Do birth plans grate on your nerves?

tntrn, ASN, 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.
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I think it's that we have to justify doing our jobs: when we have to document, document, document, and even then in a lawsuit, the patient or family will say they were never told that, they didn't understand that, they don't believe that, or whatever, it's frustrating. Ever been in a deposition? I have. Twice. One involved a woman who was having fetal distress, and at first refused a c/s. Then when she finally agreed, we had to call in another surgical team, as the first one was in a case (not so when she was first told about it). Then she insisted on an epidural, which caused yet another delay.
This was at least 25-28 years ago, and in that hospital, we did NO epidurals, ever. And all c/s (a 10% rate) were done under general. She herself caused at least two of the delays; then her kid is born with cp and she tries to pin it on us not having a second team in the house. Who knows if this kid was damaged before she ever came in, if there was meconium aspiration, or during the time she refused the c/s, or when she insisted on an epidural.
I know that case was documented in a big way: we all smelled it coming. I'm also sure they settled out of court, which is a crying shame, because honestly we did all we could to get her a section ASAP.
That's why we're frustated.

NurseyBaby'05, BSN, RN · Dec 10, 2008

I feel you. Some people are unreasonable no matter what. I think the lawsuit would have been coming regardless from the particular pt you were describing. I hate to say this but many times people see a lifetime of major expenses and go for the money any way that they can. At the same time, they absolutely do have the right to refuse.

There's a criminal court case in these parts right now against an unlicensed midwife at a home birth. The babe was known to be breech and despite s/s fetal distress the pt and her hubby refused tx to the hospital. These parents said even now knowing the outcome, they would not have done one thing differently. The local medical examiner still had the DA file charges against the midwife. Pesonally, I think they should have been filed against the parents too. It's just an ugly situation all around.

https://allnurses.com/forums/f195/trial-midwife-begins-335664.html

CEG · Dec 10, 2008

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.

Often that is simply not possible- insurance restricts many women in their choice of provider and location. Doctors often tell patients what they want to hear in terms of policies/delivery. Hospital tours and birth classes are much the same. In my short career I have had many patients experience this. The woman arrives in labor only to be told that this and that are "required"-- when did patients lose the ability to make health care decisions?

If OB care was evidence based instead of convenience and self-defense based this wouldn't be an issue.

Unfortunately those who file lawsuits frivolously have had a hand in ruining this for everyone but the medical establishment is certainly not without fault.

cradlecrewer · 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.

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.

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It bothers me because I don't think that a woman SCREAMING in pain should have to ask her boyfriend if it's okay to take something, and he doesn't allow it because it isn't in her "birth plan".

And, yes..I explain everything to my patients in a very professional manner.

PinkNBlue, BSN, RN · Dec 10, 2008

We had a patient recently who did not want her baby to be bathed while in the hospital... at all. Bleh! Apparently it's a new 'thing' now. Gross.

Some birth plans are a pain, others are just their desires written down. If possible, they'd like it done... if not, that's ok too. 99% of the birth plans that are demanding and want to go au natural end up having the most medications and needing a section. Crazy.

FireStarterRN, BSN, RN · Dec 10, 2008

Boy oh boy, don't get me started on this subject. Grrrrr, the original post really gets my blood boiling. Grrrrr :madface: :devil: :banghead: :angryfire

josephine12 · Dec 10, 2008

As a licensed midwife, and a student nurse (going back to school so I can support my family), I have a couple things to add.

Something to keep in mind is that when I see those really extreme birth plans--not all birth plans, just the ones that really tend to freak providers out because they are unreasonable--it often points to some abuse or trauma in the woman's history, disclosed or not, that is making her really scared of losing control of her body. It is very possible that she will need more time and communication about what is happening. You may or may not have that time for her (There should be a billing code for this!). THat's one thing about being a midwife--we have a lot of time to talk!

Having just embarked on this nursing school journey, I don't know how much training nurses get in this area or whether it's reinforced in the field. "When Survivors Give Birth" by Simkin and Ancheta is a great reference.

touchhealth · Dec 10, 2008

We had a patient recently who did not want her baby to be bathed while in the hospital... at all. Bleh! Apparently it's a new 'thing' now. Gross.

That's definately not a new "thing" ...my mom had me at home 28 years ago, and the natural birth mamas back then would rub the vernix into the newborns skin for it's moisturizing and antimicrobial effects. Maybe it's new in the hospital, but for homebirthing that's real normal and has been for years.

