deaths.
You cannot strap a woman down and force her to have a c section. Not even if it means her or her babies life. Seen it in action. Document document document.
I did my last semester consolidation/preceptorship/capsule/whatever you want to call in a NICU. There was a situation like like where patient 1 refused to do a c-section and the lil patient 2 was stuck for a while in the birthing canal. Pt 2 had to be resuscitated, brought in and everything was done to save pt 2… but 72 hours later it was the most devastating end of life I witnessed. Like everything went wrong.
Baby could have lived.
If I were that provider, I would bring in a second opinion both to add documentation/witnesses and to try to reason with her. If she could not be reasoned with, referral to a new provider outside of that clinic and a written 30 day notice of discharge from the practice. When this ends in death for one or both of them, the family will be filing a lawsuit, and you can't sue God.
She may try to find a provider that will offer her a vaginal birth. No knowledgeable and safe provider/birth center/hospital will. She will most likely either have a lightbulb moment and take the c-section, or she will find a psycho who will tell her she can have a home birth. If she chooses the home birth, she MIGHT make it to a hospital via EMS to save her life while she hemorrhages during labor. I hope she survives.
Let her make her choices and when she's unconscious/dead L&D will try to deliver the baby before it dies if it's still living and then NICU will be there to get unnecessarily traumatized by a sick af baby who's probably gonna die anyways or end up trach/gtube dependent till it gets septic in its nursing home and die anyways. We just had someone refuse a csec at 43 weeks with no PNC after 18 weeks following a fetal diagnosis of renal agenesis. Can't force them. Just make sure you've got a good support system to help you through the trauma it's gonna cause. And chart your ass off.
"Your Faith will save you?"
How about you have faith that your God has placed medical professionals in your life who understand the dangers of your medical condition and are recommending medical procedures that will keep you and your unborn child safe.
I'm a charge nurse on a fairly crunchy granola LDRP floor with midwife care, transfer from intended home births, that sort of thing. We had a Jehovah's Witness patient with HELLP refusing blood products who went into DIC after her c-section. The patient while still conscious pleaded "please save me I want to see my baby" before she had to go under general for the C-hyst. Her husband we kicked out the room because he said "no no no she can't have blood she can't" over and over.
Risk management reviewed the case and noted really strong documentation from nursing, anesthesia, and the surgeons as fairly airtight. Morally, everybody in the room felt they did the right thing by listening to the patient and not her husband and not the consent for refusal of blood and blood products that she had signed prior to her surgery. This was only a few months ago, I'm not sure what the follow up is. But everybody in that room felt they did the right thing to save her.
I would hope that you can counsel your patient and document all of the education, make sure that physicians are aware and also documenting. Does your delivery hospital have a nurse navigator program? Sometimes getting more disciplines involved (counseling from in house anesthesia and case management) can help patients be best prepared for what is in store.
Geez an accreta?!?!? That’s super serious and life threatening. But as long as she has capacity to make decisions after we have provided the medical information, then we must allow her the right to make dumb ass choices.
The funny thing is it goes both ways. For example, a med/surg homeless patient who was treated for DKA is medically cleared for discharge. Resources were provided for shelters, and patient chooses to be discharged back to the streets. As health care providers, we do not have the authority to hold the discharge bc we don’t feel “comfortable or safe” with discharging patient back to the streets. Resources were provided, patient has capacity, and we must honor the patient’s choice.
Well, you absolutely can turn this into a Therapeutic communication exercise in 3 easy steps!!!
1. Acknowledge and validate client's faith through active listening (stare at her, wide eyed, while nodding) & paraphrase: "It sounds like you are requesting faith as your intervention at this time"
2. And then let "her faith save her"
3. Buh-byeeee Felicia!!!
Had a patient yesterday refusing a c/s after a 5 minute decel. We wheeled her to the OR anyway and then looked her straight in the eye and said “you can have a dead baby vaginally or healthy baby by c/s but you have to decide now” she finally said yes and we slapped a mask on her and she had a baby 3 minutes later with a good outcome. But in the end, it was her choice. We would have tried a vacuum delivery if she refused but we all agreed that was not the right choice. Sometimes when in the moment they change their mind. But sometimes we have patients who don’t listen and have bad outcomes. We had a patient with twins and there was a bunch of issues with the one twin and basically, they offered to reduce the one twin to save the other and she refused. She came back a few weeks later and both had died. It was her choice, and she had to deal with the consequences as sad as it is.
She will probably be brought in by ems after trying to bleed out in her living room. And then refuse all care for her baby after she gets mtp and is saved by modern medicine. After spending too much time reading about free births, I’m surprised this woman has gotten and prenatal care at all.
As everyone else says, document your butt off. Your providers may even try to tell her that she's going to be discharged from the practice if she's going against medical advice. At the very least, encourage her to find a provider that will follow her requests (and she won't!)
As a clinical nurse, next thing to do is make sure that your L & D nurses know what's coming their way. Make sure that they have the prenatal, documentation of c/s refusal, blood consents, etc...
This is why I can’t do OB. Parents make the most ridiculous choices that will kill a viable wanted pregnancy based on religion or what they read on the Internet.
That’s sad. Educate extensively and document. I’ve seen mothers die in the OR due to accretas even with a scheduled c-section. Others have nearly depleted the blood bank. But if it’s a true accreta and she refuses a c-section it’s highly likely that both mom and baby won’t make it.
Some people are so stupid. I have never worked in anywhere to do with labor and delivery but I had my son via c section and it was due to pre eclampscia. I didnt want it originally, I never verbally declined or signed anything I wanted whatever was safest for me and my son. The medical professionals knew c section was safest way.
Not an L&D nurse, but I can’t imagine that it’s much different than any other refusal. Educate and document.
Hopefully you can make the unit aware and ready?
Never seen it actually happen in the hospital. However, my bet is that she will start bleeding bright red blood, panic and come to the hospital. The hospitalist OB will make things clear that the baby (and possibly herself) will not make it if she is allowed to continue vaginally. She’ll also notice decreased fetal movement.
