labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Friday, July 13, 2007

Turned Away

Imagine you are at your first prenatal appointment of a very wanted pregnancy. It seems like you waited forever for this appointment at 11 weeks gestation. Things have gone along quite swimmingly, experiencing minimal morning sickness and very little fatigue. During your exam, your midwife tells you that your uterus feels a little small for 11 weeks along. Perhaps your dates were off, she suggests, and decides to do an ultrasound. The office is a large practice and so they have an ultrasound machine in house.

Almost as soon as the probe visualizes inside your uterus, a small sac with a fetal pole emerges on the screen. Without a heartbeat.

You are crushed. All your dreams of being a mother are ripped away. The midwife is empathetic and after some talk about your loss, she asks you to get dressed and leaves the room.

When she comes back she gives you several options:

1. Let nature takes its course and wait for your body to expel the sac and embryo.

2. Take an oral medication to medically induce the products of the miscarriage.

3. Have a D&C, a surgical procedure to take out the sac and embryo.

After some discussion, you decide that option 2 is the best. You don’t think you can “sit around and wait” for nature because it would be emotionally taxing. You would like to avoid surgery if possible, especially since it would have to be with a provider (gynecologist) that you don’t know.

The midwife writes you the prescription for misoprostil and for a pain medication. The midwife says she will call you tomorrow and you make a follow up before leaving. Despite feeling emotionally drained and beat up, you head over to your pharmacy.

As usual, the pharmacy is busy. You wait in line to drop the prescriptions off. Once it’s your turn, the pharmacy tech enters the prescriptions into their computer and asks you if you are waiting for them. You answer that you are, and the tech points you to their waiting area. The waiting area is essentially two chairs at the end of an aisle.

You sit and watch customers pick up their prescriptions. The stream of people seems endless. All of them seem content and oblivious while you sit trying to hold back tears. A life you had hoped for has ended, and these people are just picking up their medications like it was any other day.

You’re startled to hear your name called so quickly. As you head over to the counter, you notice that the pharmacist has empty hands. You wonder where your prescriptions are.

“I’m not filling your prescription, Ms. S,” he says curtly.

Before you can reply, he continues, “The medication that was prescribed is used for abortion and it would be unethical and against my principles to fill it.”

“But that’s not the case,” you answer. You look around and realize the others at the counter are watching this exchange. You can feel tears building, almost spilling down your cheeks.

The pharmacist slams your prescriptions on the counter. “It is against my beliefs to partake in abortion. You can take these elsewhere.”

You gather the prescriptions and shove them into your purse quickly. With your head down and tears dripping off your face you leave the store ashamed. You feel too traumatized to head to the other pharmacy across town. Instead you go home and decide you’ll wait until the midwife’s phone call tomorrow.

When you tell your midwife what occurred, she is outraged. She tells you that she is going to call the pharmacist and straighten this out. She also has plans to contact the pharmacist’s supervisor.

Think this story is unbelievable? Well, it’s not. This happens to women across the country. Misoprostil is a drug that is prescribed for medical abortion in the first trimester, and many are unaware that it is also used for expelling the products of miscarriages. Pharmacists have the right to refuse fulfilling prescriptions against their religious beliefs but some fail to recognize this situation

There have been cases on of this on the news so I would imagine that it has opened some eyes. But what do these pharmacists do then, when a woman presents a prescription for misoprostil? Do they ask if it is for miscarriage or abortion? And do women feel obligated to answer this question?

Women filling the misoprostil prescription regardless of the reason do so under emotional distress. Neither woman wants to be scrutinized at this time in her life. Perhaps women’s health care providers could have a list of pharmacies in the community that will fill such prescriptions. This could avoid the terrible blow these women feel when they are turned away and scorned.


kristina said...

EXCELLENT way of making your point in a sympathetic way. I will remember this one :)

Marie-Baguette said...

