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.
It's ME having MY BABY--only by necessity am I doing it in YOUR HOSPITAL. The OP doesn't seem to realize that it is not her birth. The experience belongs to the mother, not to the hospital. This is totally a control issue.
And, YES, terminology is extremely important. Mine I called 'rushes of energy' (per Ina Mae Gaskin). It is a hard wave to ride. You can't control it, you have to ride it. Riding the wave of contractions takes plenty of concentration. But nurses who work in L&D who don't really give a **** about birthing mothers, and only really care about controlling the process, won't find it in their hearts to be advocates of a mother's natural labor and delivery. Who cares if I drink Merlot? I ate beef vegetable soup and it was delicious. I needed the calories and the fluid.
My midwife prob. called them contractions, but in my mind they were rushes of energy. What she said didn't bother me, because I knew beyond a shadow of a doubt that she was our advocate. A lot of this is attitude. And statements like 'birth plans are a PIA' tell a lot about attitude.
People know when a nurse is an advocate or an adversary. Certainly birthing mothers do.
If you are truely my advocate, then maybe I will be able to be flexible without feeling like I am being run over roughshod. If my midwife had said it was time to have an IV started or something like that, I would have been totally compliant, albeit worried.
I would have hoped by now that more L&D nurses had a heart for laboring mothers.
I wanted to be a lactation consultant, got certified and everything, but realized that there was no, no, no way that I could stand to be around the hospital birth environment, day in and day out.
I have been following this thread and have chosen not to jump in, but please don't paint such a broad brush regarding L&D nurses. Many of those posting here have never walked in our shoes and have no idea of what we have to go through to do our jobs. There is a whole body of research about the moral dilemmas and moral distress we are subjected to on a regular basis. We have a fair amount of autonomy in our practice, but most of the issues being discussed here are out of our hands.
As someone else stated, measuring pain regularly is a Commission standard for accreditation and in California it is the law. I am bound to ask about pain level as often as I take a blood pressure. Per protocol and doctor's orders that can be from every 4 hours to every hour to every 15 minutes depending on the circumstances and stage of labor. As Smiling Blue Eyes is saying, it can all be about communication. I explain to my patients up front that I have no agenda about pain meds but I am legally obligated to assess their pain. I have to document it and if I document without asking that is falsifying records. There is no evil intention or attitude on my part. I'm not on commission or anything.
Regarding the term contraction, yes it is indeed a standardized medical term. NICHD guidelines state that all medical personnel who work with laboring women need to use certain standardized terms when addressing fetal heart monitoring. Again, I need to document accurately for ethical and legal reasons.
Most of the issues you are blaming L&D nurses' attitudes for are completely out of our control. Doctors have orders. Hospitals have protocols. If I decide to pick and choose which of those I will follow I will find myself without a job and maybe without a license sooner rather than later. Not to say that I blindly follow orders, but if I don't I have to let the MD know why. You don't want internal monitoring? Fine, refuse it and I will be glad to abide by that. However, I have to discuss this with you and not just make my own decision about it.
I work registry and have been to over a dozen hospitals. I try to practice based on evidence and AWHONN guidelines but the MDs and the hospitals can make that difficult. I cannot tell you how many times I am pushing with moms in an upright position and the MD comes in and yells at me to put her head down. Or how many times I "forget" to put in unnecessary internals only to return from another patient's room to see that the charge nurse stepped in to please the doctor.
There are two sides to this story. Give nurses a break. Women need to choose their MDs and their hospitals wisely.
There are two sides to this story. Give nurses a break. Women need to choose their MDs and their hospitals wisely.
Yes, they absolutely do. Preferably before becoming pregnant. Doctors or midwives worth their salt will start having these conversations about childbirth at their facility long before delivery day.
That being said, many women aren't lucky enough to have a lot of options. The hospital she's at may be the only one in a 25-50 mile radius. That's pretty far away if you have to travel on rural roads.
Questions for you L&D nurses: Do most of the docs in your facility have the same mentality/philosophy re: childbirth or are there some variances? The other question is: Is there a way to let the women out there know who's more "natural birth friendly" than others without causing a major rukus?
