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 was just about to write to you suggesting that you have articles as back-up for your reasoning. Be sure that the reliable source of the article is noted on it, and highlight the salient points, relating them to the appropriate part of your birth plan, so a busy L&D nurse can get the gist of it quickly.
If you have someone who doesn't want to read anything you brought, ask to see the OB Dept. head and discuss the situation with her/him. Of course you will have given your plan to your doctor after discussing it with him/her, and if the Dept. head isn't there or can't resolve the situation "there are none so blind as those who will not see", you can ask your physician to intervene.
Unfortunately most times when a nurse who isn't tuned in to patient empowerment, and her/his resistance becomes a problem, it's on an "after hours" shift (between 5 pm and 8 am). Negative attitudes can cause what could/should be a supportive environment, uncooperative. Remember that you get a different nurse when the shift changes...... Find out if there are 12 or 8 hours shifts at your hospital's L&D, to be forwarned.
Having a "doula" (birth assistant) would give you extra support and make it easier to keep negative elements at bay. Also, when you practise your techniques taught at class, daily with your coach, they will be automatically available for you. That's how it will be apparant that you really don't need any intervention for pain control. Relaxation will help keep your baby's heart tones within normal range, so your nurse won't feel antsy about not having continuous monitoring. Usually an hour on it at admission and changes of shift will reassure everyone.
Try to stay away from adversarial comments that could portray you as a "difficult" patient, and dole out statements of confidence in your nurse when
you feel that's appropriate. (f you do that when it's obviously not happening, the situation just gets worse.)The goal is to have the members of your team working together cooperatively, in a trusting atmosphere. Birth plans are really a method of getting everyone on the same page.
My experience has always been that the more I fear something, the better it turns out to be (especially the delivery of my son).
Whoa there Lamazeteacher - I really resent your comment about "most times when a nurse...isn't tuned into pt. empowerment...becomes a problem, it's on an after hours shift". That sort of steroetyping is inexcusable! I'm one of those night shift nurses who spends most of her time advocating for my patients, fighting with doctors who want to order c/sections for failure to progress (translated as it's 8 p.m. and he/she wants to go home and not be bothered), intervenes when the anesthesia provider wants to get all the epidurals in now, as long as they are already on the unit, so he/she can go to sleep. While I'm doing this, fielding questions from the family, finding bedding for daddy (and tripping over him and various other relatives in a dark room, most of the instructors, birthing teachers, lactation consultants, many of the midwives and all but the occasional doula are home in their beds and "unavailable" during the off hours.
And I'm managing this with less nursing staff and little to none of the ancillary staff that are available on days! Nonetheless, I work my nights specifically so I can spend more personal time with my patients in the small hours when they seem to really need it.
I'm not getting in the middle of this, but I just want to say yet again that because birthing is a 24 hour business, it is even more important that women discuss these things with their MD BEFORE they go into labor. If they do not want continuous monitoring MAKE SURE the MD knows this and hasn't ordered continuous. I have worked nights as well and really enjoyed the more relaxed atmosphere--no MDs hurrying things along. However, a lot of these MDs have standing orders that include continuous monitoring and pit augmentation if progress is not within their parameters.
I am happy when patients bring written and signed orders in with them. Then I know that their needs have been addressed by their MD.
"You really hit a nerve with this one!" quote from Bagladyrn
I really appreciate, and know your patients do also, the efforts you make to give them the best OB care that's possible. I also worked nights in L&D (not for the altruistic reasons you do, I couldn't get off them....). I'd have been happier on a 12 hour shift, but we were still on 8 hour ones - and I taught classes there 4 evenings a week.
That said, I'm risking your ire (in the interest of clarity) by writing that the examples you cited are those of your empowerment and being an advocate for your patients.
Patients need to know that THEIR wishes are acknowledged. Your wishes are that bodies were on furniture instead of the floor in a dark labor room
where you could trip and fall over them. My feeling is that if there are more visitors than furniture in the room, too many visitors are in it, posing a safety hazard. Oh, Security!
Another problem about that is, when too many people who are not in labor are there, the coach is distracted from his/her duties to the laboring woman (watching her intently to see if her arms, legs etc. are tense, and if so,
touching them gently to encourage her to relax; and watching to see if her eyes are on her "focal point" during contractions. Changing her position by putting pillows where they're needed - between contractions).
If the baby has been born, the mom gets to choose who stays, in my opinion, and no more than 2 at a time. If she's in labor, it's obvious that sleeping friends and relatives aren't helping and shouldn't be with her unless they are. That should be in her birthing plan, too. I also suggest that they make a sign to put on their fron door at home, saying "Mom and baby sleeping" - whether they are or not.
