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...
I am an L&D nurse (obvious by my screen name ) and am always a little nervous when I see a patient is using the Bradley Method or come in with birth plans that are 'absolute'. I have to admit that I don't have much experience or knowledge of the Bradlye Method, but the people that I do know that have used it have been militant.
I fully support patients' wishes during the childbirth process, as long they understand the safety of her and her baby are my primary concern. If I can follow her wishes at the same time, wonderful! I have just had too many patients come in with "absolutely no IV, pitocin, epidural, pain meds, etc... Intermittent monitoring only!!, etc..." Than end up having a crash section for a huge abruption!!
Make your wishes known, but please keep in mind that your safety and that of the baby's is #1.
As far as being the maid, only one of my many job titles
Specializes in obstetrics(high risk antepartum, L/D,etc.
I need to tell people that the birth educator's attitude reflects that of Dr Bradly himself. I worked on the only unit that he still had priviledges. He is not delivering babies anymore.
I saw him scream at patients that requested pain relief--even a local to repair the third degree laceration that had happened. (This was, of course, the mom's fault) He refused to allow NB recussitation on a baby born with Apgar of 1! This child was to be put to breast-he would get better, and the mom had to nurse to release the placenta! This child was taken to the warmer, recussitated and sent to the Level III nursery. The placenta came out on its own
I could go on for days, but I think you get my point.
The sad part is that his method is an excellent method of childbirth if one recognizes that not all mom/babies have the perfect labor/delivery. Too many things can happen too fast in OB. These things affect both mom and baby, as well as family. It is very selfish to deny excellent care in order to have a "wonderful experience".
I need to tell people that the birth educator's attitude reflects that of Dr Bradly himself. I worked on the only unit that he still had priviledges. He is not delivering babies anymore.
I saw him scream at patients that requested pain relief--even a local to repair the third degree laceration that had happened. (This was, of course, the mom's fault) He refused to allow NB recussitation on a baby born with Apgar of 1! This child was to be put to breast-he would get better, and the mom had to nurse to release the placenta! This child was taken to the warmer, recussitated and sent to the Level III nursery. The placenta came out on its own
I do have to say, I have lots of earth crunchy friends and acquiantances who wanted low intervention, had birth plans, etc. I have never had one who didn't understand that it went out the window should an emergency occur.
It seems like in a lot of cases, one bad apple in the past has spoiled the bunch for both sides (nurses and moms).
I am a nursing student and this brings up a question for me about my pregnancy. I was planning on having my baby in a birthing center but ended up at a hospital for failure to progress. The hospital and the birthing center had very different policies. For example, you can eat as much as you want at the birthing center but have to be NPO at the hospital. Can you refuse to be NPO? Instead of telling me to refuse, my midwife just had me eat a meal before leaving the birthing center so I wouldn't get weak and exhausted. I guess if you eat something against medical advice, they can't go in and get it back out:uhoh3:. But medical facilities do have policies for a reason, the health of the client. And it also seems like they would have to "insist" on certain rules due to malpractice lawsuits, etc. So it seams to me you can refuse some things, but others you may "refuse" but will have to accept because of significant medical issues? Is this accurate? I'm just trying to understand.
she should be more careful with her analogies in the future. I know very few maids that have college education and life saving experience. People may take that to heart and not trust nurses to perform life saving measures if needed. My analogy for her would be a fast food service worker... Feeding customers garbage.
I am a nursing student and this brings up a question for me about my pregnancy. I was planning on having my baby in a birthing center but ended up at a hospital for failure to progress. The hospital and the birthing center had very different policies. For example, you can eat as much as you want at the birthing center but have to be NPO at the hospital. Can you refuse to be NPO? Instead of telling me to refuse, my midwife just had me eat a meal before leaving the birthing center so I wouldn't get weak and exhausted. I guess if you eat something against medical advice, they can't go in and get it back out:uhoh3:. But medical facilities do have policies for a reason, the health of the client. And it also seems like they would have to "insist" on certain rules due to malpractice lawsuits, etc. So it seams to me you can refuse some things, but others you may "refuse" but will have to accept because of significant medical issues? Is this accurate? I'm just trying to understand.