Hi Labor Nurse, I have a quick question for you: I would like to get a frontal thermometer for my baby. Is it OK or doctors only use the archaic kind (you see what I mean)? Thanks for your recommendation.

Working Girl said...

Wow. This makes me so mad. I feel that, as a nurse, I am required by my professional ethics to DO THE JOB THAT I AM LICENSED FOR AND THAT I AGREED TO DO even when that task conflicts with my personal ethics. I send many people home with babies who would FAIL the screening process at Pet Smart to adopt an old sick cat. When the conflict becomes too stressful for me will I take it out on the patient? NEVER. I will change my job. I feel strongly that these pharmacists should be disciplined by the state in which they are licensed. They need to either do the full job for which they are licensed or give up that license.

Labor Nurse said...

Marie, when you say "frontal" do you mean the temporal scan thermometers? If so, my personal experience with them is iffy. All of the hospitals I have worked at and the pediatricians I have asked prefer a digital oral thermometer used under the arm. I'm also told the ear thermometers are not good for infants because they could potentially injure the ear canal or eardrum. If you have a pediatrician already picked out, you could make an appointment for a consultation and ask what he/she recommends.

Working Girl, I hear you! I agree that we are licensed to provide care within our scope regardless of what our beliefs are. If there is an aspect of the job you can not morally complete then you should find something else. But I do believe pharmacists have the right to withhold prescriptions that are against their religious beliefs, just as it is ok for an RN to not participate in abortion.

tofu lou said...

UNACCEPTABLE! why should pharmacists be able to turn people away because they don't "believe" in what the med may-or-may-not be used for? is there no ethics about serving EVERYONE? ugh. don't EVEN get me started.
I did this "Pill Patrol" through in which you chose stores in your area from their list and went to see if you could get the Plan B pill. you didn't have to buy it, you just had to see if they had any in stock, how many there were, and if anyone on the staff WOULDN'T process your order. i didn't have any problems but i know many, many other people have.
let's go kick them all in the balls!
aight LaborNurse. you go girl ;)

Labor Nurse said...

Ball kicking.... one of my favorite past times!

I like your attitude Tofu Lou! You'll make a great nurse.

Tonia said...

I had a miscarriage at about 10.5 weeks and can't imagine this happening to me. I don't think I would have been able to hold my tears or my tongue and that pharmacist would have ended up feeling terrible. I ended up with a D&C and I was actually very happy with this method. Thank God for my wonderful OBGYN! He literally held my hand through my tears.

KatherineK said...

I am sooooo thankful and glad you are back. I orginally found you while pregnant with my third child. One waterbirth later and I'm so thankful to find you again. Have you written about water birth???
This is the first NEW post I've had the chance to glance at... I really love reading each and every entry.

In regards to this entry... My heart sinks for the women who have endured this!

I appreciate your writing and am ever thankful I have a place to turn that is YOU!

Please keep this up!!!! I'm off to catch up on your writing now. :)

Fernanda said...

I actually have problems (religious and otherwise) with various pharmaceuticals prescribed at a pharmacy, including Plan B. For this reason I don't think I could work in that capacity. I didn't realize this was used as a treatment for miscarriage and appreciate knowing it now. I think people shouldn't be forced to fill a prescription they know could be used to kill a human life; on the other hand, being turned away when you've already lost your baby is rough on the mother. At the very least, pharmacists should be sensitive and professional if they feel they can't fill the prescription. Everyone deserves to be treated with respect no matter what.

Labor Nurse said...

KatherineK, Thank you! I wish I did have experience with waterbirths, but unfortunately I've never worked with any provider who does them.

Fernanda, I agree that a person shouldn't be forced to do a job that is against religious beliefs. I think those individuals should find a profession that suits all of their religious beliefs. I think its unfair to the people they serve and to their coworkers to not have to fulfill all of the job requirements. I can tell you if I said to my nurse manager during an interview, I'm not participating in circumcision or abortions then I wouldn't get the job...and rightly so. Those are required duties in the job description.