Those two things would be helpful for women to know if Hospital A is their only option other than an unattended birth.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I would like to see our attitudes in the USA change a bit. Birth is a normal, healthy even in most cases. Sure we need to be prepared for emergencies. But just as important, we need our patients and their loves ones to trust us. So we need to be respectful in our dialogue and communicate when their wishes cannot be honored and why, without coming across as judgemental.
Deb-You are absolutely right. If a lot of these women were told why they were getting something instead of "You have to have xyz or your baby might have a bad outcome . . . . . ", (especially if it's an unlikely and worst-case scenario) they would be a lot easier to work-with. Not every birth is the same. There should not be cookie-cutter treatment for all of them.
There's a big difference between being ready for an emergency and treating every case like it already is one. It would be like me aggresively treating every chemo patient like they're pancytopenic. Or like treating every IV infiltrate like an extravisation. Or every IV fluid spill like a chemo spill and bringing the guys up in their Haz Mat outfits.
Instead, we monitor daily labs to see if the pt's numbers are trending down. Watch the actual patient for S/S of low blood, platelet or white counts. Watch for S/S of infection. I look at what fluid infiltrated. I check the pt's veins and if they're crappy I put in for a PICC consult.
It's like these ladies are being treated like the monitored patient that is restless or complaining that something doesn't feel right, starting to get dusky, a little puffy, or getting rales, but every thing looks okay on the monitor so they must be fine. Meanwhile you look at their ABGs and they come back looking crappy. Look at your patient and treat appropriately!
I heard something a few weeks ago that really bothered me. It wasn't a nurse that said it, but a second-year resident. "Normal lady partsl delivery is a retrospective diagnosis."
If that is what docs are learning in med school, no wonder birth has become what it has become. My personal opinion is that birth should be considered normal until proven otherwise, but it's hard to buck a system. That I do understand.
Your post explains a lot. It sounds like these docs need the "still in school" mentality beaten out of them and the seeing actual patients mentality beaten back in. :chuckle
Your post explains a lot. It sounds like these docs need the "still in school" mentality beaten out of them and the seeing actual patients mentality beaten back in. :chuckle
Don't I know it! Some are better than others....that particular one was/is no gem to be around.
I think you all are very correct in the fact doctors control the "mood" and the attitude of birth. I work with some excellent FP doctors who completely set the tone for the entire experience, not only for mom but also the staff that I work with. It's amazing the difference between a doctor that thinks birth is normal vs. one that is trained under the philosophy that birth is a disease and the only way to rid the disease is to get that baby out.
I heard something a few weeks ago that really bothered me. It wasn't a nurse that said it, but a second-year resident. "Normal lady partsl delivery is a retrospective diagnosis."
If that is what docs are learning in med school, no wonder birth has become what it has become. My personal opinion is that birth should be considered normal until proven otherwise, but it's hard to buck a system. That I do understand.
If you've ever seen the documentary "The Business of Being Born", they interview several OB/GYN residents. When asked how many natural, intervention-free labors they had been involved with, all of the docs just kinda looked around at each other. Of course, their answer was "none." They are taught in med school all of the things that can go "wrong" with a delivery and they don't focus on how natural birth is.....
If you've ever seen the documentary "The Business of Being Born", they interview several OB/GYN residents. When asked how many natural, intervention-free labors they had been involved with, all of the docs just kinda looked around at each other. Of course, their answer was "none." They are taught in med school all of the things that can go "wrong" with a delivery and they don't focus on how natural birth is.....
I watched that film not long ago. I was prepared to be offended, thinking it would be very one-sided. Instead, I found it to be very fairly reported. And no preaching one way or the other about what is "right" or "wrong", more of what do you want to do and here's how we can do it. Interesting that one of the people involved in the film (producer?) became pregnant during the making of it, had no intentions of being part of the film, then wound up with an IUGR baby, premature ROM and a emergency C/section. That too, was handled very fairly, IMHO.