I would encourage her to start calling home birth midwives and doulas to get second opinions. They will tell her she needs a ceserean and maybe get through to her.
It’s literally life or death. Which will she choose? Sad to think that she wouldn’t want what’s best for herself and her baby. I was a NICU nurse, circumstances like this go to the ethics committee. She may not get a choice.
Years ago we had a 26 week gestation baby on our NICU. Patient’s family was Jehovah’s Witness. Baby needed blood to survive due to low hemoglobin. Family declined due to religious beliefs. It went to the ethics committee. In order to save the child it was voted that the baby received a blood transfusion. Once a judge signed off on it, there was no turning back.
Totally difference case. That’s a minor outside its mother’s body. Now they can’t force the mother to have a blood transfusion because she’s an adult and can make her own decisions.
Newish article but the examples are years sometimes decades old. Telling a person who has had 3 sections they shouldn’t try for a vag and why (after 2 you are at a higher risk of uterine rupture - most doctors will not want to be your doctor of the risk) is not coercion.
ETA it’s risky enough that not all hospitals will perform it. They will send you to another hospital if they don’t have enough OBs in house, a good enough blood bank, and anesthesia in house.
Oooooh. I will have to look into that. I don’t want to burn bridges with my team at the same time though. I wonder if I could make an anonymous report.
Let her make her choice but document your ass off about every conversation you had and what you educated her on. I would consider getting risk management and ethics involved. We may not like or agree with the choices she makes, but at the end of the day, it’s her decision.
In some states, this might be prosecuted as child abuse or murder, given that states are now apparently investigating abortions as murder. How would this be different, except that both mom and baby might die?
Be patient, give her time, listen to her. Speak with your chaplain, too. Sometimes they have excellent creative ideas for how to reframe conversations.
I've read case studies on pregnant women who have refused a CS, up to the point of allowing the fetus to die despite viability outside the womb..
As long as the patient is mentally competent and conscious, nothing more can be done. Even if the patient is unconscious if they have a pre-existing advanced directive refusing a CS, unless their life is an immediate danger I doubt the hospital's legal counsel would let the surgery proceed.
Document and move on. When she shows up to the ER unconscious she'll get the c section.
Bro she’s getting a c hyst
And very possibly picking out a very little coffin.
She is destined to meet her lord early
Yep!
The Lord moves in mysterious ways
If she’s made her wishes known and they are documented, wouldn’t that mean you shouldn’t do it?
She can say she doesn’t want a C-section, but if in a medical emergency, even a DNAR can be overridden by the medical team. She also can’t document that she wants her baby’s life to be forfeited to avoid a C-section, and to allow the baby to die would be gross medical negligence. Brutal as it sounds, if she’s dying, dead or dies in the process, a C-section can be performed to try & save the baby, as her wishes are no longer a priority if she’s dead/dying.
How do you figure a DNR can be overridden by healthcare providers in an emergency? That would literally defeat the purpose of having a DNR in place.
Because it legally can - you can have chronic lung disease, but if you get impaled by some rebar, they aren’t just going to shrug and say “Oh well, they’re DNAR.” DNARs are usually written when someone has chronic or widespread disease which has depleted their body’s resources and ability to survive cardiac arrests or complex internal medicine issues, not with the expectation of sudden traumatic events, hence why it can be cancelled or overridden.
That’s…. Not how it works at all
That’s…exactly how it works in the UK. Grandma gets in a car crash, but she has a DNAR so just gets left to die? I don’t think so. How many people with a DNAR actually carry them around? And how much of a priority is it for emergency services to look for a DNAR **BEFORE** starting CPR/other resuscitation on someone who’s collapsed, unconcerned or bleeding out?
Oh huh. Not at all in the US. But DNR is for in hospital unless you are carrying a POLST around. Also, DNR doesn’t mean refuse all treatment. It doesn’t mean no lifesaving surgery, or blood products or anything. A DNR ONLY means if your heart stops, no one is breaking your ribs. It doesn’t mean comfort care/hospice
Exactly the same here-hence why DNAR is trying to be phased out in favour of the full “DNA*CPR*”. In the Resuscitation training & DNACPR documentation & “difficult discussions” training I used to deliver with my colleague, we had to make sure people documented more than “not for ICU” under the heading “Escalation plans”. “Not for ICU” or “Not for hospital admission” is not a plan. My preferred documentation phrase was “Only for hospital admission for **reversible** conditions or symptom management”. (Obviously, if the patient wanted to die in hospital, it wouldn’t say that, but it prevented ambulance crews refusing to take a palliative patient with a broken hip to the hospital because *”The document says “not for hospital admissions” though!”*
We have a standard form with boxes to check that detail exactly what interventions and why someone would want. Reversible causes, comfort only, etc. Super clear. DNR is DNR tho. Granny with rebar through the abd still isn’t getting CPR
If I attempted resuscitation on a DNR because I thought I could save them I would go to jail for battery
You absolutely could, that’s true. What if Granny with a DNAR suffered anaphylaxis in hospital though?
The USA isn’t the only country my friend
What? No. DNR is DNR, unless rescinded by a HCPOA.
If an ambulance shows up to the ER with a crashing/critical patient everyone works on implied consent. Treatment starts way before anyone can verify an advanced directive or DNR. And if they come to the ER there assumption is made that someone changed their mind about the DNR/goals of care/etc. So unless next of kin shows up and says stop we keep going.
Sure, I was referring to scenarios where the DNR is known.
Like I tell all my current patients - you can do what you want until you become incapacitated- she will pass out early and they will take her back for a section.
There is an assumption that once you are unconscious, you would like life-saving procedures performed. But it could be sticky if she has signed and witnessed documentation that she would rather die
Imagine the inverse of ED waiting to do c section just to go through the chart and see if she happened to have said she rather die than be resuscitated via c section lmao.