I tell my classes that the birth party is theirs, and they should invite only those who they know will be helpful, and no voyeurs. If there's an individual - or several who think they have a right to be there, but mom or dad don't want that, they must inform that person that they will not be welcome (and don't say it's hospital policy). Those names have to be in the birth plan!
Establishing boundaries is essential for good parenting and that can be the first step toward doing that.
Empowerment is going over the birth plan with the parent(s) to be, asking what their doctor said about this point or that, and if they still want each one (without appearing to discourage it). That can be done with the initial assessment, and any diverging from the plan noted in your nsg notes. When that is done at the getgo, in a timely manner they can't say you wouldn't let them do something, later (unless the process of labor becomes complicated, making the goal unreachable). Then note that you explained why it wasn't possible, to the participants. Of course things get so hectic at the time something unanticipated happens, that explanations have to wait.
I always tell students that when the staff look grim, and their bed may be
rolling down the hall, they'll have to wait for answers. Haste can be more necessary sometimes, for their and their baby's well being. That's when trust pays off.
Unempowering a patient occurs when she is told that there is no order for
"no continuous monitoring" and no offer to call the doc about that is made, since it's clearly written in the birth plan. Believe me, after a few 3 am calls to get that order, docs will remember to include it and just may recall which patient they have admitted.
Another thing I teach, is that being in a hospital is like visiting someone else's home; and we all have our own way of running our homes. It's their job to adapt to hospital procedures; and prepare as best they can for deviances that occur when complications ensue.
Childbirth educators are in the business of helping people have a satisfying birth experience while remaining safe. We have no wish to alienate patients from staff or their doctor. Why on earth would we do that? Please invite us to your staff meeting if/when you wish to discuss changes in methods/
approaches in intrapartum or post partum care, so we can all be "on the same page". In return, they can explain some of their pet practices, as very few instructors teach exactly the same as others.
I became a Pediatric Nurse Consultant for disabled children, and saw the aftermath (CP) of some bungled births, especially those wherein c/s was delayed long after the indications for it were very clear. My advocacy for lowering c/s rates did a 180! I feel now, that if 100 "unnecessary" c/s s occur that include one save from CP, I think the 100 that might have been avoided, were worth doing. Now giving epidurals early is something else!
Kudos to those of you who question the anaesthesiologist who runs bargain bulk sales of those. I've been known to teach that anaesthesiologists may not be available to give epidurals if they're in an emergency surgery at night (until one of those surly fellows got me fired when he found out I'd said that). Reality is hard for some to stomach. I sure got a dose of who has the power, at that place.
However a great job was just over the horizon, with Cord Blood Registry.
If the baby has been born, the mom gets to choose who stays, in my opinion, and no more than 2 at a time. If she's in labor, it's obvious that sleeping friends and relatives aren't helping and shouldn't be with her unless they are. That should be in her birthing plan, too. I also suggest that they make a sign to put on their fron door at home, saying "Mom and baby sleeping" - whether they are or not.
I tell my classes that the birth party is theirs, and they should invite only those who they know will be helpful, and no voyeurs. If there's an individual - or several who think they have a right to be there, but mom or dad don't want that, they must inform that person that they will not be welcome (and don't say it's hospital policy). Those names have to be in the birth plan!
.
Also we must have to consider the Fire Codes: When we tell people they have to leave the room, many like to congregate just outside the door. That means there will be bodies everywhere: on the floor, little kids running around. I tell them the Fire Department would have my head if they made an unannounced visit (which is true) and make them go to the waiting room. I don't really care if they don't like it.
I also tell my couple (when I get a window of time with them alone) that if people unless people weren't invited to the conception, they don't get an automatic invite to the birth. And I also tell them that regardless of who is on the Okay side of their birth plan visitor list, that can be changed. And it's the MOM's ultimate call, because it's her body on view.
I have a funny thing to relate about the conception of my next grandchild. My son and his wife had "in vitro" 4 weeks ago, while his father was in town staying with them. I thought it was rude for my ex-husband to be there......
Well, I hope they'll invite me for the birth......
I agree with the "If you weren't there for the conception...." theory (Though one mom pointed out to me that this would in theory eliminate both her and her husband since in was an in vitro conception - and they were at home when it "occurred" - we had a good laugh)
In practice though I've found that many young couples have difficulty confronting the relatives, etc. that seem to feel entitled to witness, especially when they have more important things to concentrate on. I generally let the mom know that if they don't want all these people in there I will get them out and take the "blame" - since I don't have to go home and deal with these people afterwards. On occasion I have had to take the mom into the bathroom "to help her change" in order to get a private moment with her.