I saw TBOBB a couple months ago...I thought it was very well done. It really did strike me how the med students/residents had not ever seen a natural birth. Very disturbing.
I agree with everyone regarding OBs philosophy of birthing ( our MEDwives are right next to them in that regard ) However, I left work this evening with two patients being induced pre due date as they want to be home before Christmas. I am fairly certain ( will find out tomorrow ) that one of them will end up a section. How cost effective is that ?? A 2 day induction that ends in a section. What on earth are people thinking and why are insurances paying for this nonsense ???? There is a lot to be fixed here, the fault doesn't lie with nurses, that is for sure.
JaneyW
640 Posts
It's ME having MY BABY--only by necessity am I doing it in YOUR HOSPITAL. The OP doesn't seem to realize that it is not her birth. The experience belongs to the mother, not to the hospital. This is totally a control issue.
And, YES, terminology is extremely important. Mine I called 'rushes of energy' (per Ina Mae Gaskin). It is a hard wave to ride. You can't control it, you have to ride it. Riding the wave of contractions takes plenty of concentration. But nurses who work in L&D who don't really give a **** about birthing mothers, and only really care about controlling the process, won't find it in their hearts to be advocates of a mother's natural labor and delivery. Who cares if I drink Merlot? I ate beef vegetable soup and it was delicious. I needed the calories and the fluid.
My midwife prob. called them contractions, but in my mind they were rushes of energy. What she said didn't bother me, because I knew beyond a shadow of a doubt that she was our advocate. A lot of this is attitude. And statements like 'birth plans are a PIA' tell a lot about attitude.
People know when a nurse is an advocate or an adversary. Certainly birthing mothers do.
If you are truely my advocate, then maybe I will be able to be flexible without feeling like I am being run over roughshod. If my midwife had said it was time to have an IV started or something like that, I would have been totally compliant, albeit worried.
I would have hoped by now that more L&D nurses had a heart for laboring mothers.
I wanted to be a lactation consultant, got certified and everything, but realized that there was no, no, no way that I could stand to be around the hospital birth environment, day in and day out.
I have been following this thread and have chosen not to jump in, but please don't paint such a broad brush regarding L&D nurses. Many of those posting here have never walked in our shoes and have no idea of what we have to go through to do our jobs. There is a whole body of research about the moral dilemmas and moral distress we are subjected to on a regular basis. We have a fair amount of autonomy in our practice, but most of the issues being discussed here are out of our hands.
As someone else stated, measuring pain regularly is a Commission standard for accreditation and in California it is the law. I am bound to ask about pain level as often as I take a blood pressure. Per protocol and doctor's orders that can be from every 4 hours to every hour to every 15 minutes depending on the circumstances and stage of labor. As Smiling Blue Eyes is saying, it can all be about communication. I explain to my patients up front that I have no agenda about pain meds but I am legally obligated to assess their pain. I have to document it and if I document without asking that is falsifying records. There is no evil intention or attitude on my part. I'm not on commission or anything.
Regarding the term contraction, yes it is indeed a standardized medical term. NICHD guidelines state that all medical personnel who work with laboring women need to use certain standardized terms when addressing fetal heart monitoring. Again, I need to document accurately for ethical and legal reasons.
Most of the issues you are blaming L&D nurses' attitudes for are completely out of our control. Doctors have orders. Hospitals have protocols. If I decide to pick and choose which of those I will follow I will find myself without a job and maybe without a license sooner rather than later. Not to say that I blindly follow orders, but if I don't I have to let the MD know why. You don't want internal monitoring? Fine, refuse it and I will be glad to abide by that. However, I have to discuss this with you and not just make my own decision about it.
I work registry and have been to over a dozen hospitals. I try to practice based on evidence and AWHONN guidelines but the MDs and the hospitals can make that difficult. I cannot tell you how many times I am pushing with moms in an upright position and the MD comes in and yells at me to put her head down. Or how many times I "forget" to put in unnecessary internals only to return from another patient's room to see that the charge nurse stepped in to please the doctor.
There are two sides to this story. Give nurses a break. Women need to choose their MDs and their hospitals wisely.