L & D NURSES: rate my daughters birth plan (please)

  1. *cringe* she discovered epregnancy.com...amazingly she is willing to let me post it and ask the opinion of experienced L & D Nurses. Most of the stuff seems like basic care and patient rights to me but I guess its better to spell it out than assume.

    So, tell us what you think...

    Birth Plan for: <deleted for posting>
    Due Date: February 5, 2003
    Patient of: <deleted for posting>

    December 8, 2002

    I am looking forward to sharing my birth experience with you. I have created this birth plan in order to outline some of my preferences for birth. I would appreciate you reviewing this plan, and would be happy to do so with you. I understand that there may be situations in which my choices may not be possible, but I hope that you will help me to move toward my goals as much as possible and to make this labor and birth a great experience. I do not want to replace the medical personnel, but instead want to be informed of any procedures in advance, and to be allowed the chance to give informed consent. Please feel free to ask if you have any questions or comments.
    Thank you!

    Labor Augmentation/Induction
     I would like to avoid induction but if induction is necessary, I would like to attempt it with prostaglandin gel or another means before pitocin is administered. If induction is attempted, but fails, I would like the option to come back at another time rather than pursue further intervention (assuming my membranes are intact and that waiting presents no danger to my baby or myself). I will base the decision to continue on the results of my baby's biophysical profiles and on my own personal discomfort.
     Please do not rupture my membranes artificially unless medically indicated.

    Labor
     Please perform no routine prepatory tasks (shaving, enema, etc.), unless requested.
     I expect that doctors and hospital staff will discuss all procedures with me before they are performed.
     I would like to be free to walk, change positions and use the bathroom as needed or desired.
     I prefer to wear my own clothes, rather than a hospital gown, I realize that the birthing process will likely render them unwearable.
     I will remain hydrated by drinking moderate amounts of fluids (water, juice, ice chips).
     So I can stay as mobile as possible, I would prefer to have a heparin lock instead of an IV.
     If fetal distress is suspected and time permits, I would like confirmation of this with a fetal scalp blood sample before proceeding with other interventions.
     Please allow me to vocalize as desired during labor and birth without comment or criticism.
     Please do not permit observers such as interns, students or unnecessary staff into the room without my permission.
     Interns and students may not perform vaginal exams.
     To preserve my privacy and dignity, I would prefer that everyone knock before entering.


    Page 2

    Anesthesia/Pain Medication
     I prefer an epidural to narcotic pain medication.
     I would like to try having narcotics-only administered in the epidural line before progressing to full anesthesia.

    Perineal Care
     I prefer not to have an episiotomy unless it is medically indicated.
     To help my perineum stretch, please help guide my pushing efforts by letting me know when to push and when to stop.

    Delivery
     I would like the freedom to push and deliver in any position I like.
     I would like a soothing environment during the actual birth, with dim lights and quiet voices.
     I would prefer not to use stirrups while pushing. I would appreciate help from my mom and the baby's father and staff supporting my legs as I push.

    Cesarean Section Delivery

     I feel very strongly that I would like to avoid a cesarean delivery
     If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making. I also ask that my mom also be fully informed so that she can assist me in the decision making.
     I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery. I would prefer general anesthesia in an emergency only.
     I would like to have a respectful atmosphere without chatter during any part of the surgical procedure.
     I would like my mom to be present during the surgery.
     If possible, please do not strap my arms to the table during the procedure.
     If conditions permit, I would like to be the first to hold my baby after the delivery. If my condition does not permit my being the first to hold my baby, the baby should be given to my mom immediately after the birth.
     If possible, I would like to breastfeed my baby immediately after the birth.
     I would like our plans outlined here for after the birth to be followed as closely as possible.

    Immediately after the birth
     Please place my baby on my stomach/chest immediately after delivery.
     I would like to breastfeed my baby immediately.
     My mom and the baby's father are to be given the option to cut the cord.
     Please allow the umbilical cord to stop pulsating before it is cut.
     I have made arrangements for donation of the umbilical cord blood.
     I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.
     Please remove my IV/Heparin lock/catheter as soon as possible after delivery.
    Page 3

    Newborn Care
     I would like to hold my baby through delivery of the placenta and any repair procedures.
     Please evaluate and bathe my baby at my bedside.
     Please delay eye medication for my baby until we are well past the initial bonding period (a couple hours after the birth).
     If available, would prefer erythromycin eye treatment or other antibiotic eye drops instead of silver nitrate.

    Postpartum Care
     I would prefer not to be catheterized until I've had some private time to attempt urination on my own.
     Once I've had time to recover, I would like my baby to room-in with me.
     I would like permission for access to my chart and my baby's chart.

