Do birth plans grate on your nerves?

Pax_Ramona · Dec 9, 2008

Those aren't "birth plans", those are BIRTH PAINS ! And you can be sure they will be the first to sue if something happens to the baby.:icon_roll

flightnurse2b, LPN · Dec 9, 2008

this is one of the many reasons why i think you L&D nurses are so special. i could never hang.

CEG · Dec 9, 2008

Yes, I'm old and rickety...but, I HATE birth plans!! Especially those that include NO vag exams unless she needs to push (wth), or NO IV access (wth), or NO fetal monitoring (WTH!!) etc.....
It just annoys me to no end that a girl comes in and tries to tell me what is best for her and her unborn baby, and totally interferes with efforts to keep her and her baby safe.
Then there is the sig other that really annoys me by being the patients mouth piece. "No, she doesn't need pain meds", or "No, she doesn't want to lay off of her back".(when having variables down to 60x60...UGGGG!!
These people need to just have their babies at home, and leave my nursing license out of it!!!
Anyone else bothered by birth plans? Maybe it's just me.

I know many other OB nurses hate birth plans but NOTHING you listed there has been shown to improve outcomes. In fact both multiple vag exams and electronic fetal monitoring worsen outcomes.

tntrn, ASN, RN · Dec 9, 2008

I know many other OB nurses hate birth plans but NOTHING you listed there has been shown to improve outcomes. In fact both multiple vag exams and electronic fetal monitoring worsen outcomes.

However, perhaps the mother to be should do some research on what her doctor will order, what the hospital policies are and THEN decide where and how to have her baby. In some cases, nurses' hands are tied. We don't make the policies and we certainly write the orders.

Elvish, BSN, DNP, RN, NP · Dec 10, 2008

I think a lot more people would have their babies at home if home birth were a viable option. My state does not allow CPMs to deliver babies at home legally, and there are two CNMs in the whole state that will. That closes the door for a lot of people, and then they come to the hospital. I don't like the whole dichotomy of hospital-is-the-enemy vs. homebirthers-are-loony.

I have no problem with birth plans except ones that are unreasonable. Like NO c/s under any circumstances....well, that's fine unless you abrupt severely or have a prolapsed cord. If it's reasonable, I'm cool w/ it, and my definition of reasonable is pretty wide.

NurseyBaby'05, BSN, RN · Dec 10, 2008

In some cases, nurses' hands are tied. We don't make the policies and we certainly write the orders.

Another way to look at this is: If the pt. refuses then your hands are . . . . . . (audible gasp) . . . . . . untied!

Of course, this results in longer documentation to CYA instead of pt's just blindly accepting things "because the doctor said so."

A pt's care needs to be individualized. Not everyone needs continuous monitoring. Not everyone needs IV fluids. Not everyone needs to be NPO. (Seriously, how many births wind-up being done under general anesthesia. Even emergency ones. Crash c-section is more likely.) Not everyone needs frequent vag. checks. Not everyone needs membranes ruptured, pitocin started, etc and have the baby out in just a few hours so the doc can get home on time.

Believe me, I'm all for necessary interventions. But not all are necessary all the time. I feel for you though. Society is so litigous today, I understand why it's just easier to treat every birth with every preventative measure, but a dose of common sense needs to be had to temper the fear.

NurseyBaby'05, BSN, RN · Dec 10, 2008

BTW, I think birth plans are a good thing, but that families should not look at them to be instruction lists for doctors and hospital staff. I look them as a tool for parents to realize they do have options and explore what they would want as their ideal.

People roll their eyes and expect that pt's should know these things are done in the hospital. How would they know? Often this is the first time mom is in the hospital. It's easy to forget that laypeople truly have no idea about the procedures we take for granted.

e.g. We thought dh had another kidney stone and off to the ED we went. I told him that they would give him fluids, check his labs, screen his urine and take x-rays. Pretty basic, huh? The poor tech or nurse came at him with a needle and he freaked. He said I never told him he would be getting any needles and that he was leaving. He thought he would be getting the fluids PO. He thought they would just check his urine at the lab. Meanwhile, I'm thinking "Duh, what did you think they were going to do?":lol2:

HeartsOpenWide, RN · Dec 10, 2008

If I have a baby I will accept all necessary interventions, and only because I will only be having my children in a hospital if I have true medical complications, for the very attitude that you listed. If the woman is having a non complicated pregnancy and birth, can remain hydrated, there is no reason she needs to have continuous monitoring, continuous/scheduled vag exams (although yes there are times before pushing that it needs to be done, i.e. after the water breaks), or even an I.V.

"No, she doesn't need pain meds" why does this bother you? If the woman wants pain meds then she can ask for pain meds; especially if a mom makes it clear from the beginning that she wants a natural birth.

