my birth plan - nurse friendly?

Specialties Ob/Gyn

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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.

I too read it as all other comfort measures had been done. If you feel better about bringing your birth plan in writing do it! I try to put myself in your place, where I work my co-workers would not need me to write it and my CNM would already know my plan.

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Specializes in OB.
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?

The above post made me assume that if she asked for pain meds, you would just give them. That's why I suggested that there was much more an OB nurse could do before caving to pain med requests in this type of circumstance. It does say you would ask her once if she was sure, then give it. So, I apologize for misunderstanding the post.

I've been in this position many times as both a RN and a CNM and it is difficult. I once had a patient BEGGING for pain medication in the last 20 minutes of her labor (and of course she didn't believe me when I told her it was almost over). I was scared to death she was going to KILL me when it was all over for not getting her the epidural, but she looked at me, while holding her 5 minute old baby and beamed- "Thank you so much for not listening to me!! I actually DID IT!!" She felt so empowered! (Granted, we had spent numerous hours discussing her adamant desire to go all natural... ;))

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

Well, I was going on the assumption that the OP, who feels very strongly about going natural, is probably not the type to ask for pain meds at the first horrible contraction, but would actually want to and be motivated to try other things first. It's not been my experience that women who are adamant about going drug-free typically say "Oh, I guess this does hurt! I changed my mind, give me meds!" Things usually get pretty intense before that request is made, and usually in those situations, the woman is at the end of her reserves. If she's in transition, I would explain to her that this is the most intense, but also the shortest part of labor, and that I think she can do it. I am a VERY supportive L&D nurse, especially when it comes to wanting to go natural, as that is very near and dear to my heart. But I also won't ignore or dismiss the woman who is asking for pain meds out of desperation, having exhausted her orificenal of non-pharmacologic relief options.

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

Well, if I'm lucky enough to deliver at our rural remote hospital there will be at least 1 agency nurse if not more and at least 2 new nurses that don't know and understand my history and wishes. A birth plan is an easy way to communicate with them there are also multiple departments involved or potentially involved in any patients care, surgery, other doctors, Anes. Etc at a minimum. Makes for better communication in labor and allows for or prompts discussions prenatally. I wonder at the facilities that you ladies work at that you wouldn't welcome a birth plan from anyone, even staff members. What kind of culture do YOU foster? Also the amount of posters acting like labor vocalization is anything but normal and beneficial to the labor is concerning. This birth plan is my voice and will follow me to wherever I deliver. In reality I will NOT likely deliver at my hospital so I need to be able to have a way to get my desires across

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

Nobody said ever that we wouldn't welcome a birth plan. I love birth plans. However, I was just surprised that anyone would feel that they need one at a place where they work and are presumably friends with all the other nurses, OBs and midwives on staff. It would just seem unnecessary, not necessarily unwelcome.

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

And I'm confused about your comment on labor vocalization. What exactly are you referring to?

You are obviously offended by my comments, and I did not mean to offend you. You asked our opinions as nurses, and our opinions as nurses were given. You specifically asked if it was "nurse friendly".

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Nursing is and always should be about respecting the pt. We have had moms that want another child in the delivery room. This is discussed with nurse manager and like birth plans is attached to moms prenatals (sure copy is also with her)

The same respect should also include the mom that request an epidural as soon as she can have one.

The area I am from, majority want pain meds.

Unfortunately in my 30+ years , I wish I had kept track of the birth plans vs. needing a C/S, seems to happen alot here.

Like I said before go with your birth plan. We are all nurses here, all ages from all over giving our own thoughts.

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I'm not a L&D nurse what is the point of bringing the placenta home????

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I'm not a L&D nurse what is the point of bringing the placenta home????

I am an L&D nurse and I don't get it LOL some use it as tree fertilizer in honor of the baby---others well, I have no idea. LOL

Posting from my phone, ease forgive my fat thumbs! :)

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Hi,

I do agree that you do not need to make your birth plan "coworker friendly", however, I disagree with the above positing that it is the nurses job to talk you out of pain medications. There is a big difference between offering pain medications every hour and then giving them when the mother changes her mind and requests it. Assuming that all non-pharmaceutical methods have been tried and you are still rating your pain 10/10 and begging for meds it is not the nurse's place to say "I can't give you anything, you told me not to. I understand then you were completely comfortable when you told me not to but you made me promise to say no..." Don't you think that will just frustrate you and increase your anxiety? The decisions that you make for yourself are your responsibility. As you know, it is the nurse's job to make sure that you are making well informed, educated decisions but it is not her job to decide what kind of pain you can handle or not. When someone tells us they are in pain we are to take them seriously and not argue, and if they come to the conclusion of wanting pain medications then we are to safely implement that decision. Obviously as you progress through labor the pain and discomforts will change. A birth plan is just that...a plan. It is not set in stone, you can change anything about it you want at any time. A doula is a wonderful idea to help keep you on track with your plan. Just like you said in your OP, be flexible, things can change. Good luck, I'm sure you will do wonderful!!

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! :)

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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

I am an L&D nurse and I don't get it LOL some use it as tree fertilizer in honor of the baby---others well, I have no idea. LOL

Posting from my phone, ease forgive my fat thumbs! :)

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

I work in a very progressive teaching hospital (only hospital in this large metro area that allows and supports water births in actual water birthing tubs). We see the request to take home placentas fairly regularly. Usually they do it so that they can have them encapsulated, which has been shown to decrease postpartum depression as well as increase the woman's iron stores. There are thriving businesses that do placental preparation/encapsulation. I was at a CAPPA conference a couple years ago with my sister (we had a booth for our herbal product business) and the booth next to us was one such business and I got into a long fascinating discussion with the woman about it.

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