Mar 292010
 

“Oh, honey, you never *really* know who the father is.”  – Nurse to mother who refused RhoGam because her husband was also Rh-.

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 March 29, 2010  informed consent, L&D Nurse  Add comments

  62 Responses to “"Oh, Honey, You Never *Really* Know Who The Father Is."”

  1. oh…my…gosh.

  2. That’s right. I suppose someone could’ve slipped in my bedroom at night and drugged me and raped me and impregnated me without me even knowing it.

    COME ON! Give people some credit!!

  3. Uhhhh yeah, I sort of do know who the father is… WTF!?

  4. holy. canolies.

    I knew with out a doubt who the father of my baby was. I mean, sure, I was having unprotected sex with tons of men, but it was the special one who is my baby-daddy. /sarcasm

  5. I submitted this one… and I should add, mom was a rather conservative Christian, and her husband was her one and only. It did *not* go over well.

    They really will say anything to get mothers to submit to their medical interventions, won’t they?

  6. That is a horrible, insensitive thing to say. I just want to smack whoever said that. I damn well do know the father is, thank you very much. Just call her a whore, why dontchya?

  7. This one is right up there with insisting that my child have antibiotic eye ointment *just in case* I contracted an STD since my initial visit when they tested me for them. Forget the fact that I’ve been in a monogamous relationship with my husband for 8 years and never had sex with anyone else.

    • That is just what I was thinking…and the main reason I started looking in homebirthing!

    • I refused the eye ointment too – then had to explain the nurse who *insisted* she get it or “she could go blind” that it was unnecessary since I didn’t have an STD. She tried to come up with some other reason she had to have it, but ended up leaving the room mid-sentence when she realized she didn’t have any ground to stand on. I honestly think she thought I didn’t know what it was for and would just trust her since she was the nurse…

  8. WOW. I was not aware that apparently I could be having sex with multiple partners and not even know it! Here I thought I’d only had sex with one man for the last ten years.

    • That’s what I was thinking Michelle. Apparently I have been sleepwalking out and getting it on with multiple partners for years, all the while thinking I was in a monogamous relationship, and that my husband was the father of all our children.

      Huh.

      You learn something new every day.
      /sarcasm

      And I got fed similar nonsense when I was pregnant with my #2 and #3 children. I told them my husband is RH negative and they STILL (lied to me, manipulated me) told me the rhogam was necessary “just in case” my kids over came the ZERO PERCENT chance and were born with RH+ blood from an RH- mother and father.

      In future pregnancies, I agreed to take rhogam if and only if blood typing at birth revealed an RH+ baby. Oddly enough I have exactly ZERO children with RH+ blood type! Go figure.

      • That’s nasty. Really nasty.

        That said, I was told once (I’m paraphrasing a bit here- can’t remember the exact details) that it was positive for someone’s RH+ spouse to seemingly test as RH- because they produced too low an amount of RH antibodies for the test to pick it up; however, that person’s (unborn) offspring might produce far higher levels of RH, thus potentially creating a problem.

        • That is very interesting. I had never heard of a false RH- blood type test! In his case, it was a 50/50 chance because FIL is RH- and MIL is RH+. I knew I would be RH- because my mom and dad both are.

          Apparently in our case, the test was accurate, since all our kids are RH-, and if he was actually RH+ at least ONE should have ended up being + also. :)
          You’d think when I asked about it, that would be the perfect time to mention a little thing like false blood-type test results. Sigh.

          I know RH sensitization can be a serious problem, IF it happens. My opinion is that if the mother states a preference to wait for rhogam administration until the baby is born and the blood is typed, the staff should not attempt to manipulate or coerce her into having it during pregnancy.

          That goes double if she has her husband’s blood type and RH- status clearly noted on her records, which would make the benefit of rhogam zero, while the risk levels of taking rhogam remained the same.

          • It doesn’t seem to be commonly known, even among nursing staff (although atyourcervix provided a link which mentioned it, and other things).

            It’s my uninformed opinion that the policy to strongly encourage Rhogam take-up is partially to do with false-negatives, and recessive genes, as well as women lying about/uncertain about the father.

