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.
My take on it is if they're not hurting anybody doing it, I say knock yourself out. I have seen daddies do all sorts of thing to try & settle babies down, including whipping their shirts off & putting baby to their breast. I can't imagine why they'd want to, but they're not hurting me, so I really don't care. Ditto for the nakedness. That's just me. I can understand why someone else might be bothered, but I'm not.
Aside rom the nurse, I was treated very well, my Dr was almost reluctant to do anything, but after four hours I was getting exhausted and the contractions were not consistant, so he asked if he could start a little Pit to get things going, he DID NOT want this to end up in the OR.
Have you ever sat on a laboring patient with PIH who refused an IV access (not in her birth plan), and then seized? Not pretty.
Have you ever been in a deposition where a baby died because the patient came in in early labor having decels, but chose to leave AMA until she was in "active labor"(as per her birth plan) only to return the following day with no FHT's.
I could go on...trust me, I have my reasons for not liking birth plans.
I'm happy for anyone that has never had any bad outcomes, but I unfortunately have. I am not a control freak. I love my job, but let me do it!! That's all I'm saying.
But this is one baby and mother who had decels! One scary campfire story!
My son had decels. A doctor appeared out of nowhere ready to section me and became infuriated when I said no thanks! Thank goodness the midwife supported me when I told her that lying on my back made the baby squirm! (no surprise to you L&D nurses, I suppose.) She put a pillow under my hip,the decels stopped and my son was born with no adverse affects. This is probably more of the norm than anything else.
BTW, I have also heard that hospitals don't deliver sunny side (posterior presentation) up babies except by C-section now! My son was also born sunny side up no problems. OH! I heard that its "impossible" and "dangerous" to push for more than 2 hours and deliver lady partslly. Guess what? Baby boo and I took nearly 4 hours to get through it!
I don't think I am special. I think these are routine kinks in the process and they should be accepted as such. I bet most mothers can give you a variation on the above theme.
I know you have experience but mothers have intuition! (most anyway) Again, its not about you doing your job! Its a natural process and requires no intervention.
My point is that one bad outcome should NOT turn everybody's birth into a surgical procedure!
With my 3 births I never had a plan, I was having a baby and someone was going to help. Nothing went as thought it would. Pain meds:chuckle I new when it was time. My last birth, I was n/v the last 30 min. I felt sorry for the nurse that I vomited on, she handled it so well.
I think a basic idea of what you want is good. A complete set in stone birthing plan is not good. There are hospital regulations and they are put into place to have a healthy baby. "The Dr. and his staff knows best", thats my favorite motto. You never know when things are suddenly going to go off plan, and you have to go with the flow. That kid can't read a birthing plan, they do what they want at that age.:loveya:
Specializes in LTC,Hospice/palliative care,acute care.
I also bristle a bit at the birth plan that dictates "The nurse shall not use the word "contraction" or "pain". I guess it's a "surge" and "pressure". I respect the effort by the couple to "own" the process, but insisting on vocabulary changes is just tough to remember to do.
That's like saying 'Excuse me but smoke is emanating from your nether regions-stop ,drop and roll-I'll get the chemical compound in the sprayer to help with that" Instead of "Hey-your butt is on fire-look out!"
After reading the original post my blood was boiling. I am a pre-nursing student and mother of 2 who hopefully has a future in L&D. I feel that women need to be educated and understand the reason behind their choices. If you feel that they are making a choice without undertanding, then I would feel it is my responsibility to give them an unbiased education. I understand that there is sometimes a need or patient want for interventions, but more often than not no interventions are needed.
Both of my deliveries could have been very high intervention and ended up in C-sections, but because I was educated I could make an educated decision on my outcome.
With #1 I was checked for dilating at my dr's office and had been 4cm dilated since 36 wks. I came in at the first twinge, like a lot of 1st time mom's do, and was 4.5cm and after 3 hrs on a monitor with few contractions I thought I was going home. A different nurse came in and said I was "her" 5. I was admitted and immediately put on pit. I dilated to 10 cm in about 5 hrs after being admitted. I pushed for 4 hours. After 3 hours my son's heart rate was strong and I still had plenty of energy. The OB, who was the one on call because it was my dr.s day off and he couldn't get childcare, threatened C-section and tried a vacuum extraction. I told her that as long as the baby looked strong and I felt strong I wanted to stay out of the OR. We worked through it. I don't feel like I was being unreasonable. Everything worked out and I delivered a beautiful baby boy lady partslly, with a 4th degree tear. I think that if I would have waited until I really felt that I was in labor none of this would have been an issue.
Fast forward 1 1/2 years and I was pregnant with #2 and decided to have a midwife assisted labor in a hospital. There were 5 midwives in the practice and of course the 1 that I hadn't met was the one who was on call the day that I went into labor. I labored at home and went in when my contractions were getting uncomfortable because I had a 30-45 min drive to the hospital. I got to the hospital and was checked and 8.5-9cm dilated. When I got to my room my midwife asked if I wanted to go natural because I seemed to be handling contractions well. I told her that I would like a epidural because I had the 4th degree tear with #1 and I was afraid that because of that I would hold back when pushing. She obliged, called for the epidural and then asked me what I hoped for my labor. I told her I wanted to nurse immediatly and the baby to be brought to my bare skin. And to do anything she could to keep me from another 4th degree tear. Nothing over the top, but it was nice that she asked and helped me to have a great birth experience. My son was born sunny side up, and at first seemed to be doing well so she did as I requested and he was born to my belly and I was allowed to immediately nurse. It was only a little while later that we noticed that he was grunting a bit and he had a small infection in his chest which required him to stay in the NICU for a week.
