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.
Some of what they don't want done, is also stuff that is mandated in some way by hospital policy or JCAHO. And if you don't make those people happy, well, let's just say, stuff trickles downhill and your job can be in jeopardy.
Some of what they don't want done, is also stuff that is mandated in some way by hospital policy or JCAHO. And if you don't make those people happy, well, let's just say, stuff trickles downhill and your job can be in jeopardy.
Such as what? An IV? Continuous monitoring? Asking about pain?
You can't force an intervention on anyone, "hospital policy" or not. If a patient says "No," then that's it, end of story. The patient's autonomy overrides hospital policy. Period.
And we should be making "those people" happy...they are our customers, they are employing us. We aren't some super power graciously gifting them a baby. They'll have it with or without us.
When it comes to birth plans that don't allow the staff to effectively monitor the patient, I think that some hospitals should have a pre-admit consultation that "If you give birth to the baby here, this is what we can entertain, this is what we cannot."
If they don't want anyone to monitor them, then they need to have the baby at home.
Such as what? An IV? Continuous monitoring? Asking about pain?
You can't force an intervention on anyone, "hospital policy" or not. If a patient says "No," then that's it, end of story. The patient's autonomy overrides hospital policy. Period.
And we should be making "those people" happy...they are our customers, they are employing us. We aren't some super power graciously gifting them a baby. They'll have it with or without us.
Well, I can think of a couple: IV access and epidural in place for VBAC.
If the patient says no, and the unthinkable happens, you know what comes next. Lawsuit. I want no part of any more of those. So the patients need to be way more informed than they are. And maybe they should shop around more, to find a place that might accommodate their needs.
If they want a home birth atmosphere, well, most hospitals are not the place to be. Not that I don't enjoy a good, old-fashioned non-medicated birth when it rarely presents itself, but the staff is between a rock and a hard place.
Such as what? An IV? Continuous monitoring? Asking about pain?
You can't force an intervention on anyone, "hospital policy" or not. If a patient says "No," then that's it, end of story. The patient's autonomy overrides hospital policy. Period.
And we should be making "those people" happy...they are our customers, they are employing us. We aren't some super power graciously gifting them a baby. They'll have it with or without us.
By "those people" I meant the hospital policy makers and JCAHO. I wish JCAHO would just disappear. Nothing good seems to happen as a result of their directives. They make my job much more difficult and sometimes I feel like they want me to be a robot.
When it comes to birth plans that don't allow the staff to effectively monitor the patient, I think that some hospitals should have a pre-admit consultation that "If you give birth to the baby here, this is what we can entertain, this is what we cannot."
If they don't want anyone to monitor them, then they need to have the baby at home.
That sounds an awful lot like a power-trip to me. Do you know the statistics regarding continuous fetal monitoring? When EFM first became a "standard" everyone thought it would decrease bad outcomes. Statistics show it hasn't. All it has done is led to a ridiculously high c/s rate.
There are plenty of reasons that a woman would choose to have her baby in a hospital, even though she doesn't want monitoring. Who are we to tell her she should have her baby at home? AWHONN has guidelines for a reason. Look them up. They certainly don't mandate continuous EFM.
This is HER birth experience...NOT OURS. We are there to assist her, and to intervene IF problems arise (statistically low probability). She does not need us to turn her birth into a freak show.
Well, I can think of a couple: IV access and epidural in place for VBAC.
If the patient says no, and the unthinkable happens, you know what comes next. Lawsuit. I want no part of any more of those. So the patients need to be way more informed than they are. And maybe they should shop around more, to find a place that might accommodate their needs.
If they want a home birth atmosphere, well, most hospitals are not the place to be. Not that I don't enjoy a good, old-fashioned non-medicated birth when it rarely presents itself, but the staff is between a rock and a hard place.
Having an IV for a VBAC isn't unreasonable, but it certainly isn't necessary. The risk of uterine rupture is 0.5 to 0.7%---lower than many risks in a c/s that are glossed over in the informed consent process. I disagree with the epidural, however.
If a patient expresses their wishes, and you document those wishes and that you've educated the patient regarding risks, then you are not at risk of a lawsuit.
Many patients are well-informed, and from my experience, those are the ones who get under the skin of most RNs. "How dare she come in here and pretend to know as much as me...I'm the expert, I know what's best for her." I see it day in and day out.
By "those people" I meant the hospital policy makers and JCAHO. I wish JCAHO would just disappear. Nothing good seems to happen as a result of their directives. They make my job much more difficult and sometimes I feel like they want me to be a robot.
Sorry...I read it as the patient, not JCAHO. Yeah...they do need to go away...far away.
Having an IV for a VBAC isn't unreasonable, but it certainly isn't necessary. The risk of uterine rupture is 0.5 to 0.7%---lower than many risks in a c/s that are glossed over in the informed consent process. I disagree with the epidural, however.
If a patient expresses their wishes, and you document those wishes and that you've educated the patient regarding risks, then you are not at risk of a lawsuit.
Many patients are well-informed, and from my experience, those are the ones who get under the skin of most RNs. "How dare she come in here and pretend to know as much as me...I'm the expert, I know what's best for her." I see it day in and day out.
At our facility, we have a 30 minute from decision to incision policy, and it needs to be even less than that if it's a crash. If you don't have an epidural in, you lose valuable time. That's part of the thinking for the policy anyway. My personal belief is that if it's a crash, put the patient under and get that kid out!
Even with all the documentation in the world, there can still be a lawsuit. And if you've ever been deposed, you know that they will pick it apart with a fine toothed tweezers. The patient can always say: I didn't really understand that, and there you go.
