L&D nurses - can you look at my birth plan?

[Lola77]

Hello, I posted on here earlier about my desire for a natural childbirth and the best way to approach the L&D nurses/be successful/not feel pressured into things. A lot of you responded and I really appreciate it. Like I said in my previous post, the hospital I will be birthing at has an excellent reputation for dealing with premature and sick babies (level III NICU, etc) but has a bad reputation for natural deliveries (unsupportive staff, 41% c-section rate, mandatory nursery time, etc) so I was hoping to be able to make it a good experience for everyone.

I was wondering if you would read my birth plan and tell me if the L&D nurses will just laugh at me or be glad I made my preferences known? Any advice would be great.

I know things may not work out the way I want, but I want to try to have my natural birthing experience and just hope to have a nice, supportive nurse :)

Thank you!

Birth Plan for ****** *******

Care Provider: **** ****** C.N.M.

Doula: *** *******

Facility: ****** ******* ****** ********

My husband and I have chosen to use the Hypnobirthing method of birthing in order to experience a natural, pain medicine-free birth. We are very excited about giving birth at **** ***** and hope to have an amazing experience. If possible, we would like to request a nurse who is familiar with and supportive of natural childbirth. The following are our birthing preferences for during labor and after the birth of our son:

During Labor:

1.To be supported in our choice to use Hypnobirthing techniques to naturally birth our baby by keeping the room quiet, the lights low, interruptions kept to a minimum, and speaking in a quiet voice.

2.To be supported in our choice to not have an epidural or pain medication.

3.To have my doula, **** ******, and my husband, ***** *******, at my side during labor.

4.To be free to walk around and change positions during labor. [note: they have wireless monitoring]

5.To be fully apprised and consulted before the introduction of any medical procedure including but not limited to: administering pitocin, cutting an episiotomy, breaking my water, etc.

6.When fully dilated, to be allowed to birth in a calm, quiet atmosphere free of prompts to “push”.

Post-Partum:

1.To have immediate skin-to-skin contact with baby after deliver.

2.To exclusively breastfeed baby.

3.Delay application of Erythromycin to eyes for one hour to allow for eye contact with baby and bonding.

4.To delay cord clamping/cutting until after pulsation has stopped.

5.Mandatory nursery time to be as short as possible. Baby to remain in room with parents whenever possible.

6.No circumcision.

*In the event that a special circumstance arises that causes us to deviate from our planned natural birth, we trust that you will provide us with a clear explanation of the special circumstance, the medical need for any procedure you many anticipate, and what options are available before proceeding. Thank you for reading this and helping us have a safe, memorable and satisfying natural birthing experience.

[Lola77]

Oh, and due to insurance issues, I have to birth at this hospital - because I work at an affiliated hospital, it is pretty much free for me to birth here. Anywhere else, I would have to pay 50% of costs.

[caregiver1977]

I am glad you posted this. It will be interesting to see what the nurses say about this.

[Elvish, BSN, DNP, RN, NP]

Most of the stuff in the labor section and all of the postpartum stuff is standard operating procedure at my place anyway. The stuff that's NOT standard can be done easily enough.

ETA - congratulations! :)

[GooeyRN, ADN, BSN, CNA, LPN, RN]

subbing... My 2 natural births were truly beautiful, I hope you get the same! My pitocin and epi birth sucked comparitively. Congrats and good luck!

[melmarie23, MSN, RN]

I wonder what their rationale is for mandatory nursery time. I wish more hospitals were more supportive of 24hr rooming in for mom and babe. That and I wish more places adopted LDRP instead of having separate units for laboring/delivery and postpartum. Anyway, I digress.......

To have my natural birth with my son I opted for an out of hospital birth. But I had back up plans in case I had to be transferred to a hospital setting. One thing I'd like to suggest that since your hospital does have a mandatory (grr) nursery time policy is that you request that either you or your partner accompany your baby while they need to be in there. Also, if you are wanting to breastfeed, then might I suggest that the baby receive no pacifiers and no supplemental formula (especially since they have to be in the nursery for whatever reason) so that you and baby can get breastfeeding off to a successful start.

Other than that, I think your birth plan is simple and reasonable. I hope that come time, that the staff is really supportive. I wish you the best of luck. Natural birth is awesome!

[LouisVRN, RN]

I think everything in there looks reasonable and it is not as inclusive/exclusive as some I have seen. I do not mean to hijack the thread but does anyone know if I can request to be typed and crossed on admission to L&D?

[CEG]

I personally would refuse "mandatory" nursery time. It CAN be done and there is absolutely no valid reason to require a healthy baby to go to the nursery. In fact, quite the opposite, the only evidence proves it is harmful.

I think your birth plan looks fine-- but remember your provider drives what can and can'y be done so be sure they are on board. Especially for the case of delayed cord clamping, have someone (probably your doula) watching to be sure it happens. Once it's clamped you can't go back and most providers clamp right away.

As for monitoring, intermittent auscultation (q 30 min in active labor, q 15 minutes while pushing) is equally effective as conitnous monitoring without increasing the c-section rate. Telemetry monitoring is often a huge PITA and affects mom's mobility.

Best of luck!

[obnurse/educator]

Your birth plan is perfectly reasonable. I like your approach - I have seen some pretty confrontational birth plans. Wishing you a beautiful birth and a healthy baby!

[Lola77]

Oh man, the mandatory nursery time. You guys have no idea what I have been through with it. I took my hypnobirthing class with a local doula/owner of a natural childbirth/yoga studio store and she is a local advocate for natural childbirth. She met with the director of the L&D dept and the physician liaison at the hospital I will be birthing at and I also contacted those people regarding this policy (I'm not the only one who is annoyed by it). Mandatory nursery time is MANDATORY - and these are their reasons:

1. the way they are set up, is that they have a central nursery with nursery nurses whose whole job is to do assessments and bathing. Those nurses cannot leave the nursery.

2. Staffing: the way they are staffed, my L&D nurse will not be my mother-baby nurse and is not my nursery nurse. According to them, no, assessments and bathing cannot be done by my MB or L&D nurse. Baby has to go to nursery. HAS to. They were completely inflexible.

Overall, it is an older, inflexible environment. Hence my trepidation :) Luckily, I have a great midwife, doula and I am a nurse so I have an inkling of what is going on.

Thanks for the pacifier comment - I will mention that.

Will let you guys know how it goes! My goal is to be low key and nonconfrontational - I know it won't help anyone if I go in guns pulled and temper flaring. I know there is standing policy - hello, I'm a nurse! I roll my eyes at the stupid policies on my own floor all of the time! I just hope I find some kindred spirits on the L&D floor. I plan on bribing with chocolate :)

[Hushi05]

I think it sounds very reasonable. You don't really need to include no circumcision and informed consent before procedures- they have to get your consent anyway. The cord pulsing thing isn't a nursing decision- whoever delivers you needs to know your desires.

As I've said elsewhere, birthplans are for *you* to use to clarify what you want and to use as a tool for discussion with your *provider*. There is really no need to give it to your nurse- you can just tell your nurse what you want.

[melmarie23, MSN, RN]

well then since the baby has to go to the nursery for the assessment, then I would request that you or your partner (or preferably the both of you) be able to go with. I think that is a reasonable enough request to accommodate. So is it just for the initial newborn assessment and bath that they have to go into the nursery, or are there other "mandatory" times that they need to go in for?