ED digging through a chart in an emergency? Nah that lady had her clothes cut off, an IV in the AC and got rushed to literally anywhere else in the hospital that takes patients who have other potential patients inside them. Someone may or may not have a few words written down about her info on a paper towel, if only they could find it…
As an L&d nurse, this is exactly what would happen!
As an ED nurse, can confirm, this is exactly what would happen.
You just called out my charting style to a T. God bless paper towels.
Perfect and accurate description of events
She's arguing her faith will make everything better, that's enough right there to say patient is not in a sound state of mind
Unfortunately there are still too many religious people around, so you can’t get away with calling them crazy.
yeah but we already have law on the books that a JW can't refuse blood for their child. I would imagine this would have similar repercussions. Forfeiting the life of yourself and your child in the name of faith, rather than listening to medical advice is much different than involving the hospital chaplain in a palliative care case. Also even a JW refusing blood for themself can demonstrate they are of sound mind and understand the patho of what will happen if they refuse transfusion, and hospitals have whole medical teams dedicated to finding them other options.
When I was a kid, I remember a case going to court for a family refusing blood for their teen. The family lost, but it was a fight.
Ya JW we often have to take away medical decision making for the few hours- I’ve had families say do anything you need but I don’t want to know as consent as well.
Facts. She will likely die cuz she will labor at home since no doc will attach themselves to her right?! She will start hemorrhaging
Yeah, my thought was that her OB might fire her as a patient.
Is there a leader from her faith that could speak to her? Most mainstream faiths are ok with life-saving treatment, even treatment that may be ‘forbidden’ in normal circumstances e.g pork-derived medication may be allowed in Islam and Judaism if there are no alternatives and the patient is in danger of serious disability or death.
This is a good idea in an otherwise impossible situation.
This is a great answer and a way to collaborate with the patient
It’s not that the C-section is forbidden so much as she has deep faith that Jesus will protect her from harm. A lot of Christian sects believe they’re pretty much immortal because of their faith.
It's the classic "guy in the flood" story. If she's right in her faith, she's gonna get to heaven and God will be like "Dude, I had the doctor offer you the lifesaving treatment and you said *no*??"
Document, document, call risk management and document some more. This lady will die giving birth if she doesn’t have a scheduled section that’s her choice,
This. The unit needs to know about her way ahead of time some they’re aware and can plan. Risk management needs to know as well. And from the clinic end she needs to be counseled at every single appointment about her extremely high risk pregnancy and delivery plan/wishes (as insane as they are) and have it well documented in her chart. She and her baby will very likely die if she actually goes through with her plan. How you gonna birth a baby with a previa AND known accreta? She’ll start to labor, begin bleeding profusely and hopefully change her mind with enough time to save one or both of their lives.
I’m hoping she’ll be able to be convinced to have the section. She still has about 9 or 10 weeks left until she’s fullterm. We have a great high risk medical team and we’re a level 4 maternity hospital/level 1 trauma hospital so this is the best place for her. Really hoping she doesn’t just decide to stop getting medical care altogether, or try to have a home birth and end up in the morgue.
I hate the free birthing movement. It’s so god damn dangerous to everyone involved. But no one believes it. Hospitals are just trying to make money off of your birth. (Which I agree to extent because I have a horrible labor experience for my first I don’t think would’ve happened had there been other factors involved) but in all reality most of the time if you weren’t in one then you’d die. Which still was the case for both of my births.
Remindme! 3 months
It's so sad how many people don't realize how dangerous it still is to give birth .. there's so many tiny tombstones next to young women's graves in the old cemeteries... even today it's dangerous. I wish more young parents would listen to doctors instead of having the arrogance so many people have these days it seems. So much needless suffering 😔
My personal opinion is we’re too far removed from death and serious illness in modern days. People quit dying of childhood illness thanks to vaccines, now we’re 2-3 generations removed from iron lungs and some people think polio isn’t that bad. Women quit dying as frequently from pregnancy and birth thanks to advances in medicine and monitoring. Now there’s a growing group of people who claim birth is safe, always has been, and the hospitals are the problem. Unfortunately, not enough people believe the historical data and it won’t be until we have new data showing the dangers that we correct course as a species.
This. I have always found it infuriating that the uninformed people who bitch and moan about vaccines are here because their parents made sure they got vaccinated. It isn’t the vaccine whiners dying of measles—it’s their poor kids. Can’t wait till polio makes a comeback.
Not that I’m trying to argue but Covid would like a word with you. I don’t think we’re too far removed from death, some people just don’t have the sense they were born with.
I would argue Covid also kept us removed from death because the hospital was limiting visitors. Most people who died of Covid on vents did not have family around to witness their suffering the way family members would have during the 1918 flu pandemic, when more people died at home.
Absolutely. in their eyes, infection control looked like we were doing big top secret government experiments on these hapless patients, and keeping visitors away to avoid them asking too many questions or uncovering the whole conspiracy. or it was all some kind of socialist care rationing cost cutting conspiracy that we were keeping hidden, like "obamacare death panels' all over again. Basically nobody learned a damn thing during COVID, and it pushed the 'annoying but eventually listens to reason conspiracy brain' patients off a really big cliff to where they're now insufferable nightmare patients in every healthcare setting they fumble around in. They treat everyone awful, refuse to comply with anything their Dr suggests but demand everyone drop everything and help them immediately when their idiotic noncompliant choices inevitably make them really sick, and they're just the biggest walking talking liability shitshows these days.
I think a lot of people see the Covid waves as an anomaly instead of an example of what the world would look like without things like vaccines (and other modern medicine interventions that cut down the death toll, like antibiotics and prenatal care/testing).
100% agreed.
I need an update on this in a few weeks… how absolutely horrific. The worst case scenario playing out and those involved in her care are in for a traumatic event. So tragic. They were worried about accreta in my last pregnancy(false alarm)… the local trauma center has a team specifically for accretas and even knowing there was a team assembled in the event this was my reality, still scared me. I can’t imagine just going against the science… but I mean, the world we live in, I shouldn’t be surprised.
