I want to share my ER m/c experience, and ask a ?

[mountainborn]

In February I began spotting at 11 weeks gestation. It was after 5pm, and I had the option of waiting until the next morning to check things out with my midwife, with a possible ultrasound followup or go to the ER that night for an ultrasound. I chose the ultrasound I couldn't stand not knowing all night if my baby had a hb. I hadn't had an ultrasound prior. Lucky for me I was aware that by choosing to go in I might be working with people who were high intervention and low on compassion. I was unfortunately right on both counts. I say lucky because at least I was aware and stood up for myself.

My question is in regards to the nurses and doctors insistence that I have a foley before proceeding with the ultrasound. I refused, and was met with some incredulity. First, when the nurse listed it as one of the many things that would be done to me, I said - "Oh, that won't be necessary, I'll just start drinking water right away." I wasn't sure but I could only assume they meant a catheter to fill my bladder. She mumbled something about asking the doctor. Then when the dr did finally come in, he also had "foley" on his list, and was rattling off procedures and halfway out the door before he said, "Any questions?"

I said, "Yes. I don't need a foley for an ultrasound, I'll just drink water."

This part really steamed me. He tilted his head to one side and said, "Weeeell, I can aaask..." in a sing-songy voice. Ask WHO?! He is the one making decisions here!

That was the point at which I looked at DH and told him to run to the lobby and get me a couple bottles of water, pronto. The nurse did come back in with some ice water, just as I was finishing the first 20 oz. She handed me the styros without making eye contact and said, "Here is your water, because you did not WANT the foley."

If I hadn't been in the process of losing a baby I think I would have offered the catheter to her. At least that was the excellent comeback that has been in my head ever since.

So I did get out of the foley, and also managed to dodge the, and I quote, "female exam" that the dr listed last. The man simply would not say "vaginal", or "vagina". After the ultrasound and being wheeled back to the ER, I just got dressed and waited to hear my hcg levels and ultrasound findings like that. Boy was he surprised. He told me what I needed to know and I got out of there. I was able to continue the m/c at home and felt very grateful for that.

Ok, back to my question. Re: the foley, do you think their motivation was:

A) more $$$ for the hospital
B) new intern needs practice inserting a foley
C) with a catheter already in place i'm nearly prepped for a d&c

Is this something that has happened to anyone else?

I'd like to add that the ER was not busy that night, and I was not bleeding excessively. I know that routine and unnecessary things are done all the time, but I just cannot wrap my mind around why you would put a miscarrying woman through the added discomfort of a catheter, not to mention risking a bladder infection, for no good reason.

I also wanted to share this story because I think it could have turned out so differently if I hadn't known my options and felt empowered enough to stand up for myself. Sure, I'm pissed at Dr. Foley but I also felt great about taking a lousy situation and being strong in the midst of it.

Thanks for listening!

[Mamabeakley]

I went to an ER with bleeding (earlier in a PG which turned out to be stable) and was given a Foley. I wish I had known to refuse it - it sucked. I am pretty sure they thought I might have an ectopic PG and were prepping me for emergency surgery if necessary - they also placed an IV.

But I think it would have been a lot better to drink a lot of H2O - or herbal tea with honey, since I was FREEZING by that point.

I'm sorry for your loss. :

[akilamonique]

Why would you need a foley for a miscarriage?
When I had my miscarriage(also an emergency visit-I sat in the waiting room by myself because I made my hubby stay home with our toddler, bleeding doubled over in pain for 2 hours)
They never discussed a foley with me. In fact they didn't DO anything. After 2 ultrasounds by an extremely rude tech, who kept telling me that I could NOT be as far along as I said because the baby wasn't developed enough... WELL DUH! I WAS HAVING A MISCARRIAGE FOR A REASON!!! The finally sent me back to the ER to tell me what I already knew.
The total WASTED time away from my family was 5 hours. I could have stayed home and calmed my nerves with my son and my husband. I won't be going to the ER should this ever happen again. I will wait until my DR can see me.

[rnchrista]

Originally Posted by mountainborn

Ok, back to my question. Re: the foley, do you think their motivation was:

A) more $$$ for the hospital
B) new intern needs practice inserting a foley
C) with a catheter already in place i'm nearly prepped for a d&c

Is this something that has happened to anyone else?

In the ER's I've worked in, foleys are pretty much standard of care for someone getting an early pregnancy u/s. They can fill the bladder up and do the u/s right away, instead of waiting for you to drink enough water to fill your bladder. Because they are pretty busy and have people back to back, they want to know your bladder is full, not get in there, find out it's not full enough, have you drink more, and then bring you back in.
Not saying that's right, just saying that's typical.

