my birth plan - nurse friendly?

[nurse_maya28]

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.

[itsnowornever, BSN, RN]

As long as you aren't a screamer, the pain meds isnt an issue for me. I don't like giving pain meds anyway 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! :)

[klone, MSN, RN]

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?

[PinkNBlue, BSN, RN]

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!!

[debsgreys]

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

[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! :)

[klone, MSN, RN]

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 . Instead, please assist me with and suggest non-pharmaceutical pain relief or distraction options."

[PinkNBlue, BSN, RN]

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 . Instead, please assist me with and suggest non-pharmaceutical pain relief or distraction options."

Exactly.

[nurse_maya28]

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

[nurse_maya28]

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

[klone, MSN, RN]

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

I did read it. THere was a lot of information there and I missed the part about the doula.

I didn't realize that you work in the L&D department. That makes me kind of surprised that you feel like you would need a birth plan. Does your department allow you to "special" people? Can you hand pick your providers who know your needs and wishes?

[melmarie23, MSN, RN]

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

you stating that you will havea doula could have been easily missed when glossing over this quickly (though in person, it would have been apparent...but I digress).

Now that I know that you are a RN on this unit, my question now is why do you feel the need to put all of this into writing? Birth plans are good, and I welcome them, but they are coming from someone that I am just meeting for the first time (most instances). Assuming that these co-workers know you personally, I would think that much of these birth preferences would have already been known? Is there something wrong with the unit culture that concerns you?

Regardless of my above question (and feel free not to answer), overall your plan is quite reasonable. I think the only suggestion that I would give is to simplify it. The intro paragraph makes some of the bullet points redundant (and vice versa).

BIRTH PLAN:

-Due to my Guillian- Barre, I absolutely cannot have spinal narcotics (in the event of a c/s I MUST have general anesthesia).

-I prefer to this is a pain med free as possible.

-A saline lock is permissible.

-My support persons are my husband, doula and mother. Please respect them as you would myself.

-I would like to be as mobile as possible in labor (I welcome the birthing ball!).

-I would like to use aromatherapy.

-Cervical ripening and AROM are okay, but I would prefer to avoid pitocin as an induction measure if possible.

-I am banking my cord blood. I have the kit ready for your perusal.

-I plan on taking my placenta home for encapsulation barring indications of chorio and/or mec staining.

-I am at risk for pre eclampsia and am in amenable to its treatment should it manifest again.

-I would like to remain skin to skin with my baby after birth provided we are both stable.

-I plan on breast feeding: please offer the infant NO pacifiers or formula without my explicit consent.

THANK YOU!