Wishes Regarding Students in Birth Plans

Specialties Ob/Gyn

Published

I've been reading a lot of birth plans on the web - the one I use with my clients has been currently hijacked by my computer. I know that I include this question on my birth plan about students (nursing and residents) in the room during L&D. Usually it states, "I request that no students be involved in my care." I've found that in my private doula practice I haven't run into anyone having problems regarding this preference. In the hospital, since most of the pts are Medicaid, usually they don't get a choice.

I'm just wondering, if you are in a teaching hospital, have you had any problems with pts refusing to have students in with them and how is this handled? I know that if I had private insurance, I probably would not want to have students. Yes, I know they need to learn somehow but with this issue I need to draw a line. Now, if I was a Medicaid pt, I don't think I'd have a choice and wouldn't question the issue.

How is this handled?

Specializes in Emergency & Trauma/Adult ICU.

When I was being admitted to the hospital to deliver my daughter, my husband & I were asked if we would accept students in the room. I was young at the time, and wasn't really thinking about the value of the experience, so I debated but finally said yes (right about the time a contraction hit me!). However, my complaint about this, especially knowing what I know now about clinicals, is that I never saw a student until I was literally within 2 minutes of delivering, then suddenly there was a whole herd of students in the room - at least 5. I didn't know these people - they weren't introduced to me. It felt very intrusive. I know my husband was uncomfortable with it. But there were other things to focus on, like the imminent arrival of our daughter.

Now that I think about the complete picture I think this was very poor of the school and of the hospital.

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Specializes in Emergency & Trauma/Adult ICU.

When I was being admitted to the hospital to deliver my daughter, my husband & I were asked if we would accept students in the room. I was young at the time, and wasn't really thinking about the value of the experience, so I debated but finally said yes (right about the time a contraction hit me!). However, my complaint about this, especially knowing what I know now about clinicals, is that I never saw a student until I was literally within 2 minutes of delivering, then suddenly there was a whole herd of students in the room - at least 5. I didn't know these people - they weren't introduced to me. It felt very intrusive. I know my husband was uncomfortable with it. But there were other things to focus on, like the imminent arrival of our daughter.

Now that I think about the complete picture I think this was very poor of the school and of the hospital.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Now that I think about the complete picture I think this was very poor of the school and of the hospital.

I do too. Very poor.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Now that I think about the complete picture I think this was very poor of the school and of the hospital.

I do too. Very poor.

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I wouldn't have minded students during my birth (unless it turned into a circus)..Why would a pts payor status have any significant in determining if students are aloud to observe/ learn???? Is a medicaid pt different from a private pay or insurance pay patient?

Back in the days when all the hospitals around here had mostly semi-private rooms, they would deny private rooms to Medicaid pts even if they said they could pay. Some people in Registration were downright hostile towards Medicaid pts if they asked for a private and insisted that they could pay it. But that point is moot with all private hospital rooms for PP pts in this area.

OK, I should have phrased my question differently. A pts wishes should not be excluded because of pay status. I guess we had a few doctors who were insistent that the Medicaid pts should not have a say in who could attend them during L&D. These doctors figured that since they "weren't spending a dime" for this delivery, that they shouldn't be able to say whether or not a med student (or student nurse, for that matter) should be excluded from their birth. I swear, the attitude was "why should they have privacy at tax payer expense?" I was really miffed when I heard this. Even though I have insurance, I have some abuse issues and I do draw the line at having more than who is absolutely needed at my birth.

Because of this attitude, I have noticed that if a pt has other than state funded insurance, the staff doesn't ask if they can have a student (nursing or med) attend their birth. They just send them in. If a pt has private insurance, I've noticed that a nurse comes in and asks beforehand if a student can be present.

I didn't mean to ruffle anyone's feathers here. I know that a pt's privacy should not matter regardless of pay status. As I said, I should have phrased my question differently.

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I wouldn't have minded students during my birth (unless it turned into a circus)..Why would a pts payor status have any significant in determining if students are aloud to observe/ learn???? Is a medicaid pt different from a private pay or insurance pay patient?

Back in the days when all the hospitals around here had mostly semi-private rooms, they would deny private rooms to Medicaid pts even if they said they could pay. Some people in Registration were downright hostile towards Medicaid pts if they asked for a private and insisted that they could pay it. But that point is moot with all private hospital rooms for PP pts in this area.

OK, I should have phrased my question differently. A pts wishes should not be excluded because of pay status. I guess we had a few doctors who were insistent that the Medicaid pts should not have a say in who could attend them during L&D. These doctors figured that since they "weren't spending a dime" for this delivery, that they shouldn't be able to say whether or not a med student (or student nurse, for that matter) should be excluded from their birth. I swear, the attitude was "why should they have privacy at tax payer expense?" I was really miffed when I heard this. Even though I have insurance, I have some abuse issues and I do draw the line at having more than who is absolutely needed at my birth.