[mountainborn]

Originally Posted by akilamonique

After 2 ultrasounds by an extremely rude tech, who kept telling me that I could NOT be as far along as I said because the baby wasn't developed enough... WELL DUH! I WAS HAVING A MISCARRIAGE FOR A REASON!!! The finally sent me back to the ER to tell me what I already knew.

I'm so sorry that you had to go through that.

Yep, the ER doc kept telling me I must be wrong on my dates. I would have had to have been 5 weeks off, as the ultrasound showed 6 weeks gestation and no heart tones. He never said one word of condolence, just argued with me that I was probably wrong.

I should say that I really believe there are great docs out there. I also will never ever walk into a hospital anymore without preparing myself for guys like this.

[rmzbm]

Just wanted to leave a Sorry you had to go through all that & hope you're feeling better soon!

[CookieMonsterMommy]

Yeah, I think it was motivated by them being in a rush and wanting to fill your bladder in 5 minutes instead of waiting for it to go through your body.

I'm sorry for your loss.

[Paige, CPM]

I am sorry for what you have experienced.

I wonder if you would consider meeting with the head of HR to discuss miscarriage procedures and sensitivity for future patients at their facility?

Seems like they need to offer options and compassion for women and families going through this.

A good start might be contacting the head nurse of ER, discussing what happened and asking if she could arrange a meeting with the head doc. Or perhaps your midwife would call her/him and arrange for something...perhaps she could help you put together some simple materials for an in-service for the ER staff. This can be a very empowering experience.

[jgale]

So sorry for your loss. Sounds like a really unpleasant experience. In our institution we will place a foley in someone who is miscarrying if they are bleeding heavily--really heavily--to assist in the monitoring of I's and O's (input and out-put). If her urine output is declining to below a certain level then that is an indication that her body isn't compensating well for the blood loss and she is becoming unstable. THose are ladies who are being kept in the hospital--not just getting an u/s.

The foley doesn't fill up the bladder though, it keeps it empty.

In our ER they are generally fairly confused and intimidated by pregnant women at any gestation. It may have been that the ER staff at your hospital thought "Pregnant+bleeding=foley" without considering how much you were bleeding vs how uncomfortable a foley is. I don't think putting in a foley is a particularly lucrative enterprise, esp compared to an us, for example, so I doubt that was on their agenda. Probably just not thinking too hard about things.

Anyway, sorry again for your loss and the unpleasant care you received.

Best Wishes, Jessi

[CookieMonsterMommy]

Originally Posted by jgale

The foley doesn't fill up the bladder though, it keeps it empty.

A foley or straight cath can be used to fill the bladder, usually with NS. This seems to have been the objective of the ER staff.

[MommyMidwife]

you wouldn't use a foley to fill the bladder

and they are really cheap so it probably had nothing to do with money.
Most docs don't have time (ED docs) to figure out money anyhow - they just have a protocol and follow it and go to the next person. When you presented, he looked at the protocol, ordered it and went to the next person.

You could have had a vaginal ultrasound with no problem - if it was an experienced sonographer you could have even had it without filling your bladder with water.

Definitely call the ED and talk to the head of HR...

The ED docs are terrified of all preggos, btw.

I am so sorry about your baby - how are you now?
jeni

[rnchrista]

Originally Posted by jgale

The foley doesn't fill up the bladder though, it keeps it empty.


Best Wishes, Jessi

While the typical use of a foley is to drain the urine, it can also be used to instill normal saline into the bladder. It's called retrograde filling, and I've inserted foleys for this purpose plenty of times.
It briefly mentions it here
http://ukhealthcare.uky.edu/content/...?pageid=P07784

[mountainborn]

Thanks everyone, for your hugs and thank you Christa for the link. At the time had never heard of a catheter used to fill the bladder. I really couldn't see a reason why they would drain it though, so I quickly assumed that the goal was to fill it. I said the thing about the water to the nurse as kind of a test to see if I was right. I said it with a real "I know what I'm talking about" voice.

I am doing ok, I have some very bad sad days though. I'm in counseling and have a beautiful 3 year old boy to focus on.

I will think about calling the ER head, or writing a letter. The ironic (?) thing is that I had a negative (phone) experience with this same hospital, although it was with one of their midwives instead, with my first m/c. She was basically just very rude and when I said I wanted to try and stay home she acted like that was a ridiculous idea (I was only 7 weeks). I DID write a letter, then had a really rough couple of months and never sent it. I still have it, maybe I'll just send in a combined letter. It is encouraging to have you all cheering me on.

My midwife for this pg was NOT employed by this hospital. I just went there for the ultrasound because it was close and I didn't think my ER options would be much different anywhere else.