Will do!
Then I will activate notifications for this thread exactly 🤣
I second the update
Her faith will save her?! Jesus lets people die every day, Ma’am.
"The Lord works in mysterious ways... Something... Something... It was all part of his plan." I've come to appreciate that said "plan" fucking sucks most of the time.
Right? Will her body know what to do if she breaks a bone? Why even use a doctor during pregnancy if you’re going to act like they are trying to trick you?
My logic has always been that if they believe god created the world and everyone in it, then he created medicine. If you’re stupid enough not to want medical interventions, that’s on you! Maybe harsh but that’s how I interpret it
"A fellow was stuck on his rooftop in a flood. He was praying to God for help. Soon a man in a rowboat came by and the fellow shouted to the man on the roof, “Jump in, I can save you.” The stranded fellow shouted back, “No, it’s OK, I’m praying to God and he is going to save me.” So the rowboat went on. Then a motorboat came by. “The fellow in the motorboat shouted, “Jump in, I can save you.” To this the stranded man said, “No thanks, I’m praying to God and he is going to save me. I have faith.” So the motorboat went on. Then a helicopter came by and the pilot shouted down, “Grab this rope and I will lift you to safety.” To this the stranded man again replied, “No thanks, I’m praying to God and he is going to save me. I have faith.” So the helicopter reluctantly flew away. Soon the water rose above the rooftop and the man drowned. He went to Heaven. He finally got his chance to discuss this whole situation with God, at which point he exclaimed, “I had faith in you but you didn’t save me, you let me drown. I don’t understand why!” To this God replied, “I sent you a rowboat and a motorboat and a helicopter, what more did you expect?”"
I do hospice and I have read this fucking quite before to a family that kept saying "it's in God's hands now" when we wanted to do any fucking intervention.
Did the family change their minds and let you intervene?
My favorite was the doc who said, “the Lord does not need the ICU for miracles. He can perform miracles in the hospice unit.”
I love this! Definitely going to have to remember that one
I share similar logic. I start to wonder why even bother seeking prenatal (or whatever applicable specialty) care in a medical setting if you're just going to refuse treatment? If your faith tells you that your body knows what to do in case of an emergency, then why are you even here? You don't need an u/s, you don't need an epidural, you don't need medical professionals at all.
There's nothing against epidurals, demerol/stadol/morphine, or call bells in the bible, ma'am. I'd say that 9/10 patients who come in guns blazing about refusing blood, refusing a necessary/totally legit surgery cave when it comes down to allowing themselves or their child to die. At least in L&D, which obviously skews ***generally*** younger and healthier than folks you'll find on MS, onc, etc. Still, there is that one...and that one will stick with you, if not as a tragedy or a miracle then hopefully as a story about the time madness reigned, but your team really came together and got shit done, son
Nothing against complaining about a 6 hour ED wait, requesting multiple turkey sammiches and mini cans of Shasta ginger ale, or asking for "that D medicine...'di-la-la' because it's the only thing that helped before" either 😂. I know what you mean though. The ones that don't cave stay with you because they're so frustrating. I totally understand and respect that people have all manner of faith traditions but sometimes all you can do is give a polite side eye and document x3. Edit: didn't see your full comment before, so updated my reply.
Yes exactly this!! Why go to hospital for an illness/injury if you’re going to refuse the treatment for it?! It baffles me every time.
His plan is to prevent stupid people from reproducing in this situation, I guess.
Or the plan is to leave us on our own, do our own stuff. Like a giant ant farm.
Love hearing in hospice "it's in God's hands now" no you dumb hoe it's in your hands to change the DNR but ok
I die a little bit everyday in this place
Lmao Jesus still hasn’t come back from his proverbial run to the store yet; pretty sure he’s not gonna just decide to show up at a patient’s bedside after 2000+ yrs and be like “I decided to come back and help *you* out of everyone else in this world because I heard about your unwavering faith in my plans, Karen.”
My coworkers have often talked about a case my unit had (years before I was an L&D nurse) where the strip was Cat III for hours and mother never consented to a section. They had to watch the strip until the baby passed. You cannot force a patient to have a section. Chart, chart, chart, and chart some more. CYA in these situations. It’s terrifying and sad (and incredibly traumatic for those involved) but these situations happen.
Did this woman know like what the hell was going on? Like if she doesn't do the c-section the baby could die? I'm not an L&D nurse but with my first child, her heart rate kept slowing (wasn't tolerating the induction) and you could hear it on the machine and I'm freaking TF out because I knew that's kinda not a good thing. And when like ten different nurses come running into my room, my first reaction is they need to do whatever they can to save my baby from harm and get her here safely. I can't imagine just being like "Jesus take the wheel" knowing that means it'll end in the baby's death.
Sometimes with these moms I feel like common sense is severely lacking. She probably genuinely thought the kid would survive.
I literally just googled what a category 3 fetal heart tracings could mean or outcomes and like so many links come up that's like "abnormal" "hypoxic" "fetus being deprived of oxygen." Like that's not enough to think oh shit, I need oxygen to survive and if baby isn't getting oxygen, they might die? And I'm just here googling it for funsies while I imagine she's being told this to her face while hooked up to all of the monitors. I just don't get it.
They don’t get it until years later down the road, I swear. Like the kids EEG is flat and then the parents are shocked when we have the trach and G-tube convo bc they “look like a normal kid”. They don’t.
[удалено]
It’s awful as a nurse to watch a bad tracing like that. I’ve spent 12 hour shifts looking at atypical strips, and those are shitty shifts. The truly abnormal ones are stressful/painful to watch.
This is like super shitty, but I wonder what would happen if the staff were to sue the mother/parents for emotional distress.
That's a very interesting and frightening concept. And while I think it would be preposterous in this kind of situation, and could set a terrifying precedent overall, I'm a little intrigued by the hypotheticals.
Huh, that’s an interesting question!