            Seems to me it would be good if more people knew about the false negative side of it; it’s so much more pleasant to say “we’re concerned about false negatives, etc” than “I think you’re an adulteress”. That goes for the nursing staff too- I’m sure many must *hate* even implying to their patient that she’s an idiot/cheater.

            Like someone else said, higher echelons form policies and the poor nursing staff have to put them into practice, with or without information that could make it easier.

  9. Now I don’t know if my nausea is from my migraine or from reading this comment…

  10. Wow. Could we make a more insulting assumption?

  11. Nice. This is exactly the kind of comments I received because I was married and pregnant at 16 (and my husband is also my one and only). Every nurse and a horrible OB/GYN asked repeatedly if I knew who the father was, how much promiscuous sex I was having, etc. all while my husband was sitting next to me. Sarcastic replies followed. : )

  12. “Oh, do you know that from personal experience?”

    Dear Lord. How horrid.

  13. This nurse obviously watches too much Maury Povich!

  14. “Rohypnol! Gotta love it! Keep those baby daddies guessing!”—- I mean seriously, how do these people keep their jobs?. I once had a nurse at my yearly exam insist I have an HIV test. I tried to explain to her that I had been married for 10 years and I TRUSTED my husband. But she said “just in case” we should test for it. She didn’t know what the big deal was, after all my insurance would pay for it. Maybe she was just looking out after me but it still upset me.

  15. When someone who doesn’t know you starts with ‘Oh Honey,’ it rarely ends well.

  16. Oh, honey, just because you’re a slut doesn’t mean we all are. Keep thinking that if it makes you feel better, but keep it to yourself, please.

  17. I had a nurse tell me that they had to test me for STDs because even though I have only had one sexual partner EVER, and I have no STDs “Men can’t be trusted… especially when their wives quit putting out during pregnancy.”

    needless to say, I reported her…

    • Good for you!

      And…funny thing…my husband is 11 years older than me, and HE is the one who was a virgin when we married. So I think he can manage to handle 9 months of pregnancy induced celebacy.

      Of course he never had to. Hasn’t that nurse ever learned that some women become MORE “interested” when they are pregnant?

  18. B*tch don’t go there. That’s all I have to say.

  19. I can certainly understand why you feel insulted by the comment the nurse made. But there’s a saying “Mommy’s baby; daddy’s maybe”. What it means is that as a health care provider, we know for sure who the mom is – but the provider DOES NOT know who the dad is. They can certainly ask the mom, but moms also lie. And don’t tell it doesn’t happen, because I’ve seen more than one dad walk out after the baby was born because it obviously wasn’t that man’s baby. Suppose you are lying and you got sensitized to the Rh antigen. But we (the providers) believe you when you say the baby’s dad is also Rh negative. So you don’t get the Rhogam. But then the baby dies or is severely damaged from Rh disease. Guess who’s in trouble? Not the mom who refused the Rhogam, but the provider who didn’t give it because s/he didn’t follow standard of care. So yes, you may be sure of who the dad is, but we are not.

    • This is exactly what my husband was saying when we were discussing STD screening (which I want to decline). His viewpoint was that *I* know I haven’t been having sex with anyone other than my husband, but my OB doesn’t know, and it’s not like I’m going to confess to an affair with my husband standing right there in the OB’s office.

      I can understand this, sure. But frankly, whether I get a test or a shot or anything should be my decision. If I don’t give consent, you don’t get to say, “Well, you could be lying, so I have to give it to you anyway.” Not only is it insulting, it violates informed consent.

    • The issue isn’t that the nurse said *she* didn’t know who the father is.

      The issue is that she told the mother of the baby that it is never possible for the woman to know who the father of her child is.

      I get that there are messed up crazy situations out there. I do. And the medical staff should absolutely inform the parents of the seriousness of the RH-sensitivity issue. But if the woman says she knows who the father is, her partner sits right there next to her getting blood drawn together to get a record of his blood type, and they exercise their legal right to informed refusal of the rhogam treatment, they should not be subjected to defamation of character.

      I also personally think if they sign a form stating they were informed about rhogam and declined it, the doc shouldn’t be held liable if the baby experiences complications due to RH factor issues. The doctor can’t hold the woman down and jab the shot into her, because that would be assault, it has to be her informed choice. As rhogam is a human blood product, there are certain religions that would not use it due to their religious beliefs. That’s their right, whether their care provider agrees with that particular belief or not.

