I'm a graduate nurse who is also 31 weeks pregnant; I'm interested in L&D nursing after I have my baby. We have chosen to go to a birthing center to have our first child; they required that we take childbirth classes and I liked the idea of my husband being involved with the birthing process, so we decided to choose the Bradley Method to help us.
When I initially spoke with the instructor, she seemed excited to have a 'nurse' in the class, and would occasionally ask me questions in front of the class as a 'nurse' authority figure. She claimed in class to state the Bradley Method supports any choices the couple makes, but was clearly biased towards no interventions whatsoever during birth. She was rather forceful in her opinions. However, none of the information was particularly detrimental until yesterday...
Maybe having the class on 06/06/06 got to her, but she seemed to do a complete 180. She was talking about birthing in a hospital, and trying to have a natural birth (ie, refusing to wear the hospital gown, refusing IVs, refusing to be NPO, etc) and told these horror stories in class, and how the nurse will come in and try to boss you around, but that you are there to be served, and that you should come into the hospital with the following mindset:
"the hospital is a hotel, and the nurses are the maids. The only thing they are responsible for is fetal heart rate, and for fixing up the room. They have no autonomy. Think of them as maids, and tell them what services you want."
She also said that when the patients are given the consents, they should tear the first page off and staple it to their birth plan and hand that in instead. She said that nurses just laugh at birth plans anyway.
I literally saw red!!! I was so angry that I didn't trust myself to speak, and basically withdrew from participating in the rest of the class. A few of the students asked me during the break about what she was saying, and said they didn't agree with nurses being equated with maids in the hospital.
At this point, I don't feel like ever going back to that class (we still have 4 more left). We have the workbook and I still feel the principles of the method are sound, but I feel that going back to that instructor and that class would validate what she said. I feel like I did that tacitly by not speaking up in class. I am drafting an e-mail message to her that I'm thinking about sending to the entire class (we have a listserv set up)...
Mostly this is just a vent, but I would be interested in hearing how others would have responded to this, or experiences with Bradley families in the hospital...
Heh heh. I can imagine that you took this personally, being a nurse, but I wouldn't. Some Bradley instructors can be really "out there" with paranoia about the healthcare system -- and let's face it, the paranoia isn't completely unjustified.
I think what she was trying to do with the "think of the nurse as a maid" thing was empower the mother. Many women are really intimidated by the nurses and doctors when they get to the hospital and don't have sense enough to refuse treatments they don't want (and, frankly, many nurses and doctors prefer to keep it that way).
I've given natural childbirth twice in hospitals and I've had supportive and unsupportive nurses. One especially helpful nurse faked not being able to give me an IV that I didn't want while I was in transition and even whispered in my ear "good for you, don't let them do anything you don't want" when I challenged an intern who tried to give me a shot of pitocin two seconds after I gave birth (some insane protocol they have now to prevent bleeding...).
As far as the birth plan. My nurses and doctors weren't the least bit interested, but it was still important to do because it helped me figure out what I did and didn't want.
Regardless of whether or not one believes Bradley instructors' "paranoia" about the healthcare system to be justified, equating a nurse to a maid is inappropriate. Rather than demeaning the very professionals whom these parents have chosen to help bring their babies safely into the world, the instructor would serve her students FAR BETTER by assisting them to verbalize their desires and devise birth plans that reflect them.
As for your nurse who "faked" being unable to insert an IV, SHAME ON HER. Her job as a patient advocate is to support your wishes to avoid an IV, assist you in discussing them with your physician, explain to you the risks/benefits, and then provide the care that you consent to. By "faking", she DID NOT act as your advocate, or perform her dutues in a professional manner.
Jolie, absolutely the Bradley instructor was wrong. I was attempting to explain her behavior, not rationalize it or condone it. There are better ways to empower people than to tear others down. (So next time you need to give a presentation in front of an audience, don't imagine they're naked. It's disrespectful! Heh heh.)
As far as the IV goes, fake is probably too strong a word. She told me she had to give me an IV. I said I didn't want it. She said, sorry it's hospital protocol. Then she palpated my arm for a couple of seconds, shrugged and walked away. At that moment I was in a lot of pain and moments away from pushing. I suppose should she could have followed protocol but I would argue that there are a multitude of instances when nurses don't do things exactly by the book and that's often a good thing.
"...support your wishes to avoid an IV, assist you in discussing them with your physician, explain to you the risks/benefits, and then provide the care that you consent to."
I'm not sure how this would have been possible in the three minutes that this went on, while I was dealing with hard labor. The hospital I attended is known as a "baby factory," the nurse in question was a registry nurse and I didn't have a regular doctor (I got my prenatal care through a free clinic and I already knew my baby would be delivered by whomever was on the floor).
