Nov 242012

“She’s here to rule out labor.” – L&D Nurse to another while laboring mother was waiting to be admitted into a labor and delivery room.

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 November 24, 2012  L&D Nurse, labor  Add comments

  34 Responses to ““She’s Here To Rule Out Labor.””

  1. Or we could, you know, observe her and make the determination based on the evidence rather than your preconceived notions. Just a thought. Since one of the reasons they tell us to go to the hospital is because you’re all sciencey and stuff.

  2. That’s what they’re doing. “Rule out labor” means that labor is one thing that may be going on and needs to be assessed for. When a woman comes in and says “I think my water broke”, the staff will say “she’s here to rule out SROM (spontaneous rupture of membranes)”, because she may have SROM’d, OR she might have had urinary incontinence, OR she might have had sex recently and had a gush of semen, OR she may have watery mucus. SROM is the most important possibility, so they say they’re “ruling that out”.

    • Well, technically she’s there to *confirm* or rule out labor. You can say the whole phrase or just one or the other, but when you only say one it implies that is the result you expect. If the nurse had said she’s here to confirm labor, or even to confirm or rule out, the mother would likely have felt more confident in her own assessment of what was happening. But to say she’s here to rule out labor implies the mother is stupid for thinking she really was in labor. It may be technically correct and the standard way of speaking within the profession, but it’s also rude and belittling.

    • I have never had a doctor say “rule out” to me for anything. If I bring my kid to the doctor for a supposed ear infection, the doctor says, “Let me take a look and observe the eardrum,” and not, “Well, I’m going to rule out ear infection.”

      When I went to the doctor experiencing tachycardia, the doctor said, “Let’s have an echocardiogram and a stress test to get a better picture of what’s happening.” Not, “Let’s do further testing to rule out tachycardia.”

      “Ruling out” means you’re proving something didn’t happen, not that you’re looking for evidence something did happen.

      • No, that is not what “ruling out” means in this context. Your doc didn’t say “rule out” (which by the way, tachycardia can be diagnosed by palpating your radial artery, that is not why you had an echo and a stress test- that was to “rule out” cardiovascular disease of some sort), but he probably wrote it in the order he sent for the testing.

        When a nurse says “I’m starting a line”, do you think s/he means “I’m taking this pen and drawing a line on a piece of paper”? How about “bagging a baby”, do you think that means they’re going to put the baby into a bag?

        • If you truly believe that a standard procedure that involves being rude to a patient is a good procedure then just keep talking. Otherwise accept the consturctive critisium of the birthing public and improve your bedside manner.

          • This site’s commentators are hardly “the birthing public”.

          • **snicker** So when medical professionals use the words “rule out” in a way that every other speaker of English understands as “to exclude,” that’s fine. But when we at the site refer to ourselves as “the birthing public” we’re wrong? :-) No, we’re members of the public who have given birth or will give birth, and yes, the phrase “rule out” means to exclude, not to include.

          • high-five to Jane!

          • Well, the pink link shows that the quote was submitted by a doula, NOT the mom birthing. And she says “thankfully, this was the worst that we encountered”. Clearly she was looking to be offended, because that would confirm her bias. What, a hospital birth where the only intervention was a hep lock?? Got to find something to pick at.

            “She’s here to rule out labor.” Did the doula or mom even ask the nurse what she meant by that? Apparently no, one or both just assumed the RN would of course be looking down on them or persecuting them.

            You’d probably be surprised if you knew me. I guess part of why I’m so upset by this post is that yes, I work in a hospital as a CNM, and I have been so angered by the behavior of some staff, I can’t even tell you. I had a nurse the other day admonish a mother for crying out during pushing. “Your baby doesn’t need to hear that.” I could go on, believe me. There’s no need to manufacture outrage. Good lord.

            The nurse’s saying that actually displayed openness to sending the mom home, if she wasn’t in active labor, rather than finding a mom in latent labor to give her pit. That’s a good thing, in my book.

          • No one on this site wants and explanation or to understand the other side of the coin, as one person told me many people here are “bitter about OB’s”. I understand the urge to explain, but people are just going to yell at you.

          • Do you have anything to offer here, other than acting superior and offending people? I am not trying to be mean, I am honestly asking you to evaluate that. A lot of people have been treated very poorly by medical personnel, and need some place to discuss. How can you explain “the other side of things” before you have read the pink link? Don’t you think it might be a little egotistical to think you might just KNOW better. If someone is looking for additional explanation for their treatment, I bet they’ll ask for it.