It is the responsibility of your MD/CNM/nurse to explain the risks and benefits of ANY procedure during your hospital stay, or any hospital policy such as keeping labor patients npo, requiring intermittant fetal monitoring, IVs, etc. You have the right to refuse ANYTHING. You can refuse fetal monitoring, refuse an IV,choose to eat an 8 course meal during labor, but you must also accept the consequences of your choices. If you are told that an IV is necessary for antibiotics to prevent newborn beta-strep infection, but then refuse, you must accept responsibility for your sick child.
I think that people need to remember that we are also nursing and doctoring the legal system. We go through all kinds of hoops in an attempt to plan for every possible "what-if". This leads to lots of unnecessary interventions to CYA. The sad truth is even the people w/ the very rigid birth plans can find a lawyer to claim that they didn't know or didn't realize the consequences of refusing this or that because it was not fully explained to them. I NEVER try to intimidate a patient into an IV or monitoring they do not want. I do explain to them why it is ordered. If they tell me they don't want it, that's okay. I do document their wishes, my explanations, and notify their physician. The leagal system makes pt's and healthcare providers adversaries in many cases rather than partners in a good sensible plan of care. I had the experience of once caring for an antenatal patient who refused to continue her evening monitoring and removed the belts, despite the fact that there were decels which concerned us. Her baby died in utero. Everyone felt awful, like we should have forced her to wear the monitor. I know it was her choice. It didn't make it any easier. That was more than 10 years ago and it still makes me mad to think about it.
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.
your right mitchsmom.. ( in bold and Italic ) that 's a nontheraputic response to pt. as a nurse we have to explain every thing to patient, the advantages and disadvantages of having an IVF.
you can eat as much as you want at the birthing center but have to be NPO at the hospital. Can you refuse to be NPO?
When I did OB, women who had a full meal before labor vomited it back up if about 80% of the time. Plus, if you need a Csection emergently you should be NPO to prevent aspiration pneumonia. A 25% c section rate for laboring moms is pretty conservative, so you can weigh the odds on your own. There are knowledgeable professionals that argue strongly for NPO, and some that advocate eating as mom desires, so no answer is definitely right. Think about your childbirth history, health, how the pregnancy is going so far, and how many women in your family have needed to go to section...in the end it is your decision.
Most anesthesiologists have no problem with clear fluids before scheduled surgery- up to two hours beforehand, but it is not common practice because of noncompliance. Lots of people will put a little milk in their tea, or think that a small snack won't hurt, and surgeries get cancelled. So they make the rule for everyone "NOTHING TO EAT OR DRINK" when in reality it's not that cut and dried.
I found that of the moms that said they were starving, and HAD to eat during labor, they would ask for a huge tray, but be satisfied with half a piece of toast. I was amazed the first few times it happened, but their bodies know what they need. IMO it is better to eat that little bit and be satisfied than to spend hours in labor AND hungry. I wonder how many women ended up in section just because there were so many rules and distractions that they couldn't just relax and labor their way. As a nurse I liked it best when I could get them a little something, and tell them we would see how it went down, then get a little something more. In two years I never had to make that second trip, and none of my moms vomited- maybe I was just lucky.
Pitocin is one of those things that I think stresses moms out too. If they have another hour to make progress or "we'll have to start the Pit" they hardly ever get anywhere in that hour. Half the time they spend fretting about how much it will hurt, and accepting that they need medical help to labor (maybe they just need time). The family starts talking about a section, the mom learns about all the restrictions *if* she needs Pit. No healthy woman could labor effectively under that pressure.
Yes, Pitocin is called for in lots of cases, but in lots of cases it's because someone in the room has a schedule to keep.
I had a woman on Pit stuck at 6 cm for 4 hours (oh my GOD it was awful!). She tried and tried but nothing helped. Then we decided to take a break for 15 minutes, turn the Pit off, take off the moniter, get cleaned up, sit in a rocking chair in another room, etc. She was able to think for the first time in hours, and it was such a relief to her. We started up again after a nice heart to heart and she got a half dose of IV pain meds, and that baby was out within the hour. She said afterwards that knowing she could take a break, that she was in control instead of the machines and meds, that we were all there to support her allowed her to relax. I think for a woman in labor that knowledge is half the battle.