I think she used her own judgement to evaluate how important IV access was in my case and chose not to push it. It was the right decision.
Jolie, absolutely the Bradley instructor was wrong. I was attempting to explain her behavior, not rationalize it or condone it. There are better ways to empower people than to tear others down. (So next time you need to give a presentation in front of an audience, don't imagine they're naked. It's disrespectful! Heh heh.)
As far as the IV goes, fake is probably too strong a word. She just did not try very hard. At that moment I was in a lot of pain and moments away from pushing and it was completely obvious to her that I did not want the IV so she just shrugged and gave up. I suppose should she could have followed protocol but I would argue that there are a multitude of instances when nurses don't do things exactly by the book and that's often a good thing. As far as acting as my advocate in this situation, I think she was, in trenches, so to speak. There was no time to file a report, so to speak...
But if you didn't want an IV, then it was wrong of the nurse to "try" to start it. That's my point. Whether she made a "half-hearted" attempt to start it, or simply "play-acted", she did wrong by you. Her job was to advocate for you by informing the resident that an IV was against your wishes, not to subject you to an unsuccessful half attempt or a pretend act. And as much as your wishes were contrary to those of the resident, the physician also had the right to know that an IV would not be forthcoming, as that could impact on how s/he cared for you.
When members of the healthcare team fail to communicate by deliberately with holding information or misleading each other, a patient will eventually suffer. It is unprofessional behavior, even if the patient doesn't mind. I'm grateful that your nurse's actions did not result in harm to you, but someday they will result in harm to someone.
Jolie, you bring up an interesting point. I'm only a student and I really don't understand what the patients right are, then and now. I know that in both my deliveries I was told by staff that I could not refuse certain things such as IVs and continuous monitoring. I don't understand why people are being told they don't have the right to refuse if they actually do. This goes back to why the Bradley instructor is paranoid. No one likes to feel that they are not in control of their care and this happens all the time in hospitals, especially in L&D.
I guess my nurse was wrong because she didn't inform me that I had a right to refuse the IV. (But then why did she tell me in that I had a right to refuse the pitocin?) I'm completely confused...
Jolie, you bring up an interesting point. I'm only a student and I really don't understand what the patients right are, then and now. I know that in both my deliveries I was told by staff that I could not refuse certain things such as IVs and continuous monitoring. I don't understand why people are being told they don't have the right to refuse if they actually do. This goes back to why the Bradley instructor is paranoid. No one likes to feel that they are not in control of their care and this happens all the time in hospitals, especially in L&D.
I guess my nurse was wrong because she didn't inform me that I had a right to refuse the IV. (But then why did she tell me in that I had a right to refuse the pitocin?) I'm completely confused...
Can you clear this up for me?
In a nutshell, patients have the right to refuse anything, and to force any treatment that a patient does not consent to amounts to battery.
You raise a valid point that healthcare providers are not very forthcoming in informing patients of their right to refuse treatment, especially in OB, where some providers fail to differentiate between the "desirability" of interventions such as IVs, continuous fetal monitoring and the "necessity" of them. I have seen plenty of patients refuse "routine" IVs and continuous monitoring, but very few refuse them when there was a clear-cut need, such as elevated maternal temp. However, even in a case where a mother may be endangering her own or her baby's health without having an IV or continuous monitor, they can not be done without her permission. Despite the provider's desire to do what s/he feels is best for the patient and her baby, nothing can be forced on a laboring mother or any patient without consent.
Then I have been lied to multiple times by nurses and this makes me quite angry. Hopefully, I will not be the kind of nurse that lies to her patients.
I'm sorry your wishes were not discussed and respected.
Nurses and physicians who operate in this manner give us all a bad name, and give legitimacy to the claims of "militant" childbirth instructors like the one mentioned by the OP.
In my experience, healthcare providers who scare, threaten, or badger their patients into certain courses of treatment are usually inexperienced and uncertain of their own practice, over-taxed and unable to devote sufficient time to their patients, or highly egotistical and threatened by informed patients. Obviously, none of these traits is desirable.
The beauty of our healthcare system is that we all have some degree of choice, and usually do not have to put up with unacceptable providers. I have changed doctors a number of times until I've found one with whom I can communicate. Same goes for "shopping around" for healthcare facilities. I sincerely hope you find providers you can trust, and who are worthy of your trust.
i wrote and then negotiated my birthplan with my doc in advance, with some "give" on both sides - e.g. he would do everything he could to avoid an episiotomy (and i would do perineal massage, etc. in advance) and i agreed to have an iv inserted (with a buff cap) just in case. he had no trouble with me being up and around walking, squatting, etc. and did not see the need for continual monitoring; i agreed to sit in the rocking chair and have the monitor on for a few minutes every couple of hours. also, i could deliver in position of comfort unless there was a legit medical reason not to. i also had copy on file in advance at the hospital where i delivered.