            Guess what? I LOVE MY OB. We didn’t agree on everything (two people rarely do), but we had a good partnership. I’m not here to bash all doctors. I do have a problem with medical professionals treating people rudely.

            Because, it wasn’t okay for my OB’s nurse to call my husband my boyfriend at every apt. for 8 months, regardless of how many times I corrected her.

            Or, it wasn’t okay for the OB who delivered my daughter to treat my questions/requests as invalid, insult me, give me way too much pit, and then tell me I’m incapable of delivering any baby vaginally since that birth resulted in a c-section. Because, you know, he could CLEARLY tell my hips were too narrow. Even though I never even got close to pushing. He was wrong, might I add, since my next baby was 9 lb 3 oz, born by an uncomplicated vbac.

            See how those things stick with people? I have a job (teacher) where I work with the public daily, often in an advising role. I treat my students and their parents with respect.

          • I wasn’t even going to comment on this thread until I saw the dogpile in progress. So yeah I do have something to offer a bit of friendly warning to the person who was doubtless trying to offer some insight on why a medical staff might say this. I think perspective is good, and noble. I think people should have to listen to and learn from people who are different then they are. I offer a different point of view, I believe in more medically managed labor (like the kind that saved my life, thanks mom for having that c-section! I love being alive to type things on the internet.) so I come here and learn from you, and you get exposed to my point of view as well. Maybe this means someday in the future I am more willing to try catching a mom in an odd position, and to me that’s worth it.

            As for sounding like I am trying to act superior the bitter quote was not even mine, the whole quote actually was “you sound as bitter about midwives as some of us are about OB’s”, so don’t bite me go after the person who said it. As for your OB who once said something nasty to you, I am sorry. People should in general be nicer to each other.

          • Thank you for trying to use this site to learn something. You must have missed all the other times that we have noted that we learned something on this site. I didn’t so much object to K’s first post, but the 2nd one with telling Jane (who was there) what her doctor did or didn’t say/mean and then the crap about starting a line and bagging a baby, etc. All that was just rude! I agree with you that people should in general be nicer to each other. K wasn’t nice. Jane was nice. If a profession’s standard way of speaking is rude and belittling maybe that profession needs to go examine why that is. And in case you missed it this was a nurse that was being snotty not an OB.

          • Goldilocks, I wasn’t aiming that at you, just to be clear. Sometimes this site just puts things in strange order.

          • It’s cool sometimes I can be a bit acidic at times as well, just really depends on the day, and I think this site is about as moderated as a street corner at this point.

        • To K: Technically only the test can rule out. You do a certain test. That test can either diagnose or rule out. Most of them actually can’t do both. Some tests a positive means something but a negative just means we don’t know. Other tests a negative means you can rule out a certain thing, but there still might be a list of other things to be evaluated. So even in medical jargon women don’t show up at L&D to be tested for the existence of labor.

        • Actually K, I believe you are a little confused about the correct use of the term “to rule out” since it should only be applied to a test that is limited to ruling out a a certain condition. Women do not come to L&D to have labor ruled out. They come because they think it is time. Now the nurse may perform certain procedures that can rule out labor or other things, but that isn’t why she came. There is no point in you defending snottiness. Now if you would like to explain a term, its correct uses in context and perhaps even its abuse by ingorant nurses on power trips, that would be welcome. You might want to preface your statement with something along the lines of “I know it sounds bad, but what she meant was probably…” But when you defend the actually snottiness you just look/sound cold and abusive. This site exists because far too many OB’s, nurses, etc. are cold and abusive.

          • I’m not defending anyone’s snottiness. I didn’t hear the nurse’s tone. Probably she was an unpleasant person. Lots of women come to L&D because they think it’s time, and many of them are NOT APPROPRIATE TO ADMIT. Places that admit every woman who think they were in labor would have horrendous C/S rates. If you watch someone in latent labor, often their contractions slow and altogether stop, for a day or more. You think women should just move into the hospital as soon as they think active labor has started?

            Labor is first and foremost on the list of reasons why a pregnant woman is having abdominal pain. If she is not in labor, or you have “ruled out labor”, there is something else going on and you need to figure out what it is. That’s what the nurse’s statement meant. I don’t know what her tone was. I know she didn’t say “mrs douchewaffle is here to rule out labor”, so she’s a lot nicer than many commentors here.

          • Sending a pregnant woman home if she is not yet in active labor- good.

            Being rude, mean, or dismissive to a patient under your care at any point- bad.

            No commenter has said the nurse should immediately admit the mother without confirming labor. Almost every commenter has said she should have been nice or atleast respectful while doing so. Notice that just swapping the word confirm for the phrase rule out would have totally changed the tone of the comment. It really is that easy to make your patients feel respected.

