my birth plan - nurse friendly?

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  1. This is a discussion on my birth plan - nurse friendly? in Ob/Gyn Nursing, part of Nursing Specialties ... I think I have have done an ok job of doing a birth plan for a birth I am rather anxious about, but...

    by Mar 6
    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 vaginal 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.
    Last edit by Esme12 on Mar 6 : Reason: TOS/names removed
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    by nurse_maya28 Mar 6 7:22 am
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  3. 47 Comments so far...

  4. Mar 6 by
    As long as you aren't a screamer, the pain meds isnt an issue for me. I don't like giving pain meds anyway :P I worry about the baby with meds. Make sure your facility knows HOW to send home a placenta. Skin to skin is typical. If your hospital is baby friendly then there won't be pacifiers or bottles offered.

    Posting from my phone, ease forgive my fat thumbs!
    Fiona59 likes this.
  5. Mar 6 by
    I think it's unfair to put the onus of "talking you down" onto the nurse if you request pain meds. If you request pain meds, I would say "are you sure?" and then if you insist, I'm going to give you pain meds. It's not my job to "talk you down" or refuse to give you pain meds if you ask for them. (and I'm a HUGE proponent of natural childbirth and had all three of my children without any medication, so I'm not trying to be unsupportive)

    If you're hoping to go med-free, I would suggest hiring a doula.

    Are you planning on bringing a container for the placenta?
    Fiona59, Spidey's mom, Skips, and 4 others like this.
  6. Mar 6 by
    She is planning on having a doula.

    I actually think this is a good plan. I do agree though that it's not entirely fair to have the nurse be responsible to make sure you do not get pain medication. Other than that, it's a great birth plan. Best wishes to you and good luck!!
    Fiona59 and RNinLDRP620 like this.
  7. Mar 7 by
    I agree with the others re: a fellow nurse to not give pain meds if you are screaming in her face for them. My first thought about General anesthesia is its not the best for the newborn, we only do for emergency C/S, but it seems you have done your homework in coming to this decision.
    Prayers are with you for your birth and your family
    Fiona59 likes this.
  8. Mar 7 by
    You do not need to adjust your birthplan for the comfort of the staff, first of all. This is YOUR birth! (And I am an experienced OB nurse, CNM, and mother of 3.)
    Your birth plan is completely reasonable and I disagree with the above poster that said as an OB nurse it is not "her job" to talk you down if you request pain medicine in a moment of weakness. It most certainly is every OB nurse's job to do her best to soothe, calm, find and offer alternatives, in order to allow you to fulfill your birth plan. What about a warm shower? Tub? Ball? (As you already mentioned.) Hands and knees? Standing and leaning on your husband or over the bed? Sterile water papules for back labor? There are SOOOO many options that don't include meds. That is the job of an OB nurse.
    Best wishes to you for a wonderful birth experience!
    poppycat, bebbercorn, and Alikatz like this.
  9. Mar 7 by
    Quote from mommy2boysaz
    You do not need to adjust your birthplan for the comfort of the staff, first of all. This is YOUR birth! (And I am an experienced OB nurse, CNM, and mother of 3.)
    Your birth plan is completely reasonable and I disagree with the above poster that said as an OB nurse it is not "her job" to talk you down if you request pain medicine in a moment of weakness. It most certainly is every OB nurse's job to do her best to soothe, calm, find and offer alternatives, in order to allow you to fulfill your birth plan. What about a warm shower? Tub? Ball? (As you already mentioned.) Hands and knees? Standing and leaning on your husband or over the bed? Sterile water papules for back labor? There are SOOOO many options that don't include meds. That is the job of an OB nurse.
    Best wishes to you for a wonderful birth experience!
    I am going under the assumption that we're already trying all those things you mentioned and the patient is still screaming, asking or begging for pain meds. It goes against everything against me as a nurse to refuse pain medication if the patient is begging for it and non-pharmaceutical interventions have been exhausted. Further, I think it's unfair for anyone to insist that a nurse "Do not give me medication no matter how much I ask for it" which puts total responsibility (i.e. blame) on the nurse's shoulders, when it should be on the shoulders of the patient and her labor support team.