the first nurse that was on when i got there told me i had to be in bed on continual fetal monitoring - that was the policy and she didn't care if my doc had signed off on my birth plan or not. fortunately, i am assertive (and being a clinical social worker who's not intimidated by medical professionals certainly helps) and told her that she could take the issue up with my doc or my lawyer, but that i was not just climbing in bed and shutting up. my husband (also an assertive person) backed me up and said we'd be happy to talk to her supervisor, etc. to let him/her know our position. she was quite huffy, but backed down.
luckily, the next shift came on soon after and the l & d nurse who was there for the final 5 hours of labor was fantastic. helped me through everything and said, "we'll do some of the things the midwives do" - e.g. having me use one of those big exercise balls to lean on after my water broke and labor got harder. she was encouraging and supportive, but still professional - assessing me and the baby, keeping the doc informed, etc.
as it was, my doc wasn't on call the night i delivered and his partner did not routinely put in ivs, so i never had to have that. she said, "i know you're bradley and don't want meds or unnecessary interventions... we won't ask you if you want meds, but you are free to request them - including an epidural - if you change your mind. we'll go all natural if we can, but go medical if we need to." she did her best to avoid an episiotomy, but after an hour of me pushing and her stretching "the toughest perineal skin i've ever seen!" i agreed to a small cut. next push, i had a baby and only needed a couple of stitches. was up walking around in about an hour and the nurses let me help with baby's first bath.
i had forgotten all about how mad i was at the first nurse and how she'd tried to intimidate me until i read another poster...and i can't help but think that if i'd been more naive, younger, or less educated about my rights that i could easily have just been bulldozed into shutting up and putting up. as a therapist, i don't bully my clients and i hope that as a nurse (i start school in august) i won't either!
I feel sure that most of the pts at the hospital unit I'm going to work at (& did preceptorship at) don't understand that they may refuse things.
And no one is going to voluntarily admit to them that they can, unless they basically already know it and are already refusing.
If someone didn't want an IV, they would probably explain why we use them, but not tell them 'but you have the right to refuse if you still don't want it". They would just explain it and do it (with pt not saying anything b/c they don't realize they have the option, not necessarily b/c they consent/agree, KWIM?) so I definitely understand where this line of thought is coming from.
I didn't know that I could refuse things when I had my kids, and I consider myself more knowledgeable about that sort of thing than most of the pts we have.
I feel sure that most of the pts at the hospital unit I'm going to work at (& did preceptorship at) don't understand that they may refuse things.
And no one is going to voluntarily admit to them that they can, unless they basically already know it and are already refusing.
If someone didn't want an IV, they would probably explain why we use them, but not tell them 'but you have the right to refuse if you still don't want it". They would just explain it and do it (with pt not saying anything b/c they don't realize they have the option, not necessarily b/c they consent/agree, KWIM?) so I definitely understand where this line of thought is coming from.
I didn't know that I could refuse things when I had my kids, and I consider myself more knowledgeable about that sort of thing than most of the pts we have.
Thanks for your post that makes me feel like not such an idiot for letting nurses bully me into things I didn't want. I really didn't know what would happen. I think I was just confused at the time, in hard labor, and maybe thought they could make me leave the hospital or something...
The beauty of our healthcare system is that we all have some degree of choice, and usually do not have to put up with unacceptable providers. I have changed doctors a number of times until I've found one with whom I can communicate. Same goes for "shopping around" for healthcare facilities. I sincerely hope you find providers you can trust, and who are worthy of your trust.
Actually, because I was uninsured at the time, my options were extremely limited. Our healthcare system is beautiful if you can afford it.
I was told that an IV was SOP in the hospital where I did my clinical rotation and preceptorship. That every patient had to have one for insurance purposes so that they could be given fluids or meds. I was also told that all of the laboring moms were to be kept NPO in case they were to need a C-Section.
I was so angry that I didn't trust myself to speak, and basically withdrew from participating in the rest of the class. A few of the students asked me during the break about what she was saying, and said they didn't agree with nurses being equated with maids in the hospital.
Jolie, BSN
6,375 Posts
Regardless of whether or not one believes Bradley instructors' "paranoia" about the healthcare system to be justified, equating a nurse to a maid is inappropriate. Rather than demeaning the very professionals whom these parents have chosen to help bring their babies safely into the world, the instructor would serve her students FAR BETTER by assisting them to verbalize their desires and devise birth plans that reflect them.
As for your nurse who "faked" being unable to insert an IV, SHAME ON HER. Her job as a patient advocate is to support your wishes to avoid an IV, assist you in discussing them with your physician, explain to you the risks/benefits, and then provide the care that you consent to. By "faking", she DID NOT act as your advocate, or perform her dutues in a professional manner.