            *I’m using “your” in the general sense, not specific to K.

          • Like a previous poster stated, the problem here is the implication of the chosen words. It’s rude and implies that the woman is not in labor but the silly woman only thinks she is. We understand that many women come in thinking they are in labor and it is very good for a hospital to not keep them when things are not far enough along, but it would be no less medically correct to say “here to confirm labor.” There is a lot of phraseology in the medical community that is backwards and rude and there’s really no reason it cannot be changed to be more appropriate. It almost seems as though the language were chosen to be rude on purpose. I remember being really annoyed when I went in with leaking membranes at how flippantly I was treated. I’m sure there are women who pee themselves and think that their water has broken, but if that had been the case with me it would have meant that I had suddenly become voluminously incontinent for the past 12 hours (which I imagine would be a serious problem). They did ask me to describe what had happened so it wasn’t like they didn’t know. They just put their assumptions of “poor, silly, first-time mom doesn’t know anything about this birthing stuff” on the situation instead of listening to the patient. As is evidenced from this site, it’s not an uncommon problem.

          • K: I understand what you’re saying.

  3. This was my submission. I was the doula, and the mom was handling labor well. She had already been laboring for about five hours and was feeling pressure, so we went on to the hospital. This was the nurses at the main desk in l&d, and was said with a really snotty tone when we arrived. Thankfully, this was the worst we encountered, and mom had an almost intervention free(only intervention was the heplock)/med free delivery 3 hours later.

  4. Because going into labor at some point during pregnancy is so rare… Oh wait, with all the elective inductions any more this may be true. Never mind. SMH.

  5. Gaaaaaah, this sounds just like what I experienced upon arriving. How hard is it to talk to people with respect and accept that they might have an idea of what is going on.

    Instead of being rude to the patient, couldn’t the nurse have said, “Alright. Let’s get you back to a room and see where we are it.” THEN, wait for it, wait for it… perhaps the nurse/ob and laboring mother could talk about what is going on, discuss what goals/options the mother has, and proceed from there. LOOK, no one was offended.

  6. Gee, maybe it’s just my experience, but I’m pretty sure that once labor starts, “ruling it out” is not much of an option!

    • You’d think that, but…with my most recent, I went into the hospital at 4cm. I was having strong (but not painful) regular contractions coming every 3-5 minutes, lasting 60-90 seconds each. I have a history of VERY fast labors (my first three were all 3cm to baby in under 3 hours) so I went to the hospital about an hour after monitoring my contractions. Sure enough, they were long and strong on the monitor, and everyone- me, my doctor, the nurses, we all thought I was going to have the baby that night. An hour later, the contractions just plain stopped. Bam. Didn’t have the baby for another week.

      • That happened to me, too, with my youngest. I went to the hospital with strong regular contractions. I was only at about a 1 though. They sent me home and the contractions eased in intensity about two hours later. (I had regular contractions starting around 35 weeks that never actually stopped until after he was born at 39+6)

      • The staff on when you were giving birth had the same mentality as the OP’s. I guess they thought you should have just been admitted, watched for 24 hours after your “labor” stopped, then given pit or sectioned. You said you were in labor, so you were in labor, and having insisted upon being admitted as a laboring patient, you should have been respected in that. Right?

        • I read your comment multiple times but I’m just confused. How was the mentality the same?

          Contractions stopped an hour after I was admitted (this was the evening) and hadn’t picked up again by morning (12 hours later) and since I was only 38 weeks along by that point, they very rightly sent me home. Hospital policy (again very rightly) would not allow an induction before 39 weeks without a medical necessity (of which there was none) and my doctor certainly wasn’t induction or slice happy.

          Am I missing something?

        • I don’t read where the staff was rude and snotty to Gaevren. And you refuse to acknowledge that the main point of this post was that the nurse at the desk was rude and snotty. The words she used only made it more obvious. Words you have defended as being “correct” even though they should only be applied to a test which has certain limitations and not to a person or a person’s motivation for going to L&D. Yes every woman who shows up at L&D should be evaluted to determine if it is wise to admit her, but that is no reason for using words that ruffle the feathers. No reason. No possible reason, especially considering how many other words there are to choose from.

        • You keep fighting the straw-man of us saying that every woman who thinks she is in labor should be admitted as such. No one here has said or implied that. No one here takes issue with the hospital desiring to perform tests to make sure the woman is indeed in labor. The problem is a flippant and rude attitude to the patient in front of “authority figures” no less.

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