OB Triage says "Nothing we can do at 22 weeks"

BeautyfromAshes · November 2012

I will be 22 weeks on Friday (my ticker is a bit off). I have quite a long and complicated history, but long story short this is my fifth pregnancy, one live birth with twins. I have a separate unrelated auto immune disorder that requires I get IV transfusions every 3 weeks. I had one today, and they routinely cause dehydration.

After it was over, I started experiencing really uncomfortable contractions every two minutes for over an hour. They started getting painful even though I was downing water and lying down very still. It got so bad I of course called the doctor who immediately told me to get to OB Triage right away so they could check me out.

I get there, the nurse finds the baby's heartbeat, and leaves the room. I pee in a cup, but they do not dip it for a UTI or anything. It just sat on the sink. They do not hook me up to a monitor, they do not check my cervix.

The contractions had slowed by this point, but I definitely thought they would check me out a bit. No.

The nurse goes on to tell me that because I am only 22 weeks, there is nothing they could do for me anyway. She said they would not check my cervix because it wouldn't matter if I was dilated, because babies aren't viable at 22 weeks. She did not put me on a contraction monitor and said it was because even if I was having them, medications to stop them are ineffective until 24 weeks.

WHAT? I'm sorry, that is so unbelievably NOT TRUE!!! I was flabbergasted. I questioned her about why they wouldn't just check my cervix and she again said there was no need. She gave me a glass of water and told me I could go.

Questioning her further, she said to me, "If you were truly in labor, it would mean there was probably something wrong with the baby or you had some kind of infection, in which case it is in the best interest of the mother to expel the baby." WHAT??? Have you ever heard of an incompetent cervix? Of bedrest? Of a Terb drip? Of an emergency cerclage? There are plenty of things you could do to help get this baby two more weeks in the womb so they have a shot! How can you tell me there is nothing at all you can do?!?

I literally cannot believe that just happened. Why on earth wouldn't they at least try to stop labor and get me to viability? Why on earth wouldn't they at least check my cervix so I could be better informed of what is going on? They didn't even dip my urine!!! What if I had a UTI that was causing contractions???

I told the nurse that the doctor sent me to OB triage specifically to get my cervix checked, and she said, "Well, she must just not know how we do things here."

Um...considering she practices at that hospital I am pretty sure she does!!!

Thank God the contractions slowed and now have almost stopped altogether. I just can't get over how they literally did nothing at all to monitor me or check me out.

Am I wrong to be completely livid that this just happened???

weddedwife · November 2012

I lost my son last year at 22w4d, so I know firsthand that yes, at 22 weeks there isn't anything they can do if you are truly in full-blown labor. The Terb drip won't work. Either will a cerclage if you're in active labor. There are some medications that might help, like procardia, but they are in pill form and if you were already in full-blown labor there wouldn't be time for them to work. And yes, bed rest may help but not if you're already in active labor. The key component is the contractions. If you're just dilating, that's one thing. But the contractions are the tricky part. The worst part is that if your baby is born alive at 22w they will not attempt any life-saving interventions.

That said, I would be LIVID if they did not check my cervix. When I arrived at L&D at 22w4d in PTL, I was already 4 cm dilated so there was nothing they could do. But the doctor specifically told me that if I was only 1 or 2 they could maybe attempt some things. I would at least want that maybe chance, and how are they going to know that unless they check you? They should have at least monitored you, and if you were indeed contracting, given you an IV to see if the fluids would help.

I would definitely talk to your doctor about this, and see if there's something you can do to prevent dehydration during your transfusions.

weddedwife · November 2012

BeautyfromAshes:she said to me, "If you were truly in labor, it would mean there was probably something wrong with the baby or you had some kind of infection, in which case it is in the best interest of the mother to expel the baby."

This comment, however, really pisses me off. Nothing was found to be wrong with my son, and no infection was found. My body, for whatever reason, simply refused to keep him in. I would've punched her in the face.

kelly321 · November 2012

I'm glad everything is settling down, but I would be livid as well. I think you should definitely follow up on things both on the hospital side and telling your OB about it. As weddedwife said, it's true that they can't do anything for the baby at that stage, and if you're really well into PTL then they can't do anything for you, either, but how are they supposed to know if you're in PTL if they don't check to see if you're dilated?? What if you were a fingertip or a 1? Then they could have talked about measures like a cerclage (if the ctx stopped/slowed down) or procardia or any number of options.

SarahMeyer0823 · November 2012

Omg! I am sorry that happened to you!

Mom2anAngel2 · November 2012

I am so glad the contractions stopped. I am sorry that you had to deal with this, and yes you have every right to be livid. While it is true that if you were in true labor, they may not be able to stop it, however, checking for infection and checking the cervix would not be too much to ask for.

s.alarie · November 2012

That nurse needs a reality check, a throat punch, and probably a little sit-down with her manager and/or the chief of OB at the hospital.

If there was an infection as she suggested, it is completely appropriate for the physician to perform a speculum exam to collect cultures, as well as test you for a UTI. Sending you on your way with a cup of water is just not acceptable.