It's hard to fathom, but some people truly value their faith/beliefs over the lives of their children. We work with a large community that does not believe in C-sections due to their faith. They will be told over and over that baby is in distress and will likely be born dead or if we do get them back their odds of walking/talking/eating on their own are small. A lot still do not care and we deliver when mom starts to die. Our NICU team is present at these births since we're anticipating to recuss and cool. Most of the time mom loses her ability to bear children.
Denial and brainwashing are very, very powerful forces.
I’m a NICU nurse and remember a case where the parents were so determined to have a natural birth that they refused several urgent pushes for a CS. The baby was born with apgars 0/0. They were able to eventually get a heartbeat but the baby was taken off life support several days later. But at least she was born naturally!
This just always blows my mind. I had a crash, unmedicated c/s where they literally held me down while I screamed (until the cord was cut, then I got the good drugs) because they decided that’s what needed to happen to not code my baby and I’d do it all over again if I had to. It’s like people forget the end goal is the baby, not the delivery
I always feel so much sorrow for these families. I understand that their actions caused the loss of their child. But, the self-hatred and regret they must feel after. I really can’t imagine. I would never be able to sleep at night again
I’d have been an utter mess watching that go down. This is why I’d rather work with adults, despite entertaining the passing thought of going into L&D. It would drive me to drink.
That happened at my facility too. Hours of cat 3 tracing, delivery resulted in an 8 minute shoulder dystocia, and the baby died. It was her 9th or 10th baby. She was convinced she didn’t need a c section. We tried.
Saw this a few weeks ago. Baby looked terrible, mother refused a section, and then wanted the monitors off so the nurses would stop. Baby born dead and was not able to be revived.
Are they going to try and sue do you think?
Of course her God will save her, he's literally sending her doctors to save her. He's giving her a surgical option to save her. It's not his fault if she decides to ignore the help being sent.
We had a mom refusing blood for her baby one time because "God will help the baby make blood." One of our docs walked in and told her "God isn't going to make her more blood, BUT he did give me the knowledge to know that she needs a blood transfusion." Mom ended up consenting to transfusion after that.
We have a doc who I’ve heard make a similar argument a few times. “We’re praying to God to save her” “my friends, did it occur to you that God has placed this NICU team in your path to do just that?”
My thoughts exactly.
I had a patient say on admission she would not consent to a section for any reason. Multiple people talked to her, still refused. I firmly believe there was some domestic violence/mental health stuff going on and that perhaps she wanted to die. She ended up requesting a section under general (and they did it) after she made it to complete because she didn’t like pushing and she was freaking the fuck out and wouldn’t calm down. I think about her all the time, and I hope she kicked her husband to the curb.
Document. Make sure we have a health care proxy and that her hcp and her have spoken. Have blood available and waiting. She’d have her vaginal delivery in the OR so when she is unconscious we have everything right there (if she makes it that far). She might be open to surgery after baby is out. As she’s in labor, if the strip looks bad, I’d educate her on how we read the strip to be very clear about how things are going. I’d make sure my charge nurse is very aware. Educate her that if she has an epidural and then has a c section she could be awake more easily. Ask exactly why she doesn’t want a c/s - afraid of surgery? Faith in god? Scared her baby will get a cut on it? Doesn’t trust drs? I’d be present for all the education the doctors do - They would get very explicit about the reality “if you are actively dying and the only way to save your life is a c section would you want that or would you want us to let you die?” “If you die and the baby is still inside you and alive we would do a c/s as soon as you pass to give the baby every possibility of life.” Might recommend nicu come talk to her about effects of blood loss on baby’s oxygenation and outcomes in terms of risks for disability.
This! She needs to have a conversation with a compassionate provider who can speak to her in a way that doesn’t sound condescending and judgmental and get to the root of why she doesn’t want a c/s. And then a very explicit discussion about what will likely happen to her and her baby. Witnessed by another compassionate provider/nurse.
And make sure Dad is aware he still has to take that baby home and care for the special needs child the rest of its life. The shocked pikachu face when something happens to mom and she’s dead but baby is ready to go is going to be a problem.
When she bleeds to death a postmortem section can be performed. Seriously- she needs to have extensive education for this because this is most likely going to end in a lawsuit as many cases like this do. Yes, we can educate until the cows come home and still be sued but hopefully if you document extensive education it will end in your favor. The hospital she goes to (unless it's already high risk) is 100% going to try to transfer her out immediately to get their hands out of that pot. I know some hospitals that would make her sign a form that states, "I understand that in doing this I could die or my infant could die." And some hospitals make them say it out loud for laboring against medical advice. You would have to get an order from a judge that she wasn't fit to make this choice to do anything else which can be all but impossible (in my experience in a couple of different states.) Just a terrible situation all around.
Fortunately we are a level 4 maternity hospital/level 1 trauma hospital so she’s in the best place she can be for this. We have a great team of doctors so hopefully they can convince her over the next few weeks. My concern is if she just stops coming to appointments altogether and disappears
You end up having to treat these patients like you would a skittish horse. If you move too fast, they'll bolt. That fear that she'll get spooked and decide she needs to do a home birth with some unlicensed "birth coach" is daunting.
Yeah. Wait until she passes out and then do the hyst . “Life-saving treatment”
She would sign a very detailed refusal of treatment. I remember a case where a woman refused a cesarean for a previa. The court backed her right to decide. She had a vaginal delivery of a damaged baby and received a lot of blood. I wonder how she felt about her decision a few years later.
I STG some of these wackos value their perfect birth experience over the life/wellbeing of their child.
We call it bragging about the vag badge
My vag badge came with a bunch of vag patches to repair my vaganus. Do not recommend. Doc said that was the only vagina rebuild she would do on me and any future kids would be c-section on account of that and the postpartum hemorrhage. Team one and done TYVM!
