OB procedures

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One thing bothered me on this episode and it has bothered me for about 7 years now, and that is the way this show handles OB procedures. (Mike, if you're reading any of this, maybe you can comment) In 17 years of OB nursing, I have NEVER seen anyone do a speculum exam with the patient in high fowler's position (nearly sitting) and rarely have I seen someone do a vag exam in that position. At Elizabeth's gestation, it should be difficult to reach the cervix during a vag exam unless she is lying flat with her hips slightly elevated. We also would not have had her sitting up while trying to treat preterm labor. She would have been positioned on her side with perhaps a SLIGHT elevation of the head. And finally, the only reason a pregnant woman would stay in the ER (unless she was crashing, and maybe not even then!) is that the show is called ER!

-- Christine (cmniekamp@aol.com), February 23, 2001


My only experience w/ OB is as a mom of twins, but it bothered me A LOT that they didn't take Elizabeth STRAIGHT to OB. Those people are terrific and they know their stuff. I know Abby was an OB nurse, but still, that was absurd!!! And this time they can't even claim that the ER was closer, because they started on the roof! What's up with that?!

-- Maureen (shepcaff@ix.netcom.com), February 23, 2001.

I agree with you Christine - what is with that sitting up while in pre-term labour? - almost everyone knows that she should have been supine. Oh well I guess TPTB are not up on the good ol standby treatments or something.

-- Tammara (cross@ucalgary.ca), February 23, 2001.

Yup - I love how on tv they have a delivering mom sitting up to push at such an angle that she could comfortable pick out her toe-jam. They forget that there's something in the way. My latest (11 weeks old) prevented me from bending over by 7 months. I was wearing deck shoes with no socks in November in NYS. BRRRRRRRR.

I had preterm labor with my first and third. First one I was flooded with fluids, terbutaline then major mag sulfate. With this last one they had me pumped full of so much fluid I changed appearances!! High doses of Procardia kept these contraction away. I can't figure out why they insist on sending these mothers to the ER. It never would happen unless that baby was already sticking its head out. I would guess this is their blanket policy at Warner Brothers for labor and delivery in order to preserve dramatic license. Pregnant moms - DON'T educate yourselves Thursdays at 10pm on NBC. This aint the way it happens!

-- Sharon (my3sonsand_done@hotmail.com), February 23, 2001.

I was talking with my nurse friend and she mentioned something that really bothered her too.

A slight spoiler here so I'll try to leave space. Hope this works.











My friend said that if you're having contractions at 25 weeks and it takes three rounds of drugs to stop them, you would be on strict bed rest for the remainder of the pregnancy. I'm talking, strapped-to- the-bed, legs-elevated-and-tied-together, get-up-only-to-go-to-the- bathroom, bed rest. Supposedly, it's absolute hell. Corday is supposed to be appearing in next weeks (or the week after) ep, at work. Her docs would not allow this, in the real world.

I guess that's why they call it dramatic license.

-- S. Trelles (trelles@ix.netcom.com), February 23, 2001.

In the 1st season I guess it was when Mark had the delivery from hell that ended up with a dead mom & a law suit [I don't remember the name of the episode] I almost stopped watching ER altogether. I spent most of the episode screaming at the tv over this very issue of a pregnant woman staying in the ER for what seemed like days crashing & burning before an obstetrician could be found. In 13 years as an emergency physician, I have never ASKED to bring a patient to labor & delivery. We just rolled the patients upstairs. Sometimes they got a call warning them but keeping them in the ED was never the choice of tactics. This is tv & there is more drama if EVERYTHING happens in the ED. Besides, this way the writers can remind us the Abby IS NOT an emergency nurse but an OB nurse.

-- (ripwoman@aol.com), February 24, 2001.

Yes, Ripwoman, I remember that episode SO well. It was called "Love's Labour Lost". At the time, I thought: "So, they want to do an OB storyline. They didn't know what to do, so they opened an OB textbook and pulled out every complication they could think of and they 'took care of it' in the ER!?!" It scared the heck out of every pregnant woman who even had a slight elevation in BP and our phones in L&D were ringing off the hook with panicked women wanting to know if that could happen to them too. Later, when in "Great Expectations" when they stopped in the ER to assess Carol's vitals (like they can't do that in L&D, hello) and then "had to deliver" the first twin there, I was yelling--just take her upstairs! There is also one episode where Doug Ross gives the first APGAR score before the baby is completely delivered--Hey, Dr. Ross, that's a "ONE-MINUTE APGAR" you just gave at zero-SECONDS of age! I think I just felt like Mike when he is ranting about back braces and c-collars and rapid sequence induction of general anesthesia and, and, and....

-- christine (cmniekamp@aol.com), February 24, 2001.

Christine, I remember watching that show, listening to Susan name some procedure for pushing the baby back in when the labor became arrested. I had never heard of the procedure, couldn't figure out why Susan, an internal medicine resident [yes, they all started out as internal medicine residents, Mark included], would know a) the name of the procedure or b) how to do the procedure. I even asked an OB friend about it & got a blank stare. Then again, I have seen more cracked chests on this show, lymph node biopsies, microsurgery, reattachment of limbs, you name it done in that ED than I ever seen in the trauma center I used work in. It's totally absurd. And I do have people asking me if I know how to do all that stuff.

-- (ripwoman@aol.com), February 25, 2001.

Please dont shoot me, but, ED?

-- Ritaann (er_aussie@hotmail.com), February 26, 2001.

ED= Emergency Department

-- ALexis Springer (lexicat1@webtv.net), February 26, 2001.

I spent 4 1/2 months in bed with my last pregnancy, due to pre-term labor. The very first thing they did with me was put me in a bed with Trendelenberg (sp?) blocks under the foot. I was allowed up for 5 minutes a day, to shower, used a bedpan for other things, and was given IV Ritodrin (sp? again). Of course, that was 12 years ago but I doubt that the procedure has changed much, considering.

-- Lori (simon17sez@yahoo.com), February 26, 2001.

A lady who works in my department has had two pregnancies where she went into premature labor. She was put to bed rest both times for months after contractions began early. The most recent was early in 1999. Happily she has two beautiful daughters who were born healty. Though ER is a TV show, this is one of the areas they've gone pretty far with dramatic license. In real life, Elizabeth would be put to bed until she delivered.

-- Diana (dilynne@juno.com), February 28, 2001.

I think it would be more interesting if Elizabeth was on more strict bed rest. She's the type of person that would probably be crawling up the walls after a few days. I guess because this is ER that she has to go back to work. However, I hope that she has a reduced schedule and some inner conflict that come from that. ER takes dramatic license with everything. While they might get the meds right and even the dosage, they have a hard time getting the other major details right. But, then again I guess weak and dizzy's wouldn't be as interesting as the blood and guts we see on a weekly basis.

-- Emma (webbef@hotmail.com), March 01, 2001.

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