my birth plan - nurse friendly?

Specialties Ob/Gyn

Published

I think I have have done an ok job of doing a birth plan for a birth I am rather anxious about, but wanted to be sure it was nurse/ doctor friendly. These are my co-workers, so many know my history and concerns. I want to just let a neutral groupp look it over before springing it on anyone. :)

BIRTH PLAN

Due Date 9/1/13

I am preparing this plan to outline my wishes for this birth. There are obviously many items I am flexible on, but there are a few that I am adement that MUST happen (or not happen as the case may be). I NEED to have a pain med free lady partsl delivery with minimal other medications. Due to some evidence on Guillian- Barre syndrome and subsequent spinal narcotic use and it's association with Guillian-Barre relapse, it is IMPERATIVE that NO spinal narcotics are used, even in the event of a c-section. I have already discussed this with the head of anesthesia and he is in agreement that no spinal narcotics be used. In preparation for a pain med free delivery, ****and I are taking Bradley method birthing classes and I have hired a doula to assist me. Additional wishes are as follows:

-support people include my husband; Doula and possibly my mom

- I WANT and saline lock and am amenable to fluids if needed

- I would prefer not to have pitocin for induction or augmentation if possible and wish to use AROM first

-Cervical rippening is ok with me

- Want to use birthing ball and aromatherapy

- I do NOT want pain meds. Especially spinal narcotics. PLEASE, please, please, do NOT let this happen, even if i would request it in a moment of weakness. **** and *****will be aware of this and talk me down if need be, but I wanted the staff to be aware as well

-If I am a c-section, I MUST have general

- I am doing cord blood and tissue collection. I will be bring the kit with me when I am in labor, but I have included a copy of the instructions here ahead of time for you to review before hand

- Studies indicate neuro protective benefits and post partum depression preventative effects of placenta encapsulation. For this reason, I wish to take my placenta home unless there is mec. staining or chorio, then it should be discarded

- I am very anxious about the potential (but small) risk of pre-eclampsia and eclampsia again, especially post partum and I plan on remaining in hospital for as long as possible for continued observation of signs and symptoms of pre-eclampsia

- I plan on breastfeeding as I have in the past. I would like immediate skin to skin if possible. I plan of exclusive breastfeeding and want no pacifiers or formula given. I will be rooming in unless my health or that of the baby prevent it

Thank you so much for taking the time to read this.

Specializes in Clinical Research, Outpt Women's Health.

I think your plan is fine except the part about expecting a nurse to talk you out of pain meds. It has been driven into all that a patients pain is a patients pain and must be addressed. It is an unfair expectation that the nurse caring for you should talk you out of it. She could just as easily get into trouble for "denying needed and requested pain control".

Some people have it encapsulated, meaning made into PO pills that they take as a supplement. I personally have not sent a placenta home in a very long time, most people just let us dispose of it

Oh my gosh...wow. Freaky.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

http://placentabenefits.info/research.asp

Happy eating...er...reading!

Specializes in L&D, postpartum, nursery, antepartum CLC.

I still fail to see how any of you think that after reading my birth plan that I am expecting the nurse to "talk me out of" an epidural???? please show me where I have stated that. I believe I have stated that my doula and husband would be talking me down, but I wanted the staff to be aware of my wishes. I also used the first paragraph to impart the seriousness of the situation to the staff. This goes beyond the typical mother thinking that she can go all natural and wanting it for the sake of wanting it and then expecting the nurse to refuse her pain meds. This is literally life and death for me. Another spinal of any kind could cause a relapse of guillian-Barre syndrome and the liklihood of complete or even partial recover following a relapse is much lower then with the initial event. I want to avoid that, but I want to also make the staff aware that there is a potential liability for them if I get one. I am am protecting myself AND THE STAFF by stating this in the birth plan. As I mentioned earlier, I may not be delivering in that facility I work at. I may be transferred and if I am I very well may be incapable of communication and my family may not be with me (ie. being intubated and transported by helicopter to a facility that does not share our medical record system) I don't understand why you all are reading into this that I WANT the NURSE to do anything other then her job, which in this case most importantly to me, entails advocating for her patient, especially to other departments that are unaware of the history or potential consequences of certain actions with my history.

Also when I mentioned labor vocalization that was in reaction to the first page of responces that talked about screaming in labor as if it was a bad thing.

OP maybe you need/could get an order for "no blah blah pain meds" so the nurses don't feel conflicted??

If someone was screaming out in pain I would want to help...

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Labor vocalizations are not a bad thing. Nobody here said that. I've been here long enough to safely say that I don't think anybody here believes that either.

We understand that you have a contraindication to spinal anesthesia. If I was aware of that as your nurse, I would treat that like a drug allergy. In fact, you should probably have that notated in your chart somewhere. We get that. We're reacting to the request for pain meds at all, which I'm guessing we are interpreting as IV meds.

You seem very defensive and upset by people's comments here. We are reacting to the words we have read in the birth plan. You asked for our opinions as labor nurses, and we gave them to you. I'm sorry that we're not saying what you want to hear, but like I said, we're reacting to the words that are written. If so many OB nurses are reacting the same way, perhaps you might want to look at the wording and tone of what is written with an objective eye.

I have no dog in this race, I'm simply answering the question you gave us, as an objective outsider.