That Bradley instructor is undermining those women before they ever get started. There are a lot of twits in hospitals, but a lot of people that do the best they can for the moms. If the relationship starts out badly we don't have a lot of time to fix it. I think she needs to be reported to the hospital, and to whatever agency she was certified by.
When I did OB, women who had a full meal before labor vomited it back up if about 80% of the time. Plus, if you need a Csection emergently you should be NPO to prevent aspiration pneumonia. A 25% c section rate for laboring moms is pretty conservative, so you can weigh the odds on your own. There are knowledgeable professionals that argue strongly for NPO, and some that advocate eating as mom desires, so no answer is definitely right. Think about your childbirth history, health, how the pregnancy is going so far, and how many women in your family have needed to go to section...in the end it is your decision.
Most anesthesiologists have no problem with clear fluids before scheduled surgery- up to two hours beforehand, but it is not common practice because of noncompliance. Lots of people will put a little milk in their tea, or think that a small snack won't hurt, and surgeries get cancelled. So they make the rule for everyone "NOTHING TO EAT OR DRINK" when in reality it's not that cut and dried.
I found that of the moms that said they were starving, and HAD to eat during labor, they would ask for a huge tray, but be satisfied with half a piece of toast. I was amazed the first few times it happened, but their bodies know what they need. IMO it is better to eat that little bit and be satisfied than to spend hours in labor AND hungry. I wonder how many women ended up in section just because there were so many rules and distractions that they couldn't just relax and labor their way. As a nurse I liked it best when I could get them a little something, and tell them we would see how it went down, then get a little something more. In two years I never had to make that second trip, and none of my moms vomited- maybe I was just lucky.
Pitocin is one of those things that I think stresses moms out too. If they have another hour to make progress or "we'll have to start the Pit" they hardly ever get anywhere in that hour. Half the time they spend fretting about how much it will hurt, and accepting that they need medical help to labor (maybe they just need time). The family starts talking about a section, the mom learns about all the restrictions *if* she needs Pit. No healthy woman could labor effectively under that pressure.
Yes, Pitocin is called for in lots of cases, but in lots of cases it's because someone in the room has a schedule to keep.
I had a woman on Pit stuck at 6 cm for 4 hours (oh my GOD it was awful!). She tried and tried but nothing helped. Then we decided to take a break for 15 minutes, turn the Pit off, take off the moniter, get cleaned up, sit in a rocking chair in another room, etc. She was able to think for the first time in hours, and it was such a relief to her. We started up again after a nice heart to heart and she got a half dose of IV pain meds, and that baby was out within the hour. She said afterwards that knowing she could take a break, that she was in control instead of the machines and meds, that we were all there to support her allowed her to relax. I think for a woman in labor that knowledge is half the battle.
That Bradley instructor is undermining those women before they ever get started. There are a lot of twits in hospitals, but a lot of people that do the best they can for the moms. If the relationship starts out badly we don't have a lot of time to fix it. I think she needs to be reported to the hospital, and to whatever agency she was certified by.
Long rant, thanks for listening.
women whose in labor on NPO? well.... I think a sip of wter should be allowed to boost pt energy, I cant imagine the pains during L&D.wow! its an intractable pain, then we induce labor by giving pitocin:angryfire OOHHH lala thats another dilemma to pt. but ofcourse we have to assist our pt, if the progress of labor is going smoothly or theres a complication arising in it.
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.
) and am always a little nervous when I see a patient is using the Bradley Method or come in with birth plans that are 'absolute'. I have to admit that I don't have much experience or knowledge of the Bradlye Method, but the people that I do know that have used it have been militant. 
she should be more careful with her analogies in the future. I know very few maids that have college education and life saving experience. People may take that to heart and not trust nurses to perform life saving measures if needed. My analogy for her would be a fast food service worker... Feeding customers garbage.
firstyearstudent
853 Posts
Interesting website with some good advice:
http://www.storknet.com/cubbies/childbirth/archive-lowintervention.htm