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.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Oh you are so right; it's two-way. I know OB patients have parked themselves outside dr offices, crying and hysterical because they are so uncomfortable and "want it over with". There is pressure on OBs to please people, and they often cave. I wish had a buck for every "social" induction we have done. NOW they are being termed as "maternal discomfort", however, to keep the diagnosis/justfication "medical". IT most certainly goes both ways. The fast-food menu approach patients demand does not help a bit!!!
Oh you are so right; it's two-way. I know OB patients have parked themselves outside dr offices, crying and hysterical because they are so uncomfortable and "want it over with". There is pressure on OBs to please people, and they often cave. I wish had a buck for every "social" induction we have done. NOW they are being termed as "maternal discomfort", however, to keep the diagnosis/justfication "medical". IT most certainly goes both ways. The fast-food menu approach patients demand does not help a bit!!!
Agreed. It's sooooooo tempting to go this route knowing it wouldn't be to hard to get it done. (Especially because nurses have the reputation of being difficult patients. ) This baby girl has been alternating between sciatic nerves for . . . . . oh . . . . . about twelve weeks now. I have about five more to go. Then I remember I would have to recover from surgery (more than likely) with an infant and a 21 month old and that idea goes quickly out the window. Kind of like when I think of how much ds would love a dog and want to see the look on his face. Then I wake-up back to reality. :chuckle
There are so many factors against women delivering naturally. I can believe that many residents have never seen a natural birth. Most women don't know anyone who has delivered naturally. A lot of them (women/nurses/newer doctors) don't realize that it is an option. :stone I think people don't realize that unnecessary surgery, pitocin to the eyeballs, being stuck in bed and a needle in the spine isn't an ideal outcome.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
First of all, most of labor really is COPEABLE and the hard labor is usually relatively short, in comparison to prodromal and early labor. It's a good thing to have at your disposal relaxation skills for so many reasons. Therefore, early-on, I teach in my birthing classes that relaxation and visual imagery are LIFE SKILLS. You can use them to manage labor and also rush hour traffic, or when your toddler writes on your wall with a permanent marker. I used labor breathing just the other day when bad stomach cramps hit me on the way home from work, and there was no way to stop to hit a bathroom. It WORKED like a charm!!!!
I also teach they should use such "tools" as relaxation and visual imagery first early in labor to cope. I teach a lot of tools to help distract and relax in labor. I also teach them the narcotics and anesthesia will not be nearly as effective, if they elect to use them, if they can't learn to relax and breathe first and foremost. It 's about an attitude. I tell women they are not only capable, but MADE to do this. And I teach their partners how to keep them focused and calm when they feel their ability to cope slipping.
I love to participate in natural birth. It's hard to come by in my hospital anymore. Most come to my classes and to the hospital wanting an epidural at the first hard contraction. It's hard to turn the tide, esp. when the OBs are pushing so hard for the epidural option long before they even go into labor (during prenatal office visits) . Sometimes, it's a real uphill battle. And staffing makes it such that bedside, involved coaching and support is all but a luxury for us nurses. Paperwork and machines are what we are stuck nursing, not our patients. This frustrates me to no end. I tell all my clients, bring in support and consider a doula (I have names of those I KNOW are trustworthy and work well with staff as well as their clients). Forget filling up your room with spectators, you need SUPPORTERs really.
Studies bear out, the more supported a laboring mom is, the more likely she will have fewer interventions during labor. I can attest to this, having seen it with my own eyes in 11 1/2 years as an OB nurse. It's so very sad; I see newer nurses who have no real idea how to support a naturally laboring mom, and the rest of us have all but lost the skill to do so. A real shame.
It's so very sad; I see newer nurses who have no real idea how to support a naturally laboring mom, and the rest of us have all but lost the skill to do so. A real shame.
This is so true. My nurse was "ok" but definitely offered no emotional support or useful advice. When I was in transition, she just laughed at my breathing sounds saying "Well, that's a first!" (Of course it was, she said I was the first drug-free birth she had ever done- I think she had 5 years experience!)