I will have to say that most of our patients, even the "informed" ones, are reasonable and when our policies are explained to them, they remain reasonable. I will let them know that I will try to accommodate as much as possible, but if any of those requests get in the way of a real emergency, then it's a new ball game. They are genuinely okay with that. Part of that, and a lot actually, is due to the Childbirth Class instructors, who are also employees of our facility and know the drill, policies, stats and all that. So most of our patients are not only well-informed, but are informed about what the norm is at this hospital.
Often, I find the visitors and OTHER family members are the ones who think they know it all...and that they should get to call the shots.
at our facility, we have a 30 minute from decision to incision policy, and it needs to be even less than that if it's a crash. if you don't have an epidural in, you lose valuable time. that's part of the thinking for the policy anyway. my personal belief is that if it's a crash, put the patient under and get that kid out!
even with all the documentation in the world, there can still be a lawsuit. and if you've ever been deposed, you know that they will pick it apart with a fine toothed tweezers. the patient can always say: i didn't really understand that, and there you go.
i will have to say that most of our patients, even the "informed" ones, are reasonable and when our policies are explained to them, they remain reasonable. i will let them know that i will try to accommodate as much as possible, but if any of those requests get in the way of a real emergency, then it's a new ball game. they are genuinely okay with that. part of that, and a lot actually, is due to the childbirth class instructors, who are also employees of our facility and know the drill, policies, stats and all that. so most of our patients are not only well-informed, but are informed about what the norm is at this hospital.
often, i find the visitors and other family members are the ones who think they know it all...and that they should get to call the shots.
do you suggest that patients be made to get epidurals against their wishes. there's a lawsuit waiting to happen. in all actuality, not having an epidural in a vbac is a plus...the patient is more likely to feel the pain of a rupture (not that a rupture is likely to happen anyway.)
in my facility, we can go from decision to incision in under 10 minutes for a stat c/s (i've seen 6 minutes to incision, with baby out at 7 minutes.) just last weekend we had a woman come into triage abrupting, with heart tones in the 60s as soon as she was put on the monitor at 6:55 am. no iv, no consent, no nothing. baby was out at 7:08 am. that 13 minutes included interventions to ensure that it was accurate fetal heart tones and attempts at intrauterine resuscitation.
so essentially, they are taught how to be good, compliant patients. they've been schooled on the expectations that are placed on them.
we had a lady with one of these and boy was she loco...Did not want an epidural but then begged for one at 5 cm. Later, claimed we forced her to have one (yeah, we bent you over the bed with restaints and made you).
Then, she wanted to get on her hands and knees to push, the nurse tried but for some reason her legs wouldn't stay up and kept sliding down the bed. She blames this nurse for her having to have a (gasp!) C-S for her 9lb 5oz baby with a 14 1/2 in head!
She told the L and D nurse, " if only you had let me get onto my hands and knees I would've had the baby naturally"...she had been pushing for over two hours.
Maybe she would have...maybe not. But the bottom line is she'll never know. Because someone didn't want to accomodate her wishes, she's filled with "What if..." Think about how differently the scenario could have played out if the nurse had helped her to push on hands & knees. She might have delivered lady partslly. She might not have, but she at least would have known that she tried & it didn't work. She'd feel better about an outcome that was 180 degrees from her desired outcome. Heck, she might even praise her nurse, saying "Thank you for helping me. I know you tried your hardest to help me deliver lady partslly."
In my professional opinion...if her legs were so uncontrollable, then she had way too much epidural on board. I'm sure her 2+ hours of pushing weren't effective. Why didn't someone turn off her epidural and let her labor down so that she could feel to push. Then she definitely could have gotten into hands & knees, and her odds of a successful lady partsl delivery would have been increased.
What ever happened to nurses ADVOCATING for their patients to help them with their wishes? If you had a dying patient with a living will, would you not honor their wishes? Would you not advocate for them if the docs wanted to go against their wishes? Why is it so different for a laboring mom? I'm convinced it's all about power.
Do you suggest that patients be made to get epidurals against their wishes. THERE'S a lawsuit waiting to happen. In all actuality, not having an epidural in a VBAC is a plus...the patient is more likely to feel the pain of a rupture (not that a rupture is likely to happen anyway.)
In my facility, we can go from decision to incision in under 10 minutes for a stat c/s (I've seen 6 minutes to incision, with baby out at 7 minutes.) Just last weekend we had a woman come into triage abrupting, with heart tones in the 60s as soon as she was put on the monitor at 6:55 am. No IV, no consent, no NOTHING. Baby was out at 7:08 am. That 13 minutes included interventions to ensure that it was accurate fetal heart tones and attempts at intrauterine resuscitation.
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No I don't personally advocate they be forced to have an epidural. But if they want even try to have a VBAC in our facility, and I think maybe there's only one doc who will agree to it, that's part of the deal. And now that I'm thinking about it, that doc recently had a really horrible time getting a VBAC baby out alive, and I believe he said he won't do them anymore either.
Ten minutes is great! If you have the doc in the house, if you have anesthesia that's not already doing another case, if you have staff to do all that must be done. We've had those kind too, but all the cards were already in place, we didn't have to find the deck and then shuffle.
tntrn, ASN, RN
1,340 Posts
Some of what they don't want done, is also stuff that is mandated in some way by hospital policy or JCAHO. And if you don't make those people happy, well, let's just say, stuff trickles downhill and your job can be in jeopardy.