EMTALA laws mandate that facilities perform a thorough assessment and/or treatment to ANY patient that presents to their facility to determine if an emergency condition is present. If you do choose to follow up with hospital management (and I think you should), do a little EMTALA research and bring that up. Not only was that nurse a rude b!tch, but she was likely in violation of a federal law and could lose her job. (Not that I wish that on anyone. In your case, everything sounds like it is resolving. God forbid that someone else comes to that hospital and actually goes home and delivers a 22-weeker at home.)

ETA: Appropriate care for someone at 22 weeks would include fetal doppler to confirm FHR, assessment by external fetal monitor for contractions, PO hydration (making you drink tons of water), and then whatever the physician deems appropriate (including pelvic exam, IV fluids, urine testing/cultures for infection). In most cases, this would fix whatever the problem was (dehydration, infection). But in those thankfully rare cases of IC or PTL, you'd need more treatment (like PPs suggested, procardia, terb, emergency cerclage, etc.)

Bizzy80 · November 2012

Holy cow, I would be so livid! I can't believe they wouldn't at least check your cervix or check for an infection. I agree with pp that you should follow up with this. I'm so glad your contractions have stopped.

panacea05 · November 2012

Raise hell. I'm so, so sorry you were treated like that, but I'm glad the contractions seem to be coming to an end. Keep cooking, LO!

Muffinhb · November 2012

Ive had this happen to me. If this happend again ask for the charge nurse and tell her what you want! I am so very sorry this happened to you. (hugs). I would also call and complain and explain your OB sent you there to be checked.

Ana0927 · November 2012

PetraStonegirl:

Not at all. I'm be burning through phone lines until I got the Chief of Obstetrics on the phone. You DEFINITELY need to call your OB and talk to them about this tomorrow, I would also follow up with the Charge nurse at L&D tomorrow.

Do Not Assist rules before 24 weeks applies to babies at most hospitals, not mothers. Hell, even the ER would have given you IV fluids for dehydration.

This. I cannot believe you had to go through this. I am so sorry

MandaS08 · November 2012

I would furious. Wouldn't it make sense to determine if you truly were in labor or not?

I'm so sorry you had a scare and that you had to deal with this!

Laurakat81 · November 2012

OMG. She needs to be fired! I'm so sorry you had to deal with such an insensitive and hateful twat!

cold0009 · November 2012

I am so sorry that you had to go through this. How are you doing now?

kread8 · November 2012

Everything the PPs said! I would absolutely be livid and would definitely follow up and report it! I'm so sorry you were treated that way, it's unacceptable that a health care professional would act in that manner.

That being said, I'm glad your contractions slowed. Sending T&Ps that it stays that way and your LO keeps growing in there!

ljs4117 · November 2012

PetraStonegirl:
Not at all. I'm be burning through phone lines until I got the Chief of Obstetrics on the phone. You DEFINITELY need to call your OB and talk to them about this tomorrow, I would also follow up with the Charge nurse at L&D tomorrow.

This. This this this.

I'm sorry that on top of a very scary situation, you had to deal with this rude b*. I hope you are able to get in with an OB to calm your fears.

(((hugs)))

BeautyfromAshes · November 2012

Thank you ladies, your validation is very helpful!!! I called my OB this morning and left a long message, hopefully they call back soon.

My sister is a doctor and my mom a NICU nurse, and they are absolutely beside themselves with what happened last night. My sister made a very good point that while there is nothing they could do for the baby if I indeed was in active labor, does that mean I should be sent home to deliver a live 22 weeker in my bathroom with no preparation? Why wouldn't they at least check my cervix to better prepare me for the outcome, whatever it may be???

My sister's husband actually works at this hospital, and he told me last night after we got home that they have a 22 weeker in their NICU right now as we speak, it's all a buzz about it, so that woman obviously was not sent through OB Triage.

I am not asking they attempt to save my 22 week baby, but I was hoping I could at least be monitored and given some options depending on my situation. Isn't the goal to stop labor until 24 weeks at least? Couldn't they have tried? Thank God I obviously was not in labor, I am so thankful everything stopped. My sister said if I continued to have contractions she would have dragged me to a different hospital immediately.

I will let you know what comes of it. I definitely plan to address it further.

densquared · November 2012

WOW! I don't have any idea how accurate what they told you is medically. I do know that the way you were treated is ridiculous! Especially if they were correct medically. How can anyone say the things that were said to you?I am so upset for you. I would absolutely do some complaining. Not only to your own doc, but to the OB triage supervisor as well.

luvmyducks · November 2012

I would be livid as well and demand to speak to a supervisor or something. I also think you need to tell your OB about what happened. Did you get the nurse's name? I'm so sorry you went through that and am glad the contractions have almost stopped.

1220winterbride · November 2012

I am crying at my desk after reading this. How can someone give you this information in such a cold way?? So happy you feel better but damn, that person should prob not be dealing w/ OB TRIAG, monsterous. Praying for your LO.

luvsdogs2 · November 2012

Dude, WTF. I'm so sorry this happened to you, and so glad everything's better now, but just...dude...wtf.