All that being said, I feel like because I was somewhat educated I was able to have good birth experiences. If I came into a hospital and had no idea what to expect and all you hear is that the hospitals push what they want on you and are quick to push you into a C-section I would be scared and do what I could to retain some control. If a patient comes in with an unreasonable birth plan educate them on why you can't do everything they want, but give them options to help them feel like they have some control.
First of all, childbirth is natural. An MI is not, so of course it would be ridiculous to have an "MI Plan"... you can't even compare the two...
Second, out of curiosity....how many of those bad outcomes were during births that had interventions?" Generally, interventions lead to complications...
Childbirth becomes a medical issue when it is complicated with complications...those are the ones I am referring to. I'm talking preterm labors, PIH, uncontrolled gest diab, partial abruption, prolapsed cord, thick meconium, HELLP syndrome...etc. Not the run of the mill normal labors.
Even a woman who has not benefitted from child birth ed classes has the right to informed choice about her labor and delivery. We work with a large non-English speaking population and they are given all of the same choices our well educated insured population are given. I feel it is part of my responsibility as as OB nurse to make sure every patient is empowered to ask for the kind of birth they want. That often times plenty of teaching and patience.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I have no problem with birth plans. I have said before, they are a legitimate attempt by an expectant couple or mother to communicate wishes with medical personnel, who probably do not know her well and have little time to build the repoire needed to feel comfortable in active and/or rapid labor. I find just by listening and being open to what people are saying goes a long way for me.
I have to echo a prior sentiment: I do get a bit upset when our doctors do not tell their patients that some components of their birth plans are difficult, if not impossible, to honor. It does put an onus on nursing staff to be the "bad guy" and it's unfair to both the nurse and her patient. They (OBs) have MONTHS to know these patients; we have hours, or at the most days. The opportunity arises time and again in office visits to address such issues, whereby in the hospital, we are often hit by surprise when they show up in labor and we nurses get stuck explaining why a certain request may be impossible to honor. It gets us all off on a bad start, one that can be avoided!
I teach in my childbirth preparation classes the standard interventions people can expect and if they have special needs/requests to please discuss them at length and in writing with their care providers long before they are due to deliver. I also recommend their birth plans be placed on file with their prenatal records on L and D. It helps everyone be on the same page and expectations are most realistic at the outset, in almost every case, if this is all accomplished.
One thing is clear to me: Birth plans are not the enemy. Miscommunication on any part, IS.
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.
I'm willing to guess YOU haven't been a patient giving birth recently, but Drs are TELLING their patients to come in if they 1) water breaks (contractions or not) 2) bleeding 3) contractions. This is the case BOTH of my doctors and nurses told me. I WANTED to stay home when my water broke until my contractions started, but NOPE. Dr. said get straight to the hospital. After 7 hours waiting for labor to start, I was induced.
Also, most Doctors recommend induction to their patients for convenience sake. My first baby was induced at 40 weeks, weighing 6 lbs because my OB recommended it saying there was no benefit to going past 40 weeks.
Ob's are very intervention happy these days. My last doctor was actually an exception not wanting to induce unless medically necessary- but that is the exception not the rule.
The original post is the exact reason that I have no desire to deliver in the hospital. I am currently 39 weeks pregnant with my first child. I knew from the beginning that I wanted to keep my pregnancy as intervention free as possible. Luckily, I live in an area that has a midwife-run birth center or the option of a homebirth with a CNM. Unfortunately, many women in the US just do not have any other option than going to the hospital. I am a young, healthy woman who has had an uneventful, uncomplicated pregnancy. The childbirth educator who conducted my birth classes was very frank about what to expect if we chose to deliver at the hospital: to have an IV placed upon arrival, frequent lady partsl exams, must be in bed on the monitor for at least 20 minutes out of every hour, NPO upon admission, etc, etc.... I'm sorry, but for someone who is healthy and low-risk, there is absolutely no need for any of this. And if you refuse any of these interventions you are, of course, seen as a "difficult patient." I am a very educated woman and have taken the time to research exactly what I do and do not want as part of my birthing experience (of course, should the need for intervention arise, I will not be inflexible). However, I feel that a lot of women have an idea of what they want, but have not fully done their research and therefore come across as "demanding" or "pushy" to the nurses when they want their requests honored. I truly feel for these women who want an intervention free birth, but have no other option than going to the hospital and dealing with these types of hostile attitudes toward "natural" birth....
That's my problem with the OPs post, and with some OB nurses. They are hostile toward women who want unmedicated, non-fetal monitored, no IV in place labors, and view them as 'noncompliant' and 'difficult'. I know how they talk because I used to float to OB.
A woman in labor is literally wide open vulnerable in every way. For her helpers to be undermining her wishes with hostility and contempt is horrible in my mind.
Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
My take on it is if they're not hurting anybody doing it, I say knock yourself out. I have seen daddies do all sorts of thing to try & settle babies down, including whipping their shirts off & putting baby to their breast. I can't imagine why they'd want to, but they're not hurting me, so I really don't care. Ditto for the nakedness. That's just me. I can understand why someone else might be bothered, but I'm not.