Specializes in Med-Surg.
I still fail to see how any of you think that after reading my birth plan that I am expecting the nurse to "talk me out of" an epidural???? please show me where I have stated that. I believe I have stated that my doula and husband would be talking me down, but I wanted the staff to be aware of my wishes. I also used the first paragraph to impart the seriousness of the situation to the staff. This goes beyond the typical mother thinking that she can go all natural and wanting it for the sake of wanting it and then expecting the nurse to refuse her pain meds. This is literally life and death for me. Another spinal of any kind could cause a relapse of guillian-Barre syndrome and the liklihood of complete or even partial recover following a relapse is much lower then with the initial event. I want to avoid that, but I want to also make the staff aware that there is a potential liability for them if I get one. I am am protecting myself AND THE STAFF by stating this in the birth plan. As I mentioned earlier, I may not be delivering in that facility I work at. I may be transferred and if I am I very well may be incapable of communication and my family may not be with me (ie. being intubated and transported by helicopter to a facility that does not share our medical record system) I don't understand why you all are reading into this that I WANT the NURSE to do anything other then her job, which in this case most importantly to me, entails advocating for her patient, especially to other departments that are unaware of the history or potential consequences of certain actions with my history.

Also when I mentioned labor vocalization that was in reaction to the first page of responces that talked about screaming in labor as if it was a bad thing.

First, I don't know about the rest of you, but I cringed when I saw birth plan coming from a L&D nurse. Any department I worked for (although they were on the mother-baby side), if there was a birth plan involved, it was almost guaranteed that things would not go as planned. I don't know if it was a Murphy's law thing, but we just hated to see those words on a chart lol.

Don't get me wrong, I completely understand where you are coming from though. I delivered in a hospital I had no experience with and had heard horror stories about (nothing serious, but I was used to baby friendly environments and this place definitely was NOT). I came in with my 'birthing preferences' (trying to avoid the 'plan' aspect I suppose), made it clear what was flexible and what wasn't. For instance, NO formula, NO well-baby nursery, first bath done by me and fiance, not nursery nurse. Flexible stuff- Don't offer me pain meds, I'll ask if I want them (And BOY DID I!).

While I don't see anything wrong with what you asked if you actually read what is there, I would recommend perhaps re-writing, maybe stream-lining like a previous poster suggested. When you say you want no spinal analgesia, say WHY in the same sentence. "I can't have spinal because of previous Guillain-Barre diagnosis as a result of spinal."

Specializes in Clinical Research, Outpt Women's Health.

" I do NOT want pain meds. Especially spinal narcotics. PLEASE, please, please, do NOT let this happen, even if i would request it in a moment of weakness. **** and *****will be aware of this and talk me down if need be, but I wanted the staff to be aware as well"

The above portion of your plan was what my response was based up. Your reason for no spinals is totally understood and clear as to the reason and I am sure all staff will very willingly comply with that. However, the line above puts the onus on the nurse to deny you pain meds if you request them. They really cannot do this unless there is a medical reason if you are requesting pain meds and it is not in my opinion fair to ask this of them.

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
- I do NOT want pain meds. Especially spinal narcotics. PLEASE, please, please, do NOT let this happen, even if i would request it in a moment of weakness. **** and *****will be aware of this and talk me down if need be, but I wanted the staff to be aware as well

This is where the miscommunication occurred. In your post there are only asterisks (likely a result of mod editing) where you must have stated your husband's and doula's names that were subsequently removed. As a result a brief skim of the plan could leave a reader with the impression that you were expecting a nurse to be the one controlling whether you got meds or not. I don't think anyone was intentionally trying to be offensive. They surely misunderstood what you wrote because it was unclear.

Specializes in critical care.

This is where the miscommunication occurred. In your post there are only asterisks (likely a result of mod editing) where you must have stated your husband's and doula's names that were subsequently removed. As a result a brief skim of the plan could leave a reader with the impression that you were expecting a nurse to be the one controlling whether you got meds or not. I don't think anyone was intentionally trying to be offensive. They surely misunderstood what you wrote because it was unclear.

Yeah, I had to go back to the OP and reread it. nurse_maya, your OP reads as though you expect the nurse to talk you down because there are asterisks instead of names. It looks as though you are requesting the nurse talk you down.

Specializes in L&D, postpartum, nursery, antepartum CLC.

I'd like to know what youjthought the asterisks meant? seriously if you aren't gonna take the time to fully read and comprehend a post, why are you responding. do you do this with patients too?

Specializes in L&D, postpartum, nursery, antepartum CLC.
First, I don't know about the rest of you, but I cringed when I saw birth plan coming from a L&D nurse. Any department I worked for (although they were on the mother-baby side), if there was a birth plan involved, it was almost guaranteed that things would not go as planned. I don't know if it was a Murphy's law thing, but we just hated to see those words on a chart lol.

Don't get me wrong, I completely understand where you are coming from though. I delivered in a hospital I had no experience with and had heard horror stories about (nothing serious, but I was used to baby friendly environments and this place definitely was NOT). I came in with my 'birthing preferences' (trying to avoid the 'plan' aspect I suppose), made it clear what was flexible and what wasn't. For instance, NO formula, NO well-baby nursery, first bath done by me and fiance, not nursery nurse. Flexible stuff- Don't offer me pain meds, I'll ask if I want them (And BOY DID I!).

While I don't see anything wrong with what you asked if you actually read what is there, I would recommend perhaps re-writing, maybe stream-lining like a previous poster suggested. When you say you want no spinal analgesia, say WHY in the same sentence. "I can't have spinal because of previous Guillain-Barre diagnosis as a result of spinal."

Its actually not what its from - it's just not advisable for anyone with a history of GBS or similar conditions ( like MS) to have spinal narcotics. Mine actually came from the TDap vaccine after my daughter was born

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