"No, she doesn't want to lay off of her back".(when having variables down to 60x60...UGGGG!!

Are you explaining why she needs to get off her back or are you just dictating her to do so. I find that when you give a quick explanation as to why pt are more will to comply.

Like some one else mentioned, every birth is different. Just as every woman is different.

L&DWannabe · Dec 10, 2008

As a nursing student, (future L&D hopefull) and woman who recently gave birth in 2006 and 2008, I understand both sides of this. I can understand how it is difficult to be a nurse, trained and expected to use the hospital's policies and and monitoring- to be asked not to do ANYTHING but be there just in case. However, as new mother myself who has witnessed a new "revolution" of women in childbirth- many who have done very much research and put a lot of thought into natural birth. Many studies show that hospital interventions are not improving birth outcomes- but actually leading to more c-sections and complications. Now, do I believe this is the case in all hospitals and all births, of course not, but I did not preform the research. Childbirth is not like any other field of nursing- the patients are not "sick", most really don't need the IV or fetal monitoring- however- how do you pick and choose the ones that will? The only way to assure quick response in an emergency is to aim on the side of caution. However, many women see their births as more than a medical event, but a rite-of-passage, and want it to be memorable and personable... To say that these women should birth at home is saying that women who want a more natural experience should risk their and their babies lives. Our country's health care system is NOT set up for all types of birth experiences- only one type is supported- and that is a medicated, invasive birth experience. Not all women who prefer a natural birth are ignorant of the fact that there is a possiblility for things to go wrong- so they prefer to be at a hospital, but they quickly find themselves lumped into the "hospital" birth with pitocin, fetal monitoring, epidurals, iv's, limited motion, and overall loss of control over the experience.

I am not putting down our hospital's childbirth centers nor the nurses that oversee these births, I had both of my children in a hospital and my second birth chose to deliver without pain meds, (and induced labor), However, I do feel that these women who are stuck in the middle, wanting good healthcare but not to be hooked up to machines, and drugged- should be respected. There are ways to work with them. That is EXACTLY the reason I am going into OB. I am to work WITH these women, who I believe deserve EXACTLY the birth experience they want within safe limits. I think it's the nurses who turn their noses up to the natural birth mothers that give hospital births such a bad reputation. The times are changing. You will continue to get more and more mothers with birth plans, refusing the majority of procedures- as more research continues to turn out non-eneficial results. Women are taking charge and probably will revolutionalize our OB system within the next 30 years. Just my :twocents:

VICEDRN, BSN, RN · Dec 10, 2008

I am sorry but I find this to be completely offensive!

Birth plans are a nice gimmick that facilities and providers use to lure patients in with touchy feely stories of mother/baby centered birth in a natural environment. Of course, the birth plan is completely irrelevant to providers who promptly proceed to provide care according to benevolent patriarch standards of care (ie what you think is best regardless of what is best). Of course, no one is going to tell these mothers what delivery is really like.

I tried to ask one hospital what their c-section rate is and they wouldn't say. Tours of the facility produce statements about birth balls and quiet music, not 1/3 of you will be on pit drips and 3/4 of you will have sections (here in the ATL there is a hospital with a rate that high!).

I do believe a laboring mother knows best. Honestly, I do and I am the mother of two. I will also swear to you that I will never be your patient. I will never ever in a million years EVER deliver in a hospital! EVER AGAIN! If any newly expecting mothers ask me, I say find a midwife to deliver you in a birth center or at your house. If not, go to the hospital at the last second!

If I labored at home you weren't worrying about the baby's heart rate and you weren't worried about my cervix changing so why now? Why shouldn't I just come in at any twinge? That's the most safe right?

I understand your frustration but that is based on your knowledge and experience and not on the patient's perspective. Another poster has already stated that most laboring mothers don't know that these are required and quite honestly, your license is of no concern of to these families.

I am stunned...

I know you came here to find support and vent...I hope that your frustrations are now vented.

NurseyBaby'05, BSN, RN · Dec 10, 2008

I don't see how someone's license would be at risk if the pt. refused. They have that right. If someone refuses a treatment after she has been informed of the risks/benefits and has verbalized understanding, that's on the patient. Just CYA and document, document, document. Pt's being non-compliant should not be taken personally. Also, if you're going to be sued, you're going to be sued. It wouldn't matter if the pt had every intervention in the book or none. At least by informing your pt and doing the necessary documentation to cover yoruself, you will have a leg to stand on.

Also another poster brought-up a good point. Taking 30 seconds for an explanation of why something should be done goes a long way.

e.g. Instead of "I'm going to start your IV now" . .stab . . . .; "I want to place this IV in case we need to get medicine into you quickly if an emergency develops. It's a lot easier on everyone now than when we are scrambling and things need to be done quickly."