Raise all kinds of holy hell about that beotch. And since when does a nurse alone get to make all those decisions? Very much sounds like a power trip to me.

MoreThanABride · November 2012

I'm so sorry she treated you that way, I can't believe it.

I'm glad you were not in labor and that you and baby seem to be doing well.

GraceInCA · November 2012

BeautyfromAshes:
Thank you ladies, your validation is very helpful!!! I called my OB this morning and left a long message, hopefully they call back soon.
My sister is a doctor and my mom a NICU nurse, and they are absolutely beside themselves with what happened last night. My sister made a very good point that while there is nothing they could do for the baby if I indeed was in active labor, does that mean I should be sent home to deliver a live 22 weeker in my bathroom with no preparation? Why wouldn't they at least check my cervix to better prepare me for the outcome, whatever it may be???
My sister's husband actually works at this hospital, and he told me last night after we got home that they have a 22 weeker in their NICU right now as we speak, it's all a buzz about it, so that woman obviously was not sent through OB Triage.
I am not asking they attempt to save my 22 week baby, but I was hoping I could at least be monitored and given some options depending on my situation. Isn't the goal to stop labor until 24 weeks at least? Couldn't they have tried? Thank God I obviously was not in labor, I am so thankful everything stopped. My sister said if I continued to have contractions she would have dragged me to a different hospital immediately.
I will let you know what comes of it. I definitely plan to address it further.

I'm really glad you're not in labor! I hope everything settles, and the rest of your pregnancy is as uneventful as possible.

FreyaWin2382 · November 2012

I would call your OB NOW and tell them what happened. I would also be sure that I call the nursing manager (not just the charge nurse on....as that, depending upon that institution, might very well be that nurse) and voice your experience. Even if you were/are in labor, they should have checked you and sent the UA. And her little comment about "it's better if the baby just comes out" was based on nothing but her judgement.

Don't wait until tomorrow....call NOW. And I am so sorry you had to deal with that. In the future, if you are ever in that position again, demand to speak with the resident on call or the nursing supervisor....as this nurse clearly didn't know what the heck she was doing (and I am an RN too!).

HoolahZinger · November 2012

I would be livid. If I were you, I'd get on the phone right now to a superior and discuss the situation. She should have been more professional even if PPs mentioned there may be nothing they could have done. Even then, they didn't check ANYTHING so how could they know what your current situation even is? I am seething just thinking about how poorly you were handled. I am so sorry that happened and hope things have calmed down for you and the babies.

Luthy · November 2012

Wow. I am furious on your behalf. I'm glad you called your OB and I really hope you take this as far up the ladder as necessary. I'm also SO GLAD everything is ok for now -- keep cooking little one!

ESPECIALLY since you said there's a 22-weeker in the NICU right now -- that's just unacceptable. If you HAD been in active labor what were you supposed to do, have the baby in the toilet? Absolutely ridiculous.

For what it's worth, a good friend of mine gave birth to a 22-weeker a year and a half ago, and that little girl spent 6 months in the NICU, finally got off oxygen last month and is doing amazingly -- just learned to pull herself up to stand! I know the chances are really slim that early, but it CAN happen, which just makes me even more furious at that biatch of a nurse.

buggirl72 · November 2012

I went into PTL with my son at 20 weeks. When I arrived in L&D they knew I was having contractions and were optimistic about stopping them. They immediately gave me an injection (can't remember what) and did an u/s to check my cervix. They discovered that I was already dilated to a 4 internally BUT they still put me on a mag drip and had a specialist come in to discuss options if they were able to stop the contractions. There is no way that they would have sent me home prior to Zachary being born - if the contractions had stopped, I would have been on bed rest in the hospital until we got past the 24 week mark.

I'm just so angry for you. That nurse absolutely put your life in danger and needs to be fired.

Jenah06 · November 2012

Wow... her insensitive comments on top of inappropriate information is infuriating ("expelled" was that really necessary???)... i don't think i would have gotten out of the room without either bursting into tears or requiring security!

At 22 weeks parents should be at the very least included in any decision making process if delivery is expected and not just sent away.... is this the only hospital you have the option of delivering at???

mrssoprano · November 2012

ncchnat:
You have every right to be angry. Hell, I'm angry for you!
Get on the phone and don't get off until you've talked to the head of Obstetrics, the head of the hospital, the head of the legal team, someone. Threaten them with malpractice if something happens to the baby (obviously, we're all very much hoping that something doesn't.) Scare the crap out of them and they'll make sure she doesn't do that to anyone else, ever again. I'd also call your OB and inform him/her of what happened.
I'm so sorry you had to deal with her. I'm even more sorry that you had to be scared. HUGS!

All of this, especially the bolded!

ChloBub · November 2012

What an absolute nightmare. I am furious for you! Definitely do NOT let this go - take it straight to the top. And keep us updated. So glad your contractions have stopped.