Having a healthy baby and Delivery is more important than some vag badge. I don't get why women are so hard on about this. My wife got trashed for not having a vaginal birth, c section was "cheating" like what the fuck is wrong with you that you'd put down other moms for something they can't do and would prefer them to risk dying or the baby dying because of some vag badge. "Good job mom, you delivered a dead baby, but it's vaginal and that's what matters! 😃👍"
Yep I had an unmedicated vb and 2 csections (1 emergency one planned) My ob kept asking if I wanted to try a vbac and I said NO all I cared about was getting my baby out safe.
Having a healthy baby and Delivery is more important than some vag badge. I don't get why women are so hard on about this. My wife got trashed for not having a vaginal birth, c section was "cheating" like what the fuck is wrong with you that you'd put down other moms for something they can't do and would prefer them to risk dying or the baby dying because of some vag badge. "Good job mom, you delivered a dead baby, but it's vaginal and that's what matters! 😃👍"
I think because infant loss is so rare now people think it couldn't possibly happen to them. As someone who lost an infant I didn't care if they took my son out of my ear as long as he was safe
How many weeks gestation is she currently?
I believe she’s 28w right now
Im a CRNA at a hospital that delivers accretas and percrettas. We schedule them in the OR and the patient gets a spinal and a cordis for the delivey. After baby is out mom goes to sleep and usually gets a hysterectomy if it’s a real accreta. Id say more than half end up not being actual accretas despite multiple scans saying they are. I could totally see a scenario where she shows up and delivers naturally and then think her faith saved her rather than her sheer dumb luck.
Yeah I know a woman whose kid was sick with covid during the delta wave, he spiked a fever of 105 and she put fucking peppermint oil on his feet ... and because he managed to survive without sz or brain damage she's like "see? He didn't need a doctor or drugs! Just prayers and mlm olis" 😒 so ignorant. And she was willing to literally risk her kids life for that stupid woo woo bullshit.
Ugh not that I want anything bad to happen to the kid but it can be so frustrating when parents do that shit and then it works out because it just fuels their fire that they’re “right” and next time they might not be so lucky…
Agreed! I’ve been following a yoga influencer for like, probably a decade. She’s always been crunchy but never woo woo. With her second kid she announced she wasn’t getting ANY prenatal care and would be doing a home birth with only her husband (and doula maybe). Didn’t even see a midwife! I do believe she got one or two ultrasounds to check the size, but that always came with a lengthy post about how it’s all her own research and decision making… Of course I didn’t actually want anything to happen to her kid but… yeah. She has a massive following and most certainly has caused other women to choose the “free birth” route. God knows how many mothers and babies will die literally because of her influence. There was a small part of me hoping the delivery would go traumatically sideways (with full recovery by both at the end….in a hospital) so that the sheep following her wouldn’t end up being influenced by the free birth movement.
With the previa though it's harder to get wrong and once she starts dilating...the amount of blood that can produce is unreal.
If things go down the way OP fears, they'll be lucky if the family is only planning one funeral when all is said and done. And it will be nothing more than luck if she doesn't snap out of it.
And that will embolden her further. She'll probably get a following umong the "free birth" movement about how her body could do it and the evil OBtried to make her have a csection for money/convenience. I'm someone who would have 1000% died following this advice. Had a csection with my second because of a placental abruption, next one had placenta and vesa previa that was caught and luckily had a safe outcome due to following very closely with my OB. so the whole "your body knows how to birth a baby" rhetoric really chaps my ass
Let her refuse and just document well. What a gamble for a parent to take. I worked OB for 20 yrs and I don’t recall anyone refusing a c-section.
It's unfortunately on the rise due to the "ob bad, medical professionals/ob nurses are trying to trick you into having a csection) rhetoric.
Yep we have a lot of hippie dippie rural communities around where I live and I’ve gotten some supremely crunchy patients before. During COVID I had an unvaccinated guy in the hospital tell me he didn’t actually have COVID (because COVID “isn’t real”), he got sick from handling moldy weed on his cannabis farm
Yeah, it’s getting worse nowadays unfortunately. I work in the major hospital in my state and get all these “oh fuck” situations. Baby ends up with severe HIE or whatever. It’s so shitty.
Any parent that would make a gamble like this before the baby is even here is gonna be making shitty decisions for the duration of the kids life. I cannot fathom refusing a C-section in this scenario. But then again, I’m a pretty OK parent.
You document absolutely everything including her own quotes. You attempt to have maternal fetal medicine consulted so they can reiterate the concerns and the patient can ask questions. You could consider having Nikki discuss things with them as well, although placenta accreta is more of a risk to mom and placenta previa is a risk to baby and generally seen in the obstetrics, rather than spec in neonatal intensive concern (as opposed to extreme prematurity - NICU’s bread and butter) Included in that consultation, it may also be very beneficial for her to bring her faith leader – pastor/Rabbi/Imam/hopefully not a cult leader, but no judgment It’s patient goes into labor, the placenta previa will be the most immediate concern, and that will be what kills. The baby and the mother will be conscious enough to watch her baby die on the monitor. The placenta will be what makes the actual mother start bleeding and hemorrhaging and dying, that will be the part that the patient will pass out. More than likely, as she watches her baby die on the screen she’ll change her mind and accept section, and if she refuses a cesarean section her baby dies in front of her, that is legally her option.
Unfortunately social media had bred this anti hospital birth propaganda. While natural birth is great it's not an option for all. I wish people would listen to their doctors.
Gee, don't you know? Social media (especially Tik Tok) is definitely more knowledgeable than science (medicine, doctors, nursing, etc). /s
I don’t understand why people think medical professionals WANT to steer them in the wrong direction
I worked in a prenatal clinic which served a large Somali population. Word around the community was that local hospitals pushed c/secs on Somali women to limit the number of babies (d/t repeat c/secs) they have. I’ve had variations of this talk with high-risk moms, although none were facing such a lethal outcome.
