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December 2010, Volume 40 Number 12 , p 12 - 13


  • Penny Simpson Brooke JD, MS, APRN


I'm an obstetric nurse, new to this maternity unit. This facility has a policy of not allowing cesarian sections (C-sections) before the 39th week of gestation without a compelling medical reason. But one of the obstetricians, at the patient's request, performed a C-section at week 38-and altered the patient's due date on the prenatal paperwork. Apparently he cleared this with the medical director. The baby initially had some respiratory problems, but did recover fully.I don't want to make waves in my first weeks on the job, but I'm wondering what I should do. Doesn't altering prenatal paperwork constitute fraud?-D.M., OKLA.Yes, altering the medical record can constitute fraud, but a physician may also change the due date based on newly acquired medical information. The fact that the physician cleared the early delivery with the medical director indicates some acknowledgment of the facility's policy.Your concern is valid, however, because policies that restrict induced deliveries before the 39th week of gestation are intended to protect the patient and fetus. If the newborn hadn't recovered fully from the respiratory problems, a legal issue might have developed. The courts expect healthcare providers to use sound professional judgment to safeguard their patients, regardless of any requests patients may make. Always discuss patient safety concerns with your supervisor, who can guide you regarding what issues should be reported to the risk management department.In the future, when you've developed a good working relationship with the physicians, you can ask them why a baby is being delivered earlier than usual as a clarifying question. The physician may explain the decision and ease your concerns, or your question may make the physician think twice about delivering a baby before the 39th week.While I was changing a patient's surgical dressing, another patient requested pain medication. I didn't want to make her wait until I was free, so I asked another RN to administer

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