      So, by all means inform every patient about rhogam, RH sensitivity, and all that, but don’t act as if every woman that walks through the door must be wildly promiscuous and irresponsible, and couldn’t possibly know who fathered her child, like this nurse did.

      • Michelle and Kat, I do understand what you are saying about informed consent. unfortunately, informed consent (signed by the patient, and documented by the MD what was discussed) has NOT held up in court. There has been more than one malpractice suit that had the ruling that the informed consent was essentially useless, because the plaintiff was (potentially) stressed enough to not completely understand the ramifications. Of course, that has only happened when there were bad outcomes. I personally think that if informed consent had been given, it shouldn’t be negated by the courts, but it has been. Again that puts the provider squarely between a rock and a hard place. The system is truly not perfect. And I know that you are both informed, but trust me, there are many people who just don’t get it.

        • Sheila, that ruling should be submitted to “The court ruled what?!?” because it’s beyond bizarre. If I turn down a test and then it turns out I had whatever dreadful problem it would have been testing for, well it sucks to be me. Period. Now in this case, yes, there’s a baby involved and the baby pays the price for his parents’ lying, but they’re still making the decision with information. Are the courts really saying the general public is too stupid to understand the ramifications of not consenting to every single test the doctor could possibly ever order?

          • Jane, I agree with you. If informed consent has been given and documented, ti shouldn’t be overturned in court. But tell that to the juries who see a damaged baby or a damaged person who is arguing that “I didn’t really understand, I was scared (or upset, or not paying attention, or didn’t think it would happen to me, etc.). But the fact is, informed consent has not held up in court. And this has occurred more than one time. I don’t have stats in front of me – I’m not a lawyer – but it’s been written up in medical journals. I don’t agree with it, but it’s there. That’s just plain wrong.

          • “Oh, honey, you NEVER *really* know who the father is.” – Nurse to mother who refused RhoGam because her husband was also Rh-.

            Just a refresher on the nurse’s words. Really? No women EVER REALLY KNOWS? Never? BS. And regardless of the nurse’s opinion of the woman’s integrity, the woman has the right to opt not to have the Rhogam AND the right not to be insulted for having exercised her right.

            The point of the comment wasn’t that some women MIGHT lie about their sexual habits, the point is that the care provider has no business insulting this patient for any reason. None.

            Or perhaps it would be easier to understand it this way: as another poster stated, what if the woman didn’t object because of her husband’s Rh status, but because of a religious belief that prohibited human by-products being injected? Would it then be appropriate to mock her religion? Tell her she’s a selfish baby-killer maybe?

            It isn’t the nurse’s job to determine whether the mom is making a reasonable choice. Sorry, but it isn’t. It’s just her job to present the information and give the patient the option to consent or decline. Full stop. Personal commentary is not part of the equation. It’s really not hard to figure out: insults are NEVER appropriate. Not even when you say them in a pleasant just-trying-to-be-helpful way.

          • Totally agreed. If the nurse has explained the reason for the rhogam shot, and the patient has refused it, the nurse might feel the need to explain further, or maybe not. If she doesn’t think the patient has actually understood the reasoning, she can explain it in simpler language, or even make a case that the patient should go ahead with the shot to make it easier on the hospital/practice, since THEY never really know who the father is. Maybe any one of those courses of action would be appropriate depending on the nurse and the patient and their relationship.

            But what she is NOT free to do is insult her patient to coerce her into “consenting”.

          • This nurse was way out of line.
            And I hate the ‘honey’. I plan to use it next time I have an interaction with a health care professional. It’s so demeaning, don’t you think?

            But what Sheila is saying makes sense. Aren’t we the ones that keep saying that what docs call “informed consent” is just them scaring us into doing whatever they want us to do and us saying OK?
            And then when the you-know-what hits the fan, that’s when we realize we actually didn’t really consent, and that there wasn’t very much informing going on.
            So it would make sense that in some cases, the court would rule that the patient wasn’t really informed.
            In a perfect world, the patient would have been properly informed and this wouldn’t be an issue.

