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.
Boy oh boy, don't get me started on this subject. Grrrrr, the original post really gets my blood boiling. Grrrrr :angryfire
Hi...I would be the original poster.
I guess I just don't understand why fellow nurses would have a problem with this post, especially those who work L&D.
I have worked in this area for 23 yrs. I have seen my share of bad outcomes. My job is to get a healthy newborn (and Mom) out of the deal, not a dead one, or one that is disabled for it's entire life.
I know my job and I do it well. Maybe if I put it into this perspective those who don't work L&D would see my point.
How about someone coming into the ER with chest pain,sob,pain in L arm, that has an "MI plan"? Or maybe someone coming in unable to speak, drooping on one side of their face, and unable to communicate but has their "CVA plan"? Or, a parent with a sick child that has their "menengitis plan". It's rediculous. My view is...if you come to the hospital for any reason you should expect the experts to take care of you doing what they know to do. Otherwise, stay home!
In a perfect world, if people come to this post and passionately disagree, they would say 'I understand your point and your frustrations. On the contrary, I like birth plans because XYZ' rather than getting "enraged" at the OP'ers opinion. Others are less apt to listen to your point of view when you're rebutting everything they've said. Thank goodness everyone has their own opinions. It takes all kinds of people. This is certainly no reason to get your blood boiling.
In an ideal world, L&D nurses would not cop attitudes with vulnerable laboring women who desire the security of the hospital setting, but still wish to have control over their own bodies and exert their rights and patients.
Unfortunately, in the world of L&D, we fall very short in meeting that ideal.
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!
I would venture to say that many people are not reasonable, especially when it comes to a bad pregnancy outcome.
I am aware of a case in which a couple presented to a new OB for prenatal care with their second child. The first baby had been delivered by C-section less than a year prior. The OB discussed with the couple from the first prenatal visit the increased risk of complications of labor (uterine rupture) due to the brief interval between pregnancies and the importance of considering and being prepared for a C-section if needed. The OB requested records from the first pregnancy, which the couple never produced.
The issue was re-visited during subsequent prenatal visits and well documented, but the couple consistently refused to consider a C-section. The OB suggested a second opinion or transfer to another OB which the couple also refused.
Fast forward to labor. The couple notified the OB that labor had begun, but refused to come into the hospital, despite the OB's reassurance that she would not and could not perform a C-section without consent. When the mother began to hemorrhage, she came into the ER and was met by the OB who was unable to save the baby or the mother's uterus.
The couple sued and prevailed in a jury trial. Upon interviewing the jurors post trial, the defense attorney learned that the jurors didn't really think that the OB was negligent, but felt that since a baby died, someone should compensate the parents.
Last I knew, the OB was seriously considering giving up her practice.
I realize that cases of this severity are rare. But they give pause to conscientious OBs and nurses who really try to do the best for their patients and their babies and fear repercussions from patients who consistently refuse recommended 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!
Charting requirements make it very difficult to "be flexible."
To another poster, if you don't have a monitor on and you're not doing vag exams, I would say you have NO CLUE when a prolapsed might occur.
And finally, what was said about reasonable people makes perfect sense, except that even reasonable people become crazy (and understandably so) when it's their baby that is dead or has some kind of life long problem. And probably even more crazy when the very thought that occurred due to a decision they made. Then factor in what family and friends may say to them, and encourage them to do, and you have a lawsuit.
And please, don't ever let a family video a birth. Please.
Few reasonable people, regardless of how much teaching or charting or documenting was done, remain reasonable (take responsibility for their own actions) when there's a bad outcome.
How about someone coming into the ER with chest pain,sob,pain in L arm, that has an "MI plan"? Or maybe someone coming in unable to speak, drooping on one side of their face, and unable to communicate but has their "CVA plan"? Or, a parent with a sick child that has their "menengitis plan". It's rediculous. My view is...if you come to the hospital for any reason you should expect the experts to take care of you doing what they know to do. Otherwise, stay home!
(dodging daggars)
The difference is that with the above mentioned situations is that all of the interventions are needed. They are medical emergencies. Childbirth is not. The outcomes for most moms and babies are fine without many of the common "treatments."
Many posters have reiterated that most moms don't have any other options other than to give birth in the hospital or be unattended altogether. I live in a city that has other options, but I'm one of the lucky ones.