My own daughter-in-law was greatly relieved when I told her early in her pregnancy that she didn't need to feel awkward telling me if she didn't want her m-i-l actually witnessing the birth - instead I took the time with her older daughter during the actual birth out in the waiting room.
I agree with the "If you weren't there for the conception...." theory (Though one mom pointed out to me that this would in theory eliminate both her and her husband since in was an in vitro conception - and they were at home when it "occurred" - we had a good laugh)
In practice though I've found that many young couples have difficulty confronting the relatives, etc. that seem to feel entitled to witness, especially when they have more important things to concentrate on. I generally let the mom know that if they don't want all these people in there I will get them out and take the "blame" - since I don't have to go home and deal with these people afterwards. On occasion I have had to take the mom into the bathroom "to help her change" in order to get a private moment with her.
My own daughter-in-law was greatly relieved when I told her early in her pregnancy that she didn't need to feel awkward telling me if she didn't want her m-i-l actually witnessing the birth - instead I took the time with her older daughter during the actual birth out in the waiting room.
I've done the same thing, or gotten the FOB out of the room for a little one on one time.
When my son and DIL have their kids (they're working on it), I will be there, only if invited. They know this already. It just seems like such an intimate moment for them, and I'm not sure I'm entitled or if I really want to be in the room. Outside and waiting, yes, but it will be their call, and mostly hers.
I've done the same thing, or gotten the FOB out of the room for a little one on one time.
When my son and DIL have their kids (they're working on it), I will be there, only if invited. They know this already. It just seems like such an intimate moment for them, and I'm not sure I'm entitled or if I really want to be in the room. Outside and waiting, yes, but it will be their call, and mostly hers.
I actually found it kind of difficult during the times I WAS in the room with my d-i-l to separate the "nurse" from the "mom". I found myself automatically listening to the monitor and watching what was going on with a "professional" eye. That was when I decided it was time to take my older stepgrandaughter shopping (for treats for mama and for the staff!).
I have always found when recieving these patients that compromise will go a long way. I always sit down with them early on and discuss their birth plans with them, I point out the things that may be a problem. in the end I tell them that I respect their wish and that I hope they will respect me in the aspect that I am there to make sure that they have a happy healthy baby and a happy healthy mom and that I may have to do things that disagree with their birth plan but I will do those things only as a last resort. I dont think I have ever had a couple disagree with me and I have actually taken care of a couple of them with their next baby.
I think women should choose an appropriate setting that matches their birth philosophy. It is hard to have a natural birth in a hospital and a lot of this tension gets thrown in the direction of the nurse in the form of a birth plan. It would be nice if women had more birth center options and more midwives being able to practice at home. We are working on a bill for midwives in NC right now.
lamazeteacher
2,170 Posts
Dear "Work in Progress":
I was just about to write to you suggesting that you have articles as back-up for your reasoning. Be sure that the reliable source of the article is noted on it, and highlight the salient points, relating them to the appropriate part of your birth plan, so a busy L&D nurse can get the gist of it quickly.
If you have someone who doesn't want to read anything you brought, ask to see the OB Dept. head and discuss the situation with her/him. Of course you will have given your plan to your doctor after discussing it with him/her, and if the Dept. head isn't there or can't resolve the situation "there are none so blind as those who will not see", you can ask your physician to intervene.
Unfortunately most times when a nurse who isn't tuned in to patient empowerment, and her/his resistance becomes a problem, it's on an "after hours" shift (between 5 pm and 8 am). Negative attitudes can cause what could/should be a supportive environment, uncooperative. Remember that you get a different nurse when the shift changes...... Find out if there are 12 or 8 hours shifts at your hospital's L&D, to be forwarned.
Having a "doula" (birth assistant) would give you extra support and make it easier to keep negative elements at bay. Also, when you practise your techniques taught at class, daily with your coach, they will be automatically available for you. That's how it will be apparant that you really don't need any intervention for pain control. Relaxation will help keep your baby's heart tones within normal range, so your nurse won't feel antsy about not having continuous monitoring. Usually an hour on it at admission and changes of shift will reassure everyone.
Try to stay away from adversarial comments that could portray you as a "difficult" patient, and dole out statements of confidence in your nurse when
you feel that's appropriate. (f you do that when it's obviously not happening, the situation just gets worse.)The goal is to have the members of your team working together cooperatively, in a trusting atmosphere. Birth plans are really a method of getting everyone on the same page.
My experience has always been that the more I fear something, the better it turns out to be (especially the delivery of my son).