I'm not arguing that this religious belief is wrong, I just disagree with it being a reason not to perform duties required within your profession. Pharmacists (and others with similar situations) know likely well before they finish school that there are medications out there to prevent pregnancy, etc, that they will have to dispense as part of their required job.

Real said...

This post made me think quite a bit because as part of my own personal ethics, I don't think I could hand out pills like that at all--although I leave room for idea that I *might* in the situation you just presented. Of course, there's not really a tactful way to find out that information nor is it really my business.

And in light of not knowing, I probably still couldn't do it. Just because I wouldn't want to have a hand in any of it. Do you know any stats on how many people use those pills in the case of miscarriage versus terminating a pregnancy? My guess is that it's used much more frequently to terminate a pregnancy.

But I don't think that we should ever tell people to completely ignore their personal ethical or moral standards and "just do the job" for which they were trained. Think of how many times in the course of history people are "trained" to do things that just aren't right. And we live in a country where it's ok to choose not to do those things.

It may be that if he had just quietly said to her, "I'm sorry, but because of my personal beliefs I am unable to fulfill this prescription," she may have had a chance to explain and he may have changed his mind.

OR at the very least, she would have been able to walk out of there with dignity, having been treated kindly.

If the pharmacist and his company are okay with turning away people for that prescription then I don't think they've done anything wrong. I love to see people stand up for something they believe in. That's not excuse for hurting other people, either, though. Kindness and respect are always important even, maybe especially, when there are moral/religous disagreements.

But frankly, we make decisions about who to hire based on a myriad of things and if one pharmacist doesn't provide that service, another one will. It's free enterprise. Not all places have to offer all the same services.

Labor Nurse said...

I believe that the national retail chain pharmacies have policies on such circumstances. Some leave the decision to the individual pharmacist, some don't. But that being said, I still think that no one is forcing anyone to do any certain job which is why I say finding a job where 100% of your duties do not conflict with your religious beliefs is your best option. There are also areas within pharmacy that do not include actually dispensing meds, and perhaps this would be a good place for those pharmacists to go.

I have never heard of misoprostil being used to prevent pregnancy, and I can't imagine it would be very effective even if it was taken as such.

Real, this comparison came to mind as I was thinking about your comments. I love animals more than people. I would love to spend my days among them and helping them, but I chose not to be a veterinarian. I knew that I could not perform all of the duties vets perform (like declawing cats or snipping the larynx of dogs to stop their barking), with the main reason being allowing certain people to own pets. I morally would not be able to hand back pets to their owners if I felt they were not treating them properly, etc. So obviously, I couldn't be a veterinarian for the same reason as many could not dispense medications used for abortion, etc.

PE Mommy said...

That's awful I was actually given a rx for that after I had my daughter because I had heavy bleeding. I happened to be back up on the maternity floor with my daughter because they forgot to do her newborn testing (blood test). They said while we are at it, we need to redo her bilirubin. Well the lab screwed that up because I couldn't leave till it was done. While up there the midwife for my drs office was on the floor. I explained the problem I was having and she wrote out a rx. My daughter ended up being admitted for severe jaundice and I ended up going home to bed per her suggestions (delivered at 35 weeks 5 days for severe PIH). The next morning I woke up with a fever, pain, and chills, nausea. Still had heavy bleeding. Called the dr and was sent to the ER. Ended up that I had an emergency d&c for a uterine infection and retained parts. I never did fill that rx.

I can't imagine how I would have reacted. Well yes I could have, I would have torn him a new one. ESPECIALLY if I had miscarried. If you can't do all parts of the job, you need to do a new job. PATIENT care comes first, not your religious beliefs. If you want to choose what to dispense, then open up your own private pharmacy and POST what you will dispense. You don't get to make that decision for a national chain. It is NONE of ANYONE's business what you are being treated for. Uhhh does HIPPA ring a bell for pharmacists???

A. said...

Great post, thanks.