Because of this attitude, I have noticed that if a pt has other than state funded insurance, the staff doesn't ask if they can have a student (nursing or med) attend their birth. They just send them in. If a pt has private insurance, I've noticed that a nurse comes in and asks beforehand if a student can be present.

I didn't mean to ruffle anyone's feathers here. I know that a pt's privacy should not matter regardless of pay status. As I said, I should have phrased my question differently.

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Specializes in LTC/Behavioral/ Hospice.
When I was being admitted to the hospital to deliver my daughter, my husband & I were asked if we would accept students in the room. I was young at the time, and wasn't really thinking about the value of the experience, so I debated but finally said yes (right about the time a contraction hit me!). However, my complaint about this, especially knowing what I know now about clinicals, is that I never saw a student until I was literally within 2 minutes of delivering, then suddenly there was a whole herd of students in the room - at least 5. I didn't know these people - they weren't introduced to me. It felt very intrusive. I know my husband was uncomfortable with it. But there were other things to focus on, like the imminent arrival of our daughter.

Now that I think about the complete picture I think this was very poor of the school and of the hospital.

I had a similar experience during the birth of my first child. I was asked if students could attend and I agreed. During the most difficult part of the labor, students started pouring in. My husband was actually trapped in one place, it was so crowded. Not only that, but I could hear them talking. At the time, I didn't care because I was so focussed on the pain and getting my baby out, but afterwards, I wasn't too impressed. I wouldn't ever agree to it again. I hope that the hospital that I do my clinicals at won't do things that way. If they do, I hope that I will be a lot more respectful of the laboring mother and her family.

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Specializes in LTC/Behavioral/ Hospice.
When I was being admitted to the hospital to deliver my daughter, my husband & I were asked if we would accept students in the room. I was young at the time, and wasn't really thinking about the value of the experience, so I debated but finally said yes (right about the time a contraction hit me!). However, my complaint about this, especially knowing what I know now about clinicals, is that I never saw a student until I was literally within 2 minutes of delivering, then suddenly there was a whole herd of students in the room - at least 5. I didn't know these people - they weren't introduced to me. It felt very intrusive. I know my husband was uncomfortable with it. But there were other things to focus on, like the imminent arrival of our daughter.

Now that I think about the complete picture I think this was very poor of the school and of the hospital.

I had a similar experience during the birth of my first child. I was asked if students could attend and I agreed. During the most difficult part of the labor, students started pouring in. My husband was actually trapped in one place, it was so crowded. Not only that, but I could hear them talking. At the time, I didn't care because I was so focussed on the pain and getting my baby out, but afterwards, I wasn't too impressed. I wouldn't ever agree to it again. I hope that the hospital that I do my clinicals at won't do things that way. If they do, I hope that I will be a lot more respectful of the laboring mother and her family.

0 Votes
Back in the days when all the hospitals around here had mostly semi-private rooms, they would deny private rooms to Medicaid pts even if they said they could pay. Some people in Registration were downright hostile towards Medicaid pts if they asked for a private and insisted that they could pay it. But that point is moot with all private hospital rooms for PP pts in this area.

OK, I should have phrased my question differently. A pts wishes should not be excluded because of pay status. I guess we had a few doctors who were insistent that the Medicaid pts should not have a say in who could attend them during L&D. These doctors figured that since they "weren't spending a dime" for this delivery, that they shouldn't be able to say whether or not a med student (or student nurse, for that matter) should be excluded from their birth. I swear, the attitude was "why should they have privacy at tax payer expense?" I was really miffed when I heard this. Even though I have insurance, I have some abuse issues and I do draw the line at having more than who is absolutely needed at my birth.

Because of this attitude, I have noticed that if a pt has other than state funded insurance, the staff doesn't ask if they can have a student (nursing or med) attend their birth. They just send them in. If a pt has private insurance, I've noticed that a nurse comes in and asks beforehand if a student can be present.

I didn't mean to ruffle anyone's feathers here. I know that a pt's privacy should not matter regardless of pay status. As I said, I should have phrased my question differently.

I'm absolutely appalled at that hospital's lack of respect for medicaid patients. Do you still attend births as a doula there? If you are, aren't you in a position to advocate for your client's wishes if they do not want students? Are you affiliated with the hospital (as an employee or volunteer)?

I'm having a hard time expressing my thoughts tonight... but I find that doulas often find themselves treading a fine line between advocating for their clients and maintaining a welcoming/respectful environment for themselves and their clients. For doulas affiliated with hospitals or OB practices this can be especially hard. Make too many waves and you can find yourself in a hostile work environment, or possibly even fired. Even as nurses we can find ourselves playing politics- having to know just the right way to address this MD and that CNM to ensure that our patients recieve not only the level of care they are entitled to (that's a given), but the level of respect they deserve. It's easy for someone with a big ego or a manipulative personality to bend a patient to do things their way if we (nurses, doulas, patients) enable that kind of environment & behavior.