BTW, I did wind-up giving birth in the hospital with pitocin and an epidural and that was fine. My membranes had been ruptured for 24 hours (with 3 rounds of abx) and ds had his head cocked and kept me stuck at 7cm for several hours. Were the interventions necessary at that point? You bet. And I had no problem with any of them. The CNM and I discussed it and their reasoning was that if they thought he would be out in the next hour they would leave me be @ the birth center, but it really didn't seem to be the case. They wanted to start pitocin and get a healthy baby out. Fine by me. We drove across the river to the hospital. I got my fluids, some phernergen, pitocin started, epidural an hour later and went to sleep for a few hours. Woke-up 3 hours later and ds was crowning. Four pushes later he was out and healthy as a horse and I was too. Did all of that have to be done aggresively the day before and I possibly (probably) wind-up having surgery? Absolutely not.
I'll reiterate. There's a time and place for every treatment, but not everybody needs every treatment.
I would venture to say that many people are not reasonable, especially when it comes to a bad pregnancy outcome.
I am aware of a case in which a couple presented to a new OB for prenatal care with their second child. The first baby had been delivered by C-section less than a year prior. The OB discussed with the couple from the first prenatal visit the increased risk of complications of labor (uterine rupture) due to the brief interval between pregnancies and the importance of considering and being prepared for a C-section if needed. The OB requested records from the first pregnancy, which the couple never produced.
The issue was re-visited during subsequent prenatal visits and well documented, but the couple consistently refused to consider a C-section. The OB suggested a second opinion or transfer to another OB which the couple also refused.
Fast forward to labor. The couple notified the OB that labor had begun, but refused to come into the hospital, despite the OB's reassurance that she would not and could not perform a C-section without consent. When the mother began to hemorrhage, she came into the ER and was met by the OB who was unable to save the baby or the mother's uterus.
The couple sued and prevailed in a jury trial. Upon interviewing the jurors post trial, the defense attorney learned that the jurors didn't really think that the OB was negligent, but felt that since a baby died, someone should compensate the parents.
Last I knew, the OB was seriously considering giving up her practice.
I realize that cases of this severity are rare. But they give pause to conscientious OBs and nurses who really try to do the best for their patients and their babies and fear repercussions from patients who consistently refuse recommended care.
It was the parents who were negligent. The defense attorney should have grounds for appeal. Those jurors didn't follow the law. I don't blame the doctor for wanting to give-up her practice. By the same token, many times there is a bad outcome despite all interventions and people may sue. Even if every intervention under the sun is implemented and documented to the teeth, they too could stumble upon a jury like this that feels that someone should compensate the parents. Unfortunately, that seems like part of the risk of being in OB.
It was the parents who were negligent. The defense attorney should have grounds for appeal. Those jurors didn't follow the law. I don't blame the doctor for wanting to give-up her practice. By the same token many times there is a bad outcome despite all interventions and people may sue. Even if every intervention under the sun is implemented and documented to the teeth, they too could stumble upon a jury like this that feels that someone should compensate the parents. Unfortunately, that seems like part of the risk of being in OB.[/quote']
This is my guess as well. I have a little bit of experience in that field and I can tell you that absolutely every lawyer in that room KNEW there was going to be an appeal. A case that big always has an appeal associated with it. Ok. Almost always.
I really don't want to get flamed for this but here goes: lawyers like to pick stupid jurors. They will use as many strikes as they can to get rid of people with technical skills, licensures of any type, graduate level degrees (sometimes any degree at all!), republican and any over 40 (who usually side with established authority). They like a jury stupid and emotional. They never get a jury 100% like this but a lot of times they want this kind of jury. A situation like an OB med mal, the testimony is likely to be technical and you don't want too many people getting hung up in playing "mini doctor" to make decisions.
Please keep in mind that if you heard of "a case" then its a rarity and not a commonality. Its kind of like all of those folks who think they can get pregnant at 45 with their own eggs. Does it happen? Sure. Is it common? No. The news or story that it does happen is proof that it isn't common.
Another thing to keep in mind is that people are just talking trash. A lawyer probably won't even take their case.