        • None of that is relevant. The RARE (extremely rare) chance that an informed consent document is thrown out is NO excuse for any medical professional to violate the medical rights of their patients. None. At what point do you stop with that line of reasoning? “well, too bad you don’t consent to this induction because I say you need it.” “Well too bad you don’t consent to this c-section because I deem it necessary.” “Well, too bad you don’t consent to this D&C because I want you to have it.” “Well too bad….” NO! No more! No more covering your own rear at the expense of half-naked, scared women! Calling someone a slutty whore just because she refuses to consent to an unnecessary and potentially harmful procedure (and kindly refrain from pretending Rhogam has no risks) is NEVER ACCEPTABLE. You tell her why you think it should be done. You explain what might happen if her child really does turn up Rh+. You note her legal right to informed refusal. Then you move on. You do not push or chastise or lie or manipulate or insult to get your way. Ever.

          Clear?

          Maybe if so-called “care providers” were less interested in the coverage over their own rear-ends in the first place there would be fewer reasons to fear turning up in court. But it doesn’t matter. You get to decide what’s poked into your body. She gets to decide what’s poked into hers. End of story.

          PS – Sorry for getting all worked up this time, but as a future nurse-midwife, I have absolutely had it with this kind of drivel. Informed consent/refusal always overrides the personal comfort/convenience of the care provider. Don’t like it? Too bad. But don’t wish to live in a place where it doesn’t exist, because I’ve been to those places and it ain’t pretty.

          • Informed consent honestly means nothing to a court. Just think of all the cases you hear about, with docs getting sued for xyz complication of surgery. Complications that were mentioned in the informed consent. But, those bad outcomes always happen to “somebody else”, right? I just really really wish all people understood that when a nurse or doc is pushing for something (RhoGam in this case), it isn’t for personal reasons. You should see all the binders full of standard operating procedures that have to be adhered to. All the checklists and flow sheets that have to be completed. If not, then it’s the nurse that catches all the flack from the higher ups. It’s the higher ups in management that want you to get all these procedures/interventions/medications/whatever so that you don’t sue for millions of dollars. Stop blaming the nurses for trying to do their job.

          • Where did someone blame the nurse for trying to do her job?

            Seriously, all I saw was people rightfully outraged at a nurse who insulted her patient, and made a false statement about whether it is possible for a woman to be aware of the identity of the person who fathered her child.

            And once again: the mother’s legal right to informed consent (or decline) of a procedure trumps the nurse’s *convenience* at having to inform the supervisor or whoever about the woman’s choice.

          • Trish, if informed consent means nothing to the courts, why do I still have to sign fifteen forms for every procedure? If they mean nothing, can we PLEASE do away with the forms? Please?

            (I know you don’t control that. But if you’re saying they have to pressure us to cover themselves, and at the same time the legal documents I sign mean nothing, why must I sign them?)

          • Aron, no where does it say that woman got the Rhogam. She still has the right to refuse it. But the nurse was also correct when she indicated that you (meaning us the medical people and sometimes the patient too (happens more than you may think) don’t know who the father is. People sue for damaged babies. People also sometimes turn up Rh-sensitized without any clear indication as to why the sensitization occurred. I’ve also had a patient tell me she needed to know when she conceived because she needed to know which of 2 men was the father of her baby. Just because YOU know you haven’t had sex with anyone else, doesn’t mean everyone else knows that. And you could be lying. But I don’t see that the nurse was lying.

          • See my reply a bit further up. For some reason it went there instead of where it should have. The main point is that the nurse’s actual words were “you can NEVER REALLY KNOW…” Which is just bull. Which brings me to my point and that of several others here: it is never ok to insult a patient, no matter how justified you might feel about it. And yes, telling a woman she can’t possibly really know for sure who fathered her child is insulting both to her integrity and her intelligence.

            So yes, to answer your last sentence, the nurse WAS lying – it is perfectly possible for the woman to KNOW, just (apparently) not all that easy to be believed.

        • That is a serious problem, and I would absolutely be on board with making whatever changes are necessary to prevent that sort of thing — not just to protect doctors and nurses, but to protect my right to refuse.

          However, it is still not an excuse to deny a woman her legal right to refuse treatment on the grounds that she “might be lying.”