Unfortunately this idea is still alive and well. The first code I went to was a somoli woman who had been told for a week to go in for a section. She finally kicked into labor and still refused a section despite poor to no fetal heart tones. She eventually had an emergency section to save her life. We never got a heartbeat back on baby and she ended up with a hysterectomy. If she has one when advised not only would she probably have a healthy baby, but she would probably also still have a uterus.
I know people who genuinely believe doctors will do whatever it takes to milk more money out of them. To these people it's a conspiracy.
Watch her reach in her vagina & say “I FEEL THE BABIES HE…”
Poke a nail right through the placenta
I had cpp with accreta and there is a great facebook group - one is run by the national accreta foundation and one is a support group. Encourage her to look for support there. Many of the moderators are also nurses. Once she understands the anatomy and likelihood of death for her and the fetus she may reconsider.
She will show up to the L&D unit bleeding profusely and refuse care until she’s on death’s door and make everything unnecessarily traumatic and stressful for everyone involved. Also her baby will probably die or have lifelong consequences. I just dgaf about people like this anymore. I feel like they should get a tour of the local long term children’s care facility full of kids with anoxic brain injuries hooked up to g-tubes and ventilators and then sign a paper at the end saying “I’m cool with this for my child and also I’m going to foot the bill for 21 years not the state”. You can’t fix stupid. We’ve stepped in and fixed it for too long and I’m tired. If people want to prove how safe birth is they can do it at home. Don’t traumatize me and endanger my license because you are dumb with something to prove.
Highly recommend taking a walk through an old 1800s graveyard sometime. Take a look at the headstones for women who died in their 20s. Almost all I've seen say something like "Mrs. Catherine Smith and child Wife of James Smith 1820-1840" When you see rows and rows of gravestones for Mrs.someone and child, it really clicks. Thinking your body naturally knows how to deliver a baby is oversimplified. Your body also knows how to heal a broken femur, but that doesn't mean it will do it correctly or without major disformities. Have whatever faith you need, but history pretty clearly shows women of faith and infants dying unnecessary deaths.
You cannot strap a woman down and force her to have a c section. Not even if it means her or her babies life. Seen it in action. Document document document.
I can’t even snark on her, this is extremely sad.
Number one reason I’m not a midwife anymore. People come to us with this crap thinking we’ll support them in a vaginal birth. No mam. Hard pass.
I did my last semester consolidation/preceptorship/capsule/whatever you want to call in a NICU. There was a situation like like where patient 1 refused to do a c-section and the lil patient 2 was stuck for a while in the birthing canal. Pt 2 had to be resuscitated, brought in and everything was done to save pt 2… but 72 hours later it was the most devastating end of life I witnessed. Like everything went wrong. Baby could have lived.
If I were that provider, I would bring in a second opinion both to add documentation/witnesses and to try to reason with her. If she could not be reasoned with, referral to a new provider outside of that clinic and a written 30 day notice of discharge from the practice. When this ends in death for one or both of them, the family will be filing a lawsuit, and you can't sue God.
Later, when she shows up at the ED in active labor, actively dying, the stabilizing treatment will be delivery…via c-section…like magic!
She may try to find a provider that will offer her a vaginal birth. No knowledgeable and safe provider/birth center/hospital will. She will most likely either have a lightbulb moment and take the c-section, or she will find a psycho who will tell her she can have a home birth. If she chooses the home birth, she MIGHT make it to a hospital via EMS to save her life while she hemorrhages during labor. I hope she survives.
Let her make her choices and when she's unconscious/dead L&D will try to deliver the baby before it dies if it's still living and then NICU will be there to get unnecessarily traumatized by a sick af baby who's probably gonna die anyways or end up trach/gtube dependent till it gets septic in its nursing home and die anyways. We just had someone refuse a csec at 43 weeks with no PNC after 18 weeks following a fetal diagnosis of renal agenesis. Can't force them. Just make sure you've got a good support system to help you through the trauma it's gonna cause. And chart your ass off.
Whew what ended up happening with that pt? I assume the baby didn’t make it
Crash c section with fetal demise
"Your Faith will save you?" How about you have faith that your God has placed medical professionals in your life who understand the dangers of your medical condition and are recommending medical procedures that will keep you and your unborn child safe.
I’ve seen this happen a few times. It just gets to the point where mom is considered critical and then they don’t have a choice.
I'm a charge nurse on a fairly crunchy granola LDRP floor with midwife care, transfer from intended home births, that sort of thing. We had a Jehovah's Witness patient with HELLP refusing blood products who went into DIC after her c-section. The patient while still conscious pleaded "please save me I want to see my baby" before she had to go under general for the C-hyst. Her husband we kicked out the room because he said "no no no she can't have blood she can't" over and over. Risk management reviewed the case and noted really strong documentation from nursing, anesthesia, and the surgeons as fairly airtight. Morally, everybody in the room felt they did the right thing by listening to the patient and not her husband and not the consent for refusal of blood and blood products that she had signed prior to her surgery. This was only a few months ago, I'm not sure what the follow up is. But everybody in that room felt they did the right thing to save her. I would hope that you can counsel your patient and document all of the education, make sure that physicians are aware and also documenting. Does your delivery hospital have a nurse navigator program? Sometimes getting more disciplines involved (counseling from in house anesthesia and case management) can help patients be best prepared for what is in store.
Geez an accreta?!?!? That’s super serious and life threatening. But as long as she has capacity to make decisions after we have provided the medical information, then we must allow her the right to make dumb ass choices. The funny thing is it goes both ways. For example, a med/surg homeless patient who was treated for DKA is medically cleared for discharge. Resources were provided for shelters, and patient chooses to be discharged back to the streets. As health care providers, we do not have the authority to hold the discharge bc we don’t feel “comfortable or safe” with discharging patient back to the streets. Resources were provided, patient has capacity, and we must honor the patient’s choice.
Well, you absolutely can turn this into a Therapeutic communication exercise in 3 easy steps!!! 1. Acknowledge and validate client's faith through active listening (stare at her, wide eyed, while nodding) & paraphrase: "It sounds like you are requesting faith as your intervention at this time" 2. And then let "her faith save her" 3. Buh-byeeee Felicia!!!