L&Dwannabe, I agree with you that women are the ones who demand change and right now the pendulum is not swinging toward anything natural. Women are demanding ( and getting ) just what they want which right now is early induction of labor and elective c-sections !!! The only birth I can recently remember without pitocin and epidural happened in an ambulance on the way to the hospital. The women who have birth plans rarely do their homework. Do they ask the OB's section rate ?? Do they ask OB nurses who they would go to ?? Even our MEDwives are pitocin crazy and lounge in their room reading or sleeping while the patient labors with an epidural. All of these interventions do NOT make for better outcomes and we know that. We nurses are trapped and have to conform to the hospital policies and careproviders orders. We also are not working for the fun of it, we need the money and are sooooooooo sick of being blamed for things that are not in our control.
I am new to this site, and am so impressed by the passion poured into this discussion. What is clear is that those of us that work with birth feel strongly about what we do! I had two home births, and have worked high risk L&D for 18 years. I work in a facility that has an epidural rate below 60% and has water births. There is no "right" way to birth. I greatly appreciate birth plans to help me be a better nurse. As LandD nurses, it seems our most important job is to assure a healthy Mom and babe while facilitating the type of birth a woman and her family are hoping for. Right? If at any point concerns about the well being of a babe or Mom are raised, we educate and intervene. The problem with the dominant birth culture in the US is that intervention is assumed before there is a reason. After a reactive NST, there is no need for continuous fetal monitoring. If a woman is taking po fluids well, why an IV? The key is thorough screening. And that is what we are good at, right? I can look at a woman's veins and know whether I can slip an IV in quickly if need be or not. I can assess a babe with a doppler and listen through a contraction and know if there is a troubling variation in heart rate. The real issue is that the US system is relying on technology to take a woman through birth instead of assuring a one on one nurse to be present for adequate and constant support and assessment. Once the health system is revamped, and it is coming, unnecessary use of technology in labor resulting in more unecessary use of technology and unnecessary c/sections will be replaced by the more fiscally responsible European model of nursing/midwifery managed low-risk/low-intervention birth with appropriate medical back-up. Our health care system can no longer financially support our ridiculously high c/s rate. Birth plans----GREAT! We just need to insist on adequate staffing to support those plans. Paying for on to one staffing in active labor is more fiscally responsible that a high intervention birth managed from outside the room.
Specializes in LTC,Hospice/palliative care,acute care.
This has been debated so many times on this board. If you feel so strongly about this then maybe you should look for employment in a setting in which your ideals are shared by the OB staff....As for me-I hate to see a woman with an inflexible birth plan.Babies come when and how they please-going into the process with a set idea of how it is going to be is a good way to set yourself up for failure.Moms are the Queens of Guilt for the rest of the kid's life-why start before they are even born?
Where ARE these women not wanting intervention ?? I must be living in the wrong part of the country ?? My advice to women with a birth plan.....based on over 20 years of experience in L & D during which time I have seen many changes.....some good, some bad..........would be to STAY home until labor is well established. Why do they come in at the first twinge ?? Or allow themselves to be induced when all is well with the babe ?? Come in to be induced and you are long, thick and closed prior to your due date because your mother can watch your baby......please don't hand anyone a birth plan. It is ridiculous.
This has been debated so many times on this board. If you feel so strongly about this then maybe you should look for employment in a setting in which your ideals are shared by the OB staff....As for me-I hate to see a woman with an inflexible birth plan.Babies come when and how they please-going into the process with a set idea of how it is going to be is a good way to set yourself up for failure.Moms are the Queens of Guilt for the rest of the kid's life-why start before they are even born?
cradlecrewer
23 Posts
Hi...I would be the original poster.
I guess I just don't understand why fellow nurses would have a problem with this post, especially those who work L&D.
I have worked in this area for 23 yrs. I have seen my share of bad outcomes. My job is to get a healthy newborn (and Mom) out of the deal, not a dead one, or one that is disabled for it's entire life.
I know my job and I do it well. Maybe if I put it into this perspective those who don't work L&D would see my point.
How about someone coming into the ER with chest pain,sob,pain in L arm, that has an "MI plan"? Or maybe someone coming in unable to speak, drooping on one side of their face, and unable to communicate but has their "CVA plan"? Or, a parent with a sick child that has their "menengitis plan". It's rediculous. My view is...if you come to the hospital for any reason you should expect the experts to take care of you doing what they know to do. Otherwise, stay home!
(dodging daggars)