          • I didn’t think the post indicated the woman had to receive the Rhogam. As far as I know, you can still, legally, refuse it.

    • But that’s not the same as saying that a a woman NEVER knows who the father of her baby is. Anyway, whether she’s lying or not, she’s an adult, she knows what the potential consequence could be, and it’s HER decision to make.

      That court case is unfortunate, but it still doesn’t give doctors and nurses the right to force unwanted interventions on pregnant women. Why should 100 women be lied to or mislead into getting an injection they don’t want just because ONE of them may be lying about who the father is?

      • Well, most women probably do know who the father of their baby is, but believe me, there are plenty who do not. (On the other hand, there’s plenty of guys who don’t believe they are the FOB either – but they walk away.) And the informed consent issue has come up in more than one lawsuit, not necessarily related to pregnancy/birth at all, but it’s out there.

        I do agree with you; it is HER decision to make, and the consequences of a wrong decision could be devastating. And that’s part of where the problem is.

        And slightly off subject, did you know there have been providers sued by other than the parents because of a poor outcome? Other family members have brought suit. Whether or not they were successful, I don’t know however.

  20. You know, I just had a thought…

    It would be priceless to tell Nurse Clueless here:

    “Well, when the fertility specialist performed the insemination, he used [my partner's] sperm. Do you really think they mixed up the samples?!”

    OR:
    “The in-vitro fertilization was conducted using my eggs and [partner's] sperm. If they were wrong about who the father is, I am sure my lawyer would be having a very long talk with them.”

    Man, I would love to see the look on her face.

    • Oh I had to giggle at that!

      To the actual comment, there is NO situation where this can be taken in a positive light, makes me sick. Even in situations where the mother IS lying about the who the father is, it is NOT this nurses job to push the medication by insinuating this! I could vomit…

    • Actually, even better would be to look totally clueless and say, “Yeah, how ARE babies made? What does the father have to do with it? Can you tell me?” and just look at her with eager and innocent eyes, as if you really honestly have not the first idea how babies come into the world. “How did that baby grow in there in the first place?”

  21. There is a very rare chance that two Rh- parents can produce an Rh+ child. This site explains it well: http://www.thetech.org/genetics/ask.php?id=114

  22. well i guess i shouldn’t worry… cause if it wasn’t my husband, then it was immaculate conception. pretty sure God doesn’t have a blood type to worry about.

    • And even if God does have to worry about that, God’s pretty detail-oriented anyhow. If God were to go through all that trouble, I’m sure the Rh factor wouldn’t have been a divine surprise. :-)

    • This response was too funny to *not* respond to! When 18 and preg with my oldest (now 20) the Doc was calculating my due date according to the ultrasound….which indicated that my baby was about a month smaller than what I said he was. I may not have been married, but I’d only had one relationship and I KNEW EXACTLY when I cut that relationship off and the last time we were “together.” (Background: I’m the oldest of 9 and 2 were homebirthed in my presence.) When I explained this to him and told him that my child was due in late December not late January, he pshawed me and commented with a holier-than-thou tone of voice “Well, you must be another Virgin Mary, then!” and proceeded to ignore my information! When I went into labor on Dec 25 they forcefully stopped my labor with lots of IV and oral meds and did this again a couple more times before “allowing” him to come on Jan 22!!!! UGH!!

  23. See, when someone says something like this to you, don’t get upset, just serve it right back to them. I would’ve said, “Well, honey, let’s not bring your personal situation into this, m’kay?”

    I sort of understand the fact that even though the woman is 100% sure without a doubt of who the father is, the doctors and nurses don’t. Let’s face it, people lie to doctors all the time, which makes no sense to me. Why lie to someone who’s probably heard everything? That being said, it was still super inappropriate for the nurse to say that to the mom. She should’ve kept her comments to herself.