Thank you SmilingBlueyes !!!!!! You said it better than I could. Our current practice is epidural at FT or 1 cm. BEFORE labor even begins !!!!!!!!! So they are "comfortable" for the induction and ultimate "stretching" during vag exams. Forget tolerating labor, most of our patients are not tolerating PREGNANCY !!!!!!! And I am not talking sciatica or other major pain here, just the NORMAL feelings of being pregnant. I do feel sorry for the RARE woman who actually can do a labor with no drugs. I say again, my advice would be #1. Pick your care provider carefully ( but then again, most will tell you what you want to hear ). # 2 STAY HOME IN LABOR at least until active labor. Funny, on my days off a primip came in at 8cm. and delivered an hour later..........it is the talk of the floor, no one can beleive it. A primip with NO epidural !! We all had to go in and talk to her......she was a celebrity !!!!!!!!!!!!
You guys have a point. The average patient really couldn't care less about this debate and some would probably prefer to hire someone else to carry their child and give birth.
I honestly don't know if the average patient could care less. I have met far more women who do care than don't. I am talking more on the mommy side of my life than the nursing side of my life.
In terms of the epidural stuff, I think most women go into delivery with an open mind towards pain management but easily get persuaded by the stuff another poster mentioned: threats that they won't be available in a few hours, threats it might be "too late" later on, etc.
In terms of education, I will stick with my dark pessimistic view of patient education in this regard: interventions don't sell. An OB/midwife who tells a patient the true picture of a hospital delivery will have patients running to another practice. The emphasis I have seen from those offices and on the tours of facilities is all of the touchy feely stuff: CD players, tubs (that you can't deliver in but who is going to tell you that!), birth balls, rocking chairs, choices of lighting, equipment hidden by doors, etc. The implication is that there won't be any interventions, after all, isn't that why its all hidden behind pretty cabinetry?
One of the tours I went on, the tour guide said patients were free to walk the halls. There were 65 L&D rooms, only one was empty. There wasn't a single person walking the halls. I think a mother has to have some saavy and some critical thinking to really cut through the "sell" doctors/midwives and facilities give their patients.
This is so true. My nurse was "ok" but definitely offered no emotional support or useful advice. When I was in transition, she just laughed at my breathing sounds saying "Well, that's a first!" (Of course it was, she said I was the first drug-free birth she had ever done- I think she had 5 years experience!)
Good point. We had a new nurse at our facility several years ago, who actually told us old broads that we were probably "afraid" of intervention" and that's why we kind of turned up our noses at all the epidurals! She got at least one earful from me, of course, but from other oldsters as well.
I told her if she had the chance or will to actually watch and learn from a natural birth and the old nurses who knew how to manage them, she'd probably find that the interventions weren't necessary.
Good point. We had a new nurse at our facility several years ago, who actually told us old broads that we were probably "afraid" of intervention" and that's why we kind of turned up our noses at all the epidurals! She got at least one earful from me, of course, but from other oldsters as well.
I told her if she had the chance or will to actually watch and learn from a natural birth and the old nurses who knew how to manage them, she'd probably find that the interventions weren't necessary.
That is so true . . . . .there is one woman here locally with 3 little girls and I was her nurse for two and it was a picture perfect delivery. Even the doc said "if only all deliveries were like this".
To be honest here, the interventions is one reason I've left L&D. Yesterday I saw one of the docs at the hospital and he said "when are you coming back???" and I said "never".
