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.
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....
I tell you what else all this 20 minutes out of an hour on the monitor doesn't work out in the real world. With my first, the nurse said it would be 20 minutes and reassured me she would be back since I didn't want to go on it. She came back when I pulled the cords out of the machine 45 minutes later. She was ****** at me, stated she had an admission she was busy with and that I was not to do that again.
For punishment, she reminded me that I would have to go back on the monitor in 15 minutes for another 20 minutes.
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.
Yep, I haven't reached my OB clinical yet but I have several friends who just completed theirs. They said some of the OB nurses were basically just control freaks who wanted their patients in the bed, on the monitor and NOT bugging them. They said it was the most boring clinical ever because there was nothing to do!
Its a shame because one them actually wanted to be an OB nurse but got turned off by the whole thing!
A few thoughts........I agree that MDs push inductions. They want total control. They want 9-5 obstetrics. They will jump into a section quickly as that is their defense in a lawsuit......that they "did everything they could" in a timely manner. A brain-damaged baby brings huge sums of money in a lawsuit as it is needed to care for the child for life. Most cases settle prior to going to trial as the jury is always sympathetic toward the baby and the family and the awards are even larger. We are talking millions of dollars awarded for one case. 2 of our OBs retired suddenly a few years ago when they got their bill for malpractice insurance as they simply could not stay in business. I see both sides of the issue being a nurse. For the record, I had 5 unmedicated births and left the hospital for the last 2 in 6 hours. I was I am sure I was perceived as a big pain by some nurses. I was also educated ( not a nurse for the first 2 ) and I did stay home until well into labor arriving at the hospital for a safe delivery with no time for interventions. Inductions were only done for medical reasons at the time. I am not defending the nurse who snapped at someone for unplugging the cords from the monitor but I know the little prongs are easily bent and broken and cost hundreds ( ridiculous, I know ) of dollars to replace. I do feel I am a patient advocate but agree with a previous writer that so much of this teaching should be taking place between the careprovider and the patient. There is only so much one can absorb when overwhelmed and in labor. Thanks to all of the fine professionals on this board who contribute to our stimulating and thought-provoking discussions.
Last I checked, a woman cannot be forced back on to the moniter.
"punish" you, was she serious? What were you, five?
I'm sorry you were put through that.
I was 21 (so sort of like a 5 year old. lol). She was probably talking down to me, don't you think?
I didn't know she couldn't force me. I assumed that if I didn't do it, I would asked to leave the hospital or that I could get in trouble with child protective services and go to jail. I think that's how a lot of young women think in those situations. I just lacked the sophistication to know the difference.
I honestly thought I was being "bad" enough when I pulled the monitor cords out but I was also in labor so I was kind of in that agitated laboring stage.
Having grown up some, I have learned to stick up for myself better!
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.
Thank you for adding to your original thought; it really changes things. Had you mentioned this originally I think less people would have gotten fired up.
Here's where I come from on the birth plan thing. And my 32 years of nursing has been spent about 50/50 in low risk areas and high risk areas.
When a patient comes in, ostensibly to have a safe delivery with a good baby, and proceeds to tell me I won't you this, you can't do that, we're opposed to such and such, yada, yada, yada, I just want to ask: Well, then why are you here?"
Had a home birth patient, many years ago, who'd been pushing at home 6 hours and finally came in. First words from the lay midwife was "she doesn't want an IV." Really?
Guess what? you're in my ballpark now, and an IV might be the one and only thing (maybe with just a sniff of pitocin) that is going to get her a lady partsl delivery.
If the birth plan has flexibility worked into it no problem, but I just wonder sometimes.
If I have the opportunity to discuss a plan with a couple on a private tour for example, I will discuss that flexilibity is a biggee. Most times they understand. But if that's not done in the office, or birth prep class, and we, the staff, are left holding the bag when crunch time comes, then guess what those patient satisfaction scores will be?
And I also find that some people have stuff on their plans they don't even know what it is. Just found something in a book or on the internet somewhere and decided to add it.
I'm not opposed to birth plans per se, but we surely know the plan is just a plan; the patients need to know that too.
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.
You failed to say this in your original post. The scenerio you presented there said nothing about complications. Had you started on that path to begin with, you probably wouldn't have met with as many indignant posts.
Had a lovely birth yesterday. No birth plan. Non-English speaking. But given options; this multip delivered without IV access (Yes, I had scoped it out and she had beautiful veins), intermittent monitoring, staying out of bed her whole labor, and SROM as babe delivered. She did end up with IM pit PP, but she beamed with joy at her accomplishment. Women should be given all of their options even if their requests are not written down. Healthy, term, low-risk Mama? Assume the best. Use vigilant assessment skills. Insist on one to one staffing in active labor. Again, I believe we as nurses have a lot of power to act as our patient's (consumer) advocates. We are the ones who can shape the direction of birth culture, from teaching prospective patients in Child birth ed classes to be self advocates to being strong voices for our patients' wishes at bedside. We have to shift brith culture away from assumed intervention for healthy, term mamas! Again, paying for a nurse for each active labor patient is cheaper that multiple interventions and high c/s rate.
Again, paying for a nurse for each active labor patient is cheaper that multiple interventions and high c/s rate.
Boy, would I love to see a study published in a reputable journal demonstrating this. It should be posted in every administrator's, risk manager's and staffing coordinator's office and provided to every prenatal patient as educational material!
How many studies need be done to demonstrate that excessive intervention does not improve outcome? We all know that increased use of inductions results in increased intervention, leading to increased c/s rate. Each c/s increases risk of many other grave complications. It has been abundantly demonstrated that more monitoring does not improve outcomes--it is prudent use of monitoring that provides the assessment tool needed to lead to intervention if concerns arise involving babe. It has been abundantly documented that a constant birth attendant at a laboring woman's side decreases risk of need for interventions and c/s rate. The problem lies in the fact that hospitals profit greatly from baby factories where women and nurses buy into a birth culture where everyone is induced at 38-39 weeks, gets her epidural, AROM by luunch---all leadinng to an unacceptable, but profitable c/s rate. I have only been reading the posts on the web site for a week, but it has become painfully clear to me that OB care in this country is primarily not evidence based. sad for child bearing families and for nurse satisfaction.
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VICEDRN, BSN, RN
1,078 Posts
I tell you what else all this 20 minutes out of an hour on the monitor doesn't work out in the real world. With my first, the nurse said it would be 20 minutes and reassured me she would be back since I didn't want to go on it. She came back when I pulled the cords out of the machine 45 minutes later. She was ****** at me, stated she had an admission she was busy with and that I was not to do that again.
For punishment, she reminded me that I would have to go back on the monitor in 15 minutes for another 20 minutes.
Reality sucks!