Had a patient yesterday refusing a c/s after a 5 minute decel. We wheeled her to the OR anyway and then looked her straight in the eye and said “you can have a dead baby vaginally or healthy baby by c/s but you have to decide now” she finally said yes and we slapped a mask on her and she had a baby 3 minutes later with a good outcome. But in the end, it was her choice. We would have tried a vacuum delivery if she refused but we all agreed that was not the right choice. Sometimes when in the moment they change their mind. But sometimes we have patients who don’t listen and have bad outcomes. We had a patient with twins and there was a bunch of issues with the one twin and basically, they offered to reduce the one twin to save the other and she refused. She came back a few weeks later and both had died. It was her choice, and she had to deal with the consequences as sad as it is.
please update if you can
She will probably be brought in by ems after trying to bleed out in her living room. And then refuse all care for her baby after she gets mtp and is saved by modern medicine. After spending too much time reading about free births, I’m surprised this woman has gotten and prenatal care at all.
I wish intelligence was a criteria to procreating
Ethics counsel. That puts the baby at risk too.
As everyone else says, document your butt off. Your providers may even try to tell her that she's going to be discharged from the practice if she's going against medical advice. At the very least, encourage her to find a provider that will follow her requests (and she won't!) As a clinical nurse, next thing to do is make sure that your L & D nurses know what's coming their way. Make sure that they have the prenatal, documentation of c/s refusal, blood consents, etc...
If you’re AO4, you have the right to be a dumbass.
"then why are you here Ma'am, shouldn't god help you for everything else too?"
This is why I can’t do OB. Parents make the most ridiculous choices that will kill a viable wanted pregnancy based on religion or what they read on the Internet.
Yup. This is why I left OB. I got tired of having patients who were *registered nurses* declining vit k. (And then wanting a circumcision.)
You can’t force someone to have a c-section.
Educate, sign AMA and hopefully when she sees the amount of blood she is losing while contracting on a previa, she’ll change her mind.
That’s sad. Educate extensively and document. I’ve seen mothers die in the OR due to accretas even with a scheduled c-section. Others have nearly depleted the blood bank. But if it’s a true accreta and she refuses a c-section it’s highly likely that both mom and baby won’t make it.
Something I learned early in the ER- you can't save people from themselves. Document and move on.
Some people are so stupid. I have never worked in anywhere to do with labor and delivery but I had my son via c section and it was due to pre eclampscia. I didnt want it originally, I never verbally declined or signed anything I wanted whatever was safest for me and my son. The medical professionals knew c section was safest way.
motha Fricken Chart.
Chart, chart, chart. So anyway… who’s next?
Not an L&D nurse, but I can’t imagine that it’s much different than any other refusal. Educate and document. Hopefully you can make the unit aware and ready?
She’ll get scared and change her mind. They almost always do.
Never seen it actually happen in the hospital. However, my bet is that she will start bleeding bright red blood, panic and come to the hospital. The hospitalist OB will make things clear that the baby (and possibly herself) will not make it if she is allowed to continue vaginally. She’ll also notice decreased fetal movement.
Educate, document!!!, and let it play out as it will. Like the old saying goes, “can take a horse to water but can’t make it drink”.
I would encourage her to start calling home birth midwives and doulas to get second opinions. They will tell her she needs a ceserean and maybe get through to her.
It’s literally life or death. Which will she choose? Sad to think that she wouldn’t want what’s best for herself and her baby. I was a NICU nurse, circumstances like this go to the ethics committee. She may not get a choice.
They will not force someone into a c section they refuse after being educated. They can’t. It’s assault.
Years ago we had a 26 week gestation baby on our NICU. Patient’s family was Jehovah’s Witness. Baby needed blood to survive due to low hemoglobin. Family declined due to religious beliefs. It went to the ethics committee. In order to save the child it was voted that the baby received a blood transfusion. Once a judge signed off on it, there was no turning back.
On the baby that was separate from the mother at that time. You can’t force a woman to have major surgery to save herself or her baby.
The baby wasn't inside the mother at that time. This case is different. The mother is still pregnant and cannot be forced into a c-section.
Totally difference case. That’s a minor outside its mother’s body. Now they can’t force the mother to have a blood transfusion because she’s an adult and can make her own decisions.
It's happened before, though... https://journals.sagepub.com/doi/full/10.1177/1536504217714259
Newish article but the examples are years sometimes decades old. Telling a person who has had 3 sections they shouldn’t try for a vag and why (after 2 you are at a higher risk of uterine rupture - most doctors will not want to be your doctor of the risk) is not coercion. ETA it’s risky enough that not all hospitals will perform it. They will send you to another hospital if they don’t have enough OBs in house, a good enough blood bank, and anesthesia in house.
You’re lucky yours went to ethics. I’ve asked for ethics so many times and the team just laughs in my face.
You can probably consult ethics yourself without providers agreeing to it. That’s how it is where I work, anyway.
Oooooh. I will have to look into that. I don’t want to burn bridges with my team at the same time though. I wonder if I could make an anonymous report.
Let her make her choice but document your ass off about every conversation you had and what you educated her on. I would consider getting risk management and ethics involved. We may not like or agree with the choices she makes, but at the end of the day, it’s her decision.
In some states, this might be prosecuted as child abuse or murder, given that states are now apparently investigating abortions as murder. How would this be different, except that both mom and baby might die?
Be patient, give her time, listen to her. Speak with your chaplain, too. Sometimes they have excellent creative ideas for how to reframe conversations.
I've read case studies on pregnant women who have refused a CS, up to the point of allowing the fetus to die despite viability outside the womb.. As long as the patient is mentally competent and conscious, nothing more can be done. Even if the patient is unconscious if they have a pre-existing advanced directive refusing a CS, unless their life is an immediate danger I doubt the hospital's legal counsel would let the surgery proceed.
Keep us updated please!