OSCE stations › A laboring woman refuses an urgent cesarean for fetal distress

Full access · Communication · Ethical issues: DNR, capacity, surrogates, refusal · 12 min

A laboring woman refuses an urgent cesarean for fetal distress

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Ms. Amara Lewis, 31, is at 39 weeks in her second labor, with a labor epidural that has worked well for three hours. Her first baby was delivered by emergency cesarean under general anesthesia after a spinal did not work; she describes that birth as terrifying. For the last 20 minutes the fetal heart tracing has been category III despite position changes, fluids and stopping oxytocin. The obstetrician has recommended an urgent cesarean and Ms. Lewis has refused. The operating room is being prepared. The obstetrician has asked you to speak with her now.

Your task: speak with Ms. Lewis about her refusal. You have 8 minutes; a warning sounds at 6 minutes.⁴