doctor won't approve my birth plan...

crysobrn · Jun 26, 2007

I don't think these are huge requests by any means. Our protocols state that we have to have IV access and still we've had docs that have said it's okay to have NO access if the patient requests (depending on the situation).

Intermittant monitoring as long as you are not on pitocin is usually not a big deal either. Hmm I wonder if you took classes at this hospital, did the mention flexibility there? I'd maybe ask for a tour of the unit and ask the staff?? Then IMO if the doc is still uncooperative find a new one. It's never too late to change and it could make all the difference in your experience.

ParalyzeDragon · Jun 26, 2007

From a labor and delivery RN view, it is hard to monitor a pt with intermittent monitoring in places where there are a shortage of nurses. The hospitals in the region I live in all have protocols where the mother must be monitored 20 or 30 minutes out of every hour and other require 10 minutes of monitoring per 30 minute intervals. For a normal unit it is impossible to honor these requests because it takes to much time to take the pt off the monitor and back off so often. This process is time consuming, especially when a RN has 3 laboring pt. LD is high acuity and "bad things happens."It is safer to have mother on continuous monitor when the RN is swamped, If there is fetal distress noted the RN can prioritize and respond to what needs attention first.For safety reasons CFM is used. I would hate to have a fetus be in destresss and not be able to get out in time before permanent damage is done while in utero. With CFM at least we know what is happening inside mother. I think this would be possible if the RN pt ratio was 1:1, but it never that in the hospitals I have worked in.

TrudyRN · Jun 26, 2007

It sounds like you should be considering home birth, with a midwife in attendance or a birthing center run by midwives.

With my last, I had stated and signed to refuse eye gtts, I wanted them to delay cord-cutting, and I wanted Dad to be able to do it. To this day, I am angry that not a single wish, signed for on all their stupid permits, was honored, despite assurances from my doctor and from the Head Nurse and Charge Nurse. And my kids are grown. There was no trouble at the time of birth, both of us were fine. The staff just simply refused to honor my signed-for wishes. I should have sued.

justme1972 · Jun 26, 2007

I agree that you probably need to be considering a home birth with a midwife, because that sounds like the direction that you would most likely have your wishes honored.

I personally, am a "over-thinker" and centered my entire birth plan around "should something go wrong", so I choose a hospital with a 24/7 Neonatologist and a NICU on site, even though I had no health issues and started out with a textbook pregnancy.

Did something go wrong? Yup, and I needed every resource they had. It was a HUGE comfort to know, that I was already in the best place I needed to be.

crissrn27, RN · Jun 26, 2007

Those request are simple enough. If possible I would do the homebirth or birthing center thing. NO ONE at my hospital is allowed to have intermittent fetal monitoring, and I have never seen a saline lock used. Not right, I know, but thats how it is. If homebirth or birthing center is out I would shop around and see if I could find a doc and a hospital that would honor my wishes.

I'd say 95% of those "what if" complications in my hospital are caused by things we do, pitocin, mom on back, drugs, etc. So I personally would feel more comfortable in my home with a midwife, or in a birthing center, but we don't have any such things around here, darn it. Hopefully you do. Good Luck!!

hoppermom3 · Jun 26, 2007

Our pts always have SL and intermittent EFM unless they are on Pit (which is fairly rare for us) or have a spinal or epidural (which is pretty common). We highly encourage moms to be up and around as long as possible, using the birthing ball, bathtub, etc...

Dayray, RN · Jun 26, 2007

I don't think there is anything wrong with a saline loc or intermittent monitoring. Those are my 2 rules to take care of a patient, have to have a saline loc and let me listen occasionally. AWON standards for intermittent monitoring are for a 1-min monitoring every 30-min and a NST (20-30min) every 2 hours. Aside from those 2 things you can run around nakid and sing songs if you want.

Honestly it doesn't matter what their protocols are you don't have to submit to anyone.

Could it be that, some part of your birth plan might have seemed offensive to him? Or are there other requests involved? Very often docs and nurses are offended by some of language in birth plans. Some seem to be very accusatory or unreasonably cut and dry.