  24. Her comment was unprofessional; please, please tell me she was reported. This site is a good forum for women having good and bad experiences’ but, if you only express your anger here, nothing changes.
    Now having said that, I’d like to explain from my perspective what I see and hear. I try to interview women by themselves because it is so important to have accurate information for the OB, nurse and Pediatrician. If the woman has a significant other at her side, I wait till this person goes to the bathroom or leaves to get something to eat to ask some of the most personal and intimate of questions because I’ve lost count of the number of women I’ve interviewed and they have said stuff like: ” I had an abortion but no one knows”, ” This isn’t my first baby, I gave my other one up for adoption and I don’t want my husband to know”, I’ve had herpes and I think it might be active right now and I don’t want my family to know”, “My husband is going to be here, we’re separated and my boyfriend even though it’s my husband’s baby”, “Josh and Mark are going to both be here because we don’t know whose baby it is”, father of baby ” when can I have a paternity test”?, ” I don’t know if that baby is mine”or stunned white family to see a black baby come out. We have been assaulted, threatened with guns,razors and knifes primarily because of the age group we work with. It is such a pleasure to work with couples that are married, plan a natural birth, and are prepared. But, it’s not personal when I ask if you’ve ever had a sexually transmitted disease? what was it and how long ago? or have you ever done drugs of any kind? When? and I need to know the total number of pregnancies and what happened with each one. This infomation impacts on your labor, if we need to get treatment on board, and notification of problem to the Ped. I had a patient with active herpes that would not consent to a C/S because she didn’t want her husband and family to know. The OB explained the importance out the ying yang and offered to lie to the husband and family. I don’t knw what happened to this baby but me and the OB cried.
    In terms of informed consent, it’s the responsibility of the OB to obtain the consent and the nurse witnesses the consent. Every parent has the right to refuse any treatment/injection for the baby; however, if by not receiving the treatment/injection could harm the baby then the hospital can and will go to the magistrate to obtain an emergency court order to treat or give an injection. To my knowledge there has never been a need for this intervention in regards to Rhogam, Vitamin K, or Hep B. Eye antibiotic ointment is the law in some states. You talk about obtaining consents to scare women, well I’ll tell you a story and it’s true. An OBGYN performed a pap smear on a women and it came back abnormal so the office sent her a letter explaining her pap was abnormal and please come in. She didn’t show up, so another letter went out. She didn’t show up. The office called and left messages of how very important it was to come back in for treatment. No patient. Finally, a certified letter went out. No patient. When she finally showed up,her abnormal pap had developed into cancer of the cervix. No one should die from cancer of the cervix since an abnormal pap can be fixed. The family brought suit against the OBGYN because he didn’t tell her she could die. The family won. Most lawsuits have a 2-3 year max to be initiated. Not OB. Families can bring suit for up to 27 years in states like South Carolina. It never seems to matter. TheaMarie

  25. Yes, there is the small chance of a Rh+ child coming from two Rh- parents. This is one of the reasons we do bloodwork so frequently in Rh- mothers so we can detect if she has or is developing antibodies. If you have a miscarriage you’ll receive Rhogam or if you are in an auto accident while pregnant you’ll receive Rhogam for future protection.
    Testing for STDs in your prenatal visit is the Standard of Care. These are expectations of care handed down by our organizations, the CDC, medicare and medicaid. In court, we are judged by whether or not we abided by the SOC. Oh, I was one of those inaccurate blood Rh factors. I too am Rh negative; however, for years I was listed as Rh positive. I was an Army brat so this info was on my dog tags. I hope some of what I’ve said has answered some questions for you guys. TheaMarie

  26. There are many men that may have had a previous relationship that can bring HPV into the picture that for some women will not show up until they are in their mid thirties. There are about 100 different kinds of HPV viruses with about 7 of these that cause cancer of the cervix. Herpes doesn’t always show up as a major outbreak, for some women, it shows up on the pap and yet neither partner has stepped outside the marriage but only one outside relationship prior to marriage can bring these viruses into the picture with no one aware until pregnancy or abnormal pap years later. OK, I’m done now. TheaMarie

  27. I was made to sign a waiver when I refused the rhogam and the doctor only said “this is because not all women are 100% sure who the father is” and my reply was unless you REALLY can get pregnant off public toilet seats then I am 100% sure who the father is. I knew about the small chance of us making an RH+ baby, but if that were to happen I only really needed the Rhogam AFTER delivery and only if it were a rough delivery.

  28. Oooh! I like it! This is the kind of retarded comment where you get to look back at that nurse and wink knowingly and say “Thanks for looking out for me, I can tell you’ve felt this uncertainty before.”

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