    Breastfeeding
     I plan to breastfeed and want to nurse immediately following the birth.
     Please do not give my baby supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.
     If I am unable to give my consent to any aspect of my baby's care my mom is designated and authorized to speak and act on my behalf.
     I would like to know more about breastfeeding.
     I would like to meet with the staff lactation consultant.

    Additional notes
     I am planning for my baby to be circumcised before we leave the hospital.
     I would like still photographs taken during labor and after (not during) the birth as space and circumstances permit.
     In the event that unforeseen circumstances arise and I am unable to make care decisions for myself or my baby I designate and authorize my mom to act on my behalf including the giving of informed consent.
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  2. 61 Comments

  3. by   cindyln
    Looks pretty standard to what we do where I work.The access to chart wouldn't fly though.
  4. by   dawngloves
    I used this form!
    I would edit it down some. 3 pages is a little legnthy (ie: it is mentioned three times she wants to BF after delivery)
  5. by   deespoohbear
    Originally posted by cindyln
    Looks pretty standard to what we do where I work.The access to chart wouldn't fly though.
    I was under the impression with HIPAA, you have the right to access your chart.
  6. by   cindyln
    Maybe because I work in a military hospital but our patients don't have access to their records.
  7. by   fergus51
    Here we have the right to access charts, but only after filling out a form, so she wouldn't be able to have it right away.

    A lot of the things on the form are standard and could just be left out or only need to be discussed with the doctor. For instance, we don't do shave preps or enemas, we only use general anesthesia in an emergency, no one would rupture her membrances without asking her permission. The doctor is the only one who has any say over what type of medication she will get or episiotomies, etc. I would make sure she discusses not wanting the routine injection of pitocin and understands the risks.

    There are some things she should discuss with the doctor who is familiar with hospital policies. Like the erythromycin, we have to give that within one hour of birth, so we can't always wait for bonding to be done, but we do it while mom is holding baby. Also assessing baby at the bedside can be a problem for some pediatricians. And we do strap moms arms to the table for c-sections for safety reasons but they are allowed to breastfeed as soon as they are stiched up and in the recovery room (we do not allow it in the OR because we need to get those patients out as soon as possible in case of an emergency). Those are the only real areas I could see as being a bit tricky, but it really depends on the hospital.
  8. by   OzNurse69
    I'm not in L&D so correct me if I'm wrong, but I always thought that in order to collect cord blood for donation, it had to be done before the cord had stopped pulsating (don't know where I picked up that piece of useless trivia, but it's in the back of my brain!!) Was I mistaken all along?? Or are these two requests (cord blood donation & waiting til the cord stops pulsing before cutting) incompatible?
  9. by   OBNURSEHEATHER
    I'm not an L&D nurse either, so could someone explain to me the rationale for waiting until the cord stops pulsating? Or not waiting? Or anything about that general theme of information would be extremely helpful.

    Heather
  10. by   kids
    Hey...I don't know nuthin bout birthin no babies...I only know what to do with them if something is not right-and then only after they come home.

    Anders says thanks for the input, and there are 3 versions of this... one for the support people (me & Dad), one for the Nurses...this is the one for the doctor (she didn't want to look to stupid when she take it in to talk to him about it.

    Her biggest fear is not getting "her" Doc & things not going the way "they" agreed on.

    Thanks OzNurse...maybe I should read her donor info sheet, I'd hate for it to go thru the process & not be usable (hell, I don't even know where she came up with the idea).
  11. by   fergus51
    Heather, I think the rationale for waiting for the cord to stop pulsing is that it will make the birth less trumatic or shocking to the baby. I have had a few patients who also wanted this and that's how they explained it because I had never heard of it before. I don't mind doing it, but I also don't think it is really necessary. One of the many things I don't mind if my patient prefers it.
  12. by   OBNURSEHEATHER
    I guess I learn something new everyday! Thank you fergus!

    Heather
  13. by   imenid37
    the length is a little daunting. to be honest, the length will turn people off. shorter is better. i think if it's very long, people won't read it, they'll just skim it and b*tch about the pt. w/ the big long birth plan.

    we usually don't do shaves or enemas, so she could delete this part. i think most places have moved away from this. the prostin gel can have some side effects too. i know lay folks often view pitocin as the devil itself. pg gel is a ripenining agent used to prep the pt. for induction as augmentation, not necessarily a substitute for pit.

    overall, it's not unreasonable and doesn't really deviate from standard care. just remember things don't always go as planned, but hopefully things will go very well for your daughter and her baby. good luck grandma!
  14. by   bagladyrn
    Please ask her to keep in mind, as well as on paper, that childbirth never goes exactly as planned/expected. Keep an open mind on changes in the plan, and realize that the L&D staff are not your adversaries, are there to help, not to inflict unneccessary procedures. I've had the unfortunate experience of a rigid husband insisting on a full explanation before any action as his wife was bleeding out and baby's hr was in the 60's because their birth plan demanded it. My response was less than polite.

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