My mother had me, my little sister and little brother all at home. Additionally, my boyfriend was born as home and his sister too. All I can say is once I witnessed a HEALTHY, no-complication homebirth it just couldn't compare to the hospital births I saw. I'm not suprised that natural births in a hospital setting don't pan out...because it's in such an un-natural setting!

I definately support hospital interventions when needed, and wish there was more dialog and cooperation between hospitals and people who want to birth naturally either in the hospital or at home. But personally, the way things are now, I plan on avoiding the hospital as long as my labor is without complications. ESPECIALLY because there is the risk of having a nurse be disrespectful about my choices. For those who do attempt a natural birth in a hospital setting, I hope it is someplace where birthplans are honored, rather than condemned.

SheaOBRN · Dec 10, 2008

L & D'er here.......no, none of our interventions are helping bring about better outcomes, absolutely they lead to more c-sections....but what are we to do????? Are you telling me that when this child is not what they expected the parents won't sue the hospital, doctors, and nurses? And you can bet that the doctors will turn on the nurses for blame......I am all for natural birth, women were made to birth babies, but I am sick of being made out to be the enemy! I am not! I ask everybody if they have preferences for their labor and delivery, even without a birth plan....just be flexible, we all want a healthy mom and baby!

And to L&Dwannabe.....I hope you find a unit that you can be at the bedside for support. But realistically, you will most likely have at least 1 other pt to work with too and charting out the wazoo that will pull you away from the bedside-thats just how it is when it comes to staffing and budgets.....it isn't about good patient care.

HappyNurse2005, RN · Dec 10, 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.

What a poor attitude. This isn't just a medical procedure they are undergoing, this is the birth of their child! A life changing all important day. Who can blame them for wanting it to go a certain way?

Besides the fact that BIRTH IS NORMAL and none of what you listed is that extreme. Why do we need lady partsl exams? If she doesn't have an epidural, you'll be able to watch her and see she's making progress by how she's acting. She'll know when she needs to push. I've had deliveries where they were never checked to be "told" they were 10cm and it was time to push. THey just knew it was time, started pushing, and baby came out.

Yes, sometimes a lady partsl exam is needed, maybe to rule out a prolapsed cord, but most people would understand and relent in that situation.

No IV? Again, birth is not a medical procedure and in an emergency, we could get one.

NO monitoring? Again, anything more than intermittant Doppler-ing of the heart rate is not proven to be beneficial, it only serves to increase the csection (and lawsuit) rate.

THink about it this way, too, if you are worried about yourself-its less charting! Less columns to do if she's not on the monitor continuously. No worries about if the IV bag is running dry, no need to cath her, no need to unplug her for her to go to the bathroom.

Why should she be worried about our policies? She is paying teh doctor and paying for the hospital-she is the consumer, and should be able to do it how she wants to, within reason. (IE-you cant have your baby at the nurses station). If everything is normal, then we should be doing everything we can to make her birth what she wants it to be.

I love birth plans.

HappyNurse2005, RN · Dec 10, 2008

L & D'er here.......no, none of our interventions are helping bring about better outcomes, absolutely they lead to more c-sections....but what are we to do????? Are you telling me that when this child is not what they expected the parents won't sue the hospital, doctors, and nurses? And you can bet that the doctors will turn on the nurses for blame......I am all for natural birth, women were made to birth babies, but I am sick of being made out to be the enemy! I am not! I ask everybody if they have preferences for their labor and delivery, even without a birth plan....just be flexible, we all want a healthy mom and baby!
And to L&Dwannabe.....I hope you find a unit that you can be at the bedside for support. But realistically, you will most likely have at least 1 other pt to work with too and charting out the wazoo that will pull you away from the bedside-thats just how it is when it comes to staffing and budgets.....it isn't about good patient care.

So the patients should be flexible-well, we shoudl too. If you chart appropriately, then, you should be covered no matter what. If you act appropriately, then, great! Chart what is done and what is said.

I was just discussing this with a physician. Reasonable people, like myself, would realize that if a baby came out "less than perfect" because of a choice I made, (say, if I chose to lady partslly birth a 11 pound baby and get a shoulder dystocia and Erb's palsy) that it was my choice and I wouldn't be sue happy!

PinkNBlue, BSN, RN · Dec 10, 2008

That's definately not a new "thing" ...my mom had me at home 28 years ago, and the natural birth mamas back then would rub the vernix into the newborns skin for it's moisturizing and antimicrobial effects. Maybe it's new in the hospital, but for homebirthing that's real normal and has been for years.

I work in a hospital so for my hospital, yes, it is a new thing. :)