    I think a more reasonable way of wording it is a simple "I am aware of my pharmaceutical pain relief options. I very strongly desire to labor and birth med-free. Please do NOT offer me pain medication or ask about my pain level/score <if you object to that, many women do>. Instead, please assist me with and suggest non-pharmaceutical pain relief or distraction options."
    Skips, RNinLDRP620, Alikatz, and 5 others like this.
  10. Mar 8 by
    Quote from klone
    I am going under the assumption that we're already trying all those things you mentioned and the patient is still screaming, asking or begging for pain meds. It goes against everything against me as a nurse to refuse pain medication if the patient is begging for it and non-pharmaceutical interventions have been exhausted. Further, I think it's unfair for anyone to insist that a nurse "Do not give me medication no matter how much I ask for it" which puts total responsibility (i.e. blame) on the nurse's shoulders, when it should be on the shoulders of the patient and her labor support team.

    I think a more reasonable way of wording it is a simple "I am aware of my pharmaceutical pain relief options. I very strongly desire to labor and birth med-free. Please do NOT offer me pain medication or ask about my pain level/score <if you object to that, many women do>. Instead, please assist me with and suggest non-pharmaceutical pain relief or distraction options."

    Exactly.
    LaborDiva, Fiona59, and RNinLDRP620 like this.
  11. Mar 8 by
    Quote from klone
    I think it's unfair to put the onus of "talking you down" onto the nurse if you request pain meds. If you request pain meds, I would say "are you sure?" and then if you insist, I'm going to give you pain meds. It's not my job to "talk you down" or refuse to give you pain meds if you ask for them. (and I'm a HUGE proponent of natural childbirth and had all three of my children without any medication, so I'm not trying to be unsupportive)



    If you're hoping to go med-free, I would suggest hiring a doula.

    Are you planning on bringing a container for the placenta?
    Did you even read it? I do have a doula hired and I stated that my husband and the doula will be talking me down if needed, but that i wished for the staff to be aware of my strong feelings. They have containers that I can use there. I know its the department that I am a L&D nurse in
  12. Mar 8 by
    Quote from mommy2boysaz
    You do not need to adjust your birthplan for the comfort of the staff, first of all. This is YOUR birth! (And I am an experienced OB nurse, CNM, and mother of 3.)
    Your birth plan is completely reasonable and I disagree with the above poster that said as an OB nurse it is not "her job" to talk you down if you request pain medicine in a moment of weakness. It most certainly is every OB nurse's job to do her best to soothe, calm, find and offer alternatives, in order to allow you to fulfill your birth plan. What about a warm shower? Tub? Ball? (As you already mentioned.) Hands and knees? Standing and leaning on your husband or over the bed? Sterile water papules for back labor? There are SOOOO many options that don't include meds. That is the job of an OB nurse.
    Best wishes to you for a wonderful birth experience!
    Thank you so much. I guess I should have stated this earlier, but I thought it was understood - I am also an L&D nurse that will delivering in the department that I work in (god willing). I would never expect that a nurse should deny pain meds to a patient that is ademant that they want it. I am not the type of person to scream at folks - especially co-workers. That is why I am prepping with the bradley method and employing a doula. My main fear is the possibility of being transferred to a high risk unit hours away and making sure my strong feelings are understood. I mean this is literally life and death for me for many reasons. All I wanted to do was impart how serious I am about this to the staff - i am by no means expecting anyone other then CLay and the doula to be responsible for talking me down. This ain't my first rodeo either so I am not going in blind. I am also very realistic since I am extremely high risk due to the guillian-barre syndrome and previous eclampsia. You sound just like the sort of nurse/midwife I would love to have in my corner. Thank you again fo your support
    mommy2boysaz likes this.