Anyway... we ALWAYS ask patients if they mind having a student. Medicaid patients are not treated any differently than privately insured patients. We stress that the students are paired with a nurse and are not there as spectators but as a part of the birth "team". Most of our patients, especially multips, are comfortable sharing their labor & birthing experience with students when the students are respectful of the mother's birth environment. I've even had postpartum patients comment that they didn't think they'd want a student at their birth but found their student nurse so friendly and helpful that they were glad they had, that they enjoyed having them as a part of their birth experience,

0 Votes
Back in the days when all the hospitals around here had mostly semi-private rooms, they would deny private rooms to Medicaid pts even if they said they could pay. Some people in Registration were downright hostile towards Medicaid pts if they asked for a private and insisted that they could pay it. But that point is moot with all private hospital rooms for PP pts in this area.

OK, I should have phrased my question differently. A pts wishes should not be excluded because of pay status. I guess we had a few doctors who were insistent that the Medicaid pts should not have a say in who could attend them during L&D. These doctors figured that since they "weren't spending a dime" for this delivery, that they shouldn't be able to say whether or not a med student (or student nurse, for that matter) should be excluded from their birth. I swear, the attitude was "why should they have privacy at tax payer expense?" I was really miffed when I heard this. Even though I have insurance, I have some abuse issues and I do draw the line at having more than who is absolutely needed at my birth.

Because of this attitude, I have noticed that if a pt has other than state funded insurance, the staff doesn't ask if they can have a student (nursing or med) attend their birth. They just send them in. If a pt has private insurance, I've noticed that a nurse comes in and asks beforehand if a student can be present.

I didn't mean to ruffle anyone's feathers here. I know that a pt's privacy should not matter regardless of pay status. As I said, I should have phrased my question differently.

I'm absolutely appalled at that hospital's lack of respect for medicaid patients. Do you still attend births as a doula there? If you are, aren't you in a position to advocate for your client's wishes if they do not want students? Are you affiliated with the hospital (as an employee or volunteer)?

I'm having a hard time expressing my thoughts tonight... but I find that doulas often find themselves treading a fine line between advocating for their clients and maintaining a welcoming/respectful environment for themselves and their clients. For doulas affiliated with hospitals or OB practices this can be especially hard. Make too many waves and you can find yourself in a hostile work environment, or possibly even fired. Even as nurses we can find ourselves playing politics- having to know just the right way to address this MD and that CNM to ensure that our patients recieve not only the level of care they are entitled to (that's a given), but the level of respect they deserve. It's easy for someone with a big ego or a manipulative personality to bend a patient to do things their way if we (nurses, doulas, patients) enable that kind of environment & behavior.

Anyway... we ALWAYS ask patients if they mind having a student. Medicaid patients are not treated any differently than privately insured patients. We stress that the students are paired with a nurse and are not there as spectators but as a part of the birth "team". Most of our patients, especially multips, are comfortable sharing their labor & birthing experience with students when the students are respectful of the mother's birth environment. I've even had postpartum patients comment that they didn't think they'd want a student at their birth but found their student nurse so friendly and helpful that they were glad they had, that they enjoyed having them as a part of their birth experience,

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I would definitely say no to having students (or any non-essential personnel) in the room. Where I work (and as was mentioned above), the students don't enter the room until delivery is imminent. When I am at my worst --and possibly in the most pain -- this hoarde of people comes rushing in. Excess chatter, laughing in the background, a crowded room -- all of this would do nothing but annoy me and my husband to the extreme, as well as make the whole birthing process a complete 3-ring circus instead of the cherished event it's supposed to be.

As for students or even 1st years doing my delivery? Not a chance, and I will request as much. Most of the time they're clueless about what needs to be done, such as protecting the perineum during delivery, not to mention having only book knowledge about what to do in case of shoulder distocia, etc.

My husband is in the military and the chances of me delivering in a teaching hospital are pretty much 100%. But I do not feel in any way that this does not give me the right to refuse non-essential personnel or students access to my room or my care. Just as long as I am courteous and up front with the staff concerning my wishes, there should be no problem accomadating them. :) So far I've only seen a handful of women request the above, but it was very easy for us to make it happen and there were no further comments.

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I can't belive that a hospital would allow all of these students to come rushing in at the last minute. Birth isn't a spectator sport. As I said before I had a student nurse with one of my deliveries and she was great. She said with me the whole time and wasn't intrusive at all. Plus, like I said she was a doula before that and wanted to be a CNM. But I would not allow more than one student in and they would have to be there most of the time. And I wouldn't let anyone but a midwife help me deliver.

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