Unnecessary interventions are why I am counting the days til I leave and I won't look back !!! I just hope to get out of there before I see another inverted uterus resulting in a hysterectomy on a 22 year old woman ( cord traction ) or another woman nearly bleed out from a nick of an artery during a c-section ( some have hysters, some don't ) If I never saw another case of pit to distress, do you think I will miss it ?? Tetanic contractions leading to prolonged bradycardia and an OR trip cause Mom wanted to be induced cause "she couldn't sleep". The only catastrophe waiting for me I haven't seen is a ruptured uterus with loss of babe and Mom.......I hope to escape it before retirement. These are reasons we are terrified.......we are EDUCATED women who are paid to be aware and alert for comlications. Contrary to what patients and some doctors think, we ARE more than the medical waitresses we have been reduced to. Too bad nurses are basically powerless in the system or things really would be different and better for the patients, but we are truly the last people anyone listens to...........patients or management included.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Unnecessary interventions are why I am counting the days til I leave and I won't look back !!! I just hope to get out of there before I see another inverted uterus resulting in a hysterectomy on a 22 year old woman ( cord traction ) or another woman nearly bleed out from a nick of an artery during a c-section ( some have hysters, some don't ) If I never saw another case of pit to distress, do you think I will miss it ?? Tetanic contractions leading to prolonged bradycardia and an OR trip cause Mom wanted to be induced cause "she couldn't sleep". The only catastrophe waiting for me I haven't seen is a ruptured uterus with loss of babe and Mom.......I hope to escape it before retirement. These are reasons we are terrified.......we are EDUCATED women who are paid to be aware and alert for comlications. Contrary to what patients and some doctors think, we ARE more than the medical waitresses we have been reduced to. Too bad nurses are basically powerless in the system or things really would be different and better for the patients, but we are truly the last people anyone listens to...........patients or management included.
OMG your doctors and unit sound positively dangerous. I can't blame you for leaving. I am fortunate to work with nurses who have in excess of 30 years' experience each and yet still are interested in evidence-based nursing care and keeping up to date on latest information and standards in OB nursing care. Our doctors are also very careful , for example, never to place excessive traction on cords to "hurry the placenta" along, or push us to pit to distress, etc. Episiotomy is only performed as a last resort, such things like this. Are we even close to perfect? NO, I am frustrated at their push for epidural anesthesia, for example. And a lot of us nurses are losing the skill to deliver comprehensive care for naturally-laboring moms.
This is partly the reason I went into CB education. A lot of our patients were not going to classes cause they were being taught on the other side of town at another hospital most of the time, and they felt they were not relevant to them. I teach at our hospital, TO our policies and procedures and their doctors' routines and style of delivering care. It helps so much. They feel "ownership" and belonging now. And I always teach them to ask a few questions:
"what is the purpose of this intervention?"
"what are the risks versus benefits?"
"what can I expect next if this fails?"
I teach them they are active participants in their health care, not passive lumps who should let things "happen to" them cause the doctors know best. My coworkers say there is a definite difference among the clients attending class, and their comments are positive. What's more, our dr's are really encouraging their patients to all attend class, even if this is not their first baby, if it's been a while or they gave birth elsewhere. Education, ownership, and self-assertion are priceless IMO. Not everyone is receptive or willing, but it's my job to try and encourage them to be. I owe them no less.
Our midwives require that you attend the birth classes they offer if you want to deliver at the birth center.....if you don't attend they will only deliver you at the hospital.
) This baby girl has been alternating between sciatic nerves for . . . . . oh . . . . . about twelve weeks now. I have about five more to go. Then I remember I would have to recover from surgery (more than likely) with an infant and a 21 month old and that idea goes quickly out the window. Kind of like when I think of how much ds would love a dog and want to see the look on his face. Then I wake-up back to reality. :chuckle
SmilingBluEyes
20,964 Posts
Oh you are so right; it's two-way. I know OB patients have parked themselves outside dr offices, crying and hysterical because they are so uncomfortable and "want it over with". There is pressure on OBs to please people, and they often cave. I wish had a buck for every "social" induction we have done. NOW they are being termed as "maternal discomfort", however, to keep the diagnosis/justfication "medical". IT most certainly goes both ways. The fast-food menu approach patients demand does not help a bit!!!