I see a birth plan as a good tool to start people talking. If there are requests that are dangerous or too cut and dry, he should take the opportunity to educate you and make sure you understand and feel good about the plan. Next time you see him bring it up again and ask him if something in the birth plan is unreasonable or if you seem too demanding. He should not be so easily offended but maybe this is something new to him

I don't think you should have to have a home birth to get what you want. You defiantly should talk more with your OB and ask about specifics on his protocols. If his ideas and yours don't mesh or he is unable to provide you with explanations for the way he does things look into another OB. The only time you should completely leave things up to doctors or nurses is when they are telling you , you need an emergent c-section, up until that time you should be able to ask all the questions you want and make decisions unless a rational explanation is given to you

LizzyL&DRN · Jun 26, 2007

Does the hospital offer wireless fetal monitoring? Our hospital just got this system and i'm soooo happy about it. If mom wants to move around we do ask that she have a saline lock, but we can monitor the baby the whole time. Not many moms use the system unfortunately. Most of our docs are pretty accomodating to moms that request to move around and walk. Call the nurse's station and ask if they have the capability to wirelessly monitor your UCs and the baby. Then maybe doc would approve it. If not, find a new doc that you are comfortable with. By the way, it is your body, the doc cannot force you to have a saline lock or force you to be monitored continuously. You do have a say. I highly recommend the saline lock though. If I was laboring naturally without pain meds, I would be very upset if they wouldn't let me outta bed. Good Luck!

mitchsmom · Jun 26, 2007

My desire is to give birth w/o painkiller (i.e. epidural)... So, I put down on my birth plan my preference for an intermittent monitoring and a saline lock (instead of IV)... so that I can walk around...
Doctor responded by saying that their protocol do not allow the above. He added that I may want to review the items w/ my nurse on the day of my delivery...

On our unit, you would have more success talking to the doctors because their routine orders include fluids and continuous monitoring so in order to get around that we'd have to talk to them anyway & it would be better done in advance.

They usually have the ultimate say in these things & it kind of sounds like he's passing the buck/avoiding the subject & by the time you get to the unit it will be too late. Maybe that unit is different but it sounds kind of doubtful... he should have the say and it just sounds kind of funny for him to tell you to talk about it on delivery day?

Am I asking too much (I thought the above could be accomodated w/o too much hassle)... Or may I still politely insist on my preference w/o alienating the staff...
This is my first birth so I would appreciate any advice from exp. mothers and L&D nurses. Thx. much in advance!

I don't think you are asking too much at all. With my last birth (3rd), I had intermittent monitoring the while time (I refused to have my water broken until the end and was a healthy uncomplicated patient). I walked, bathed, swayed, and sat on the ball and got checked every so often. I don't think I could have done it unmedicated if I was strapped to the bed the whole time - it was so much more painful for me lying in the bed. I literally was sitting on the birth ball at the foot of the bed one minute and crawled up onto the bed and had the baby about two minutes later.

And it was probably less work for the nurse b/c dh and I just did our thing. I peed by myself, we went to the nurses station if we needed something. If I was on the monitor the whole time, she'd have to come evaluate/chart it, adjust monitor belts, unhook me to go pee, bring things to me, etc.

With my patients, I try to do a 'happy medium' (?) by helping moms to move as much as possible with the monitor on - they can still sit in a rocker, stand, get on the birth ball, etc. with the monitor still on. I actually wish more patients would push the MD's for ambulation!! Most of our patients just go along with whatever we (the MD's) say though.

What usually holds my "happy medium" up for our patients is the MD's come and break everyone's water first thing (like ASAP, at 1cm if they can) and then they want them on bedrest, some not even to get up to bathroom after that.

My advice if you can't get the MD to ok intermittent monitoring, don't go to the hospital until you are further into labor!!! If you need to get checked & end up still being in latent/early labor, you should be able to still go home and come back. A freestanding birth center would also be a nice option if the MD won't budge and you can't find one that will.

Do you know other moms that would be able to hook you up with a provider/ place to deliver that can meet your needs?

Good luck!

allnurses Guide · Jun 26, 2007

There is wireless monitoring!!??? :eek: I've been joking for years that the person who invents wireless monitoring (and wireless IV infusion, and wireless cardiac monitoring, etc.) will be a bazillionaire.

As to the op's birth plan - I also agree with another poster who said this doesn't have to be a choice between a hospital and home delivery. You need to be proactive and research hospitals in your area.

We don't insist on continuous monitoring unless you are being induced or have an epidural. Even then you can get up to the bathroom and one doc even lets us turn off the pit for awhile so you can ambulate around the hospital.

I don't think your wishes are at all unreasonable.

Best wishes!

steph

lovemyjob · Jun 26, 2007

Try searching out different doctors. I also disagree with this being a home vs hospital issue. Finding a doctor who is suuportive of your wishes will write the orders for your monitoring and fluids.

Your wishes arent that out of the ordinary. I think a good discussion of your wishes with a few of your local MD's will help you find a provider who will help make your delivery a compromise of your wishes and the delivery of a healthy baby (deviating form your wishes if a problem arises.)

Good Luck!