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...
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!
These are not unusual requests and that doctor knows darn well that it is not up to the nurse whether you can have those things, it's up to his orders. Sounds like he is trying to avoid discussing it with you.
As for fetal monitoring, it doesn't improve outcomes, just increases the number of c-sections. Intermittent monitoring is just as effective without unnecessary surgeries. Telemtry units are better than being wired down but are still constricting and uncomfortable IMO.
I would recommend a midwife to you since they seem to generally have more respect for the natural process of labor. Sounds like your doc cannot handle patients being active in their plan of care.
A lot of nurses smile nicely when given the birth plan and then do whatever they want to anyway. "Doctor's orders. It is/isn't our policy. Protocols." So you want to get out of bed. Get out of bed. What are they going to do? Call security? That's assault. So is giving you pain med if you refuse. Writing it down isn't enough. Tell those people that will be with you.
Once in labor you may change your mind. You may want that epidural. (I would.) There MAY me a reason to monitor baby more frequently. It is you and your baby, but you come to the hospital (best place I think for the first birth at least) for the expertise and knowlege of the nurses. I think everyone can be respectful all around. Don't forget, if you find yourself unable to get along with your nurse after trying, you can request another one. "Difficult patient" label? Maybe. It depends on the hospital. But don't you want to remember the supportive people you had around you, and not the thorns in your side? A friend of mine refused the anesthesiologist on duty that night. The hospital had no trouble finding another one.
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!!
:yeahthat:
It is the same way where I work! I hate that it is that way. Our docs won't even let ruptured moms ambulate even if head is well engaged:o There is no way any of the docs would allow just a saline lock for a laboring mother. Unfortunately there aren't any birthing centers that I am aware of in our community.
I delivered my dd at a military hospital that does allow intermittent monitoring unless on pit, or has an epidural. They do allow and encourage ambulation. I SROM'd at home and came to the hospital 4/100%/0 but not regularily contracting. My midwife was in my room trying accupressure to get me contracting without having to start pit. It didn't work and I ended up with an epidural and pitocin.
If your plan is something that you feel that strongly about; I agree with pp that you should investigate other options in your area. Good luck to you. I hope that you can find what you are looking for.
This is my first birth so I would appreciate any advice from exp. mothers and L&D nurses. Thx. much in advance!
Well, the main thing I want to comment on is the pain issue.
I just had my fourth baby a week ago today. The only one I had "natural" was my second which was born at home with a midwife. What a nightmare, that was the worst pain I've ever felt. I thrashed around on that bed and was crying out in pain and hyperventilating and everything else. I had to suffer for awhile last week but I sure was thankful when the epidural started working.
I want to have more and I sure hope I have the option of an epidural with the next ones. I don't think it makes me any less of a mommy to want to be as pain-free as possible.
One thing, though, is that they will do the eye drops (at least where I was) whether you want them or not.
Regardless, once you meet that little baby it likely won't matter how he/she got here. You will be going through a life-altering experience for sure. You'll love that little baby so much it will hurt.
I see nothing wrong with your birth plan. It certainly is not outrageous. Most of our pt's are monitored via IA and we do not have use of routine IV's either. If your are low risk it should not be a problem. You have the right to refuse an IV orcontinuous EFM. I suggest you ask your doctor why he insists on both of these things.
Our standard orders are for EFM 20-30 min/hr and saline lock. I don't think your requests are over the top. I think there are many smaller hospitals that can accomodate you. We mostly do 1:1 in L/D and intermittent monitoring is fine unless we have a problem. As long as you would agree to it if we were having decels or using pit (we let people off for 15-20 min. here and there on pit if all is well). As for no pain med, we will also do our best to support you and get you there too. I don't think your requests are so "special" that you need to go w/ a home delivery. Good luck finding a provider that is a bit more flexible. I think there is someone out there.
Well, the main thing I want to comment on is the pain issue.
I just had my fourth baby a week ago today. The only one I had "natural" was my second which was born at home with a midwife. What a nightmare, that was the worst pain I've ever felt. I thrashed around on that bed and was crying out in pain and hyperventilating and everything else. I had to suffer for awhile last week but I sure was thankful when the epidural started working.
I want to have more and I sure hope I have the option of an epidural with the next ones. I don't think it makes me any less of a mommy to want to be as pain-free as possible.
One thing, though, is that they will do the eye drops (at least where I was) whether you want them or not.
Regardless, once you meet that little baby it likely won't matter how he/she got here. You will be going through a life-altering experience for sure. You'll love that little baby so much it will hurt.
They may tell you they have to do the eye gtts, but they don't. It is your baby and they can't do anything without your permission. That being said, we don't even ask about eye gtts and vit K, we just do it. If a mom request that we don't do it, most of them tell her that it is "state required", which is not the truth, but usually works. The newborn screening, vit K, eye gtts, hep b shot, hearing screening can all be refused, just bring typed forms, signed by mom, stating that these things are not to be done. I don't necessarily agree with moms that don't want all of those things, but it is her baby and her decisions.
We try to force stuff on these people, and most just take it, fearing that we will call SS or something (and some probably would), but if you have a valid concern and don't want these things, what is SS going to do? They send crack babies home with mom usually, so I don't think they are gonna take your baby b/c you refuse SOP.
Just like with monitoring, IV fluids, meds, etc while in labor. If your baby is not in danger then get up, move around, refuse to allow them to start fluids, BE FIRM. They can't tie you down and do these things, unless your baby is in jeopardy (and they better be able to back up that statement, if they do restrain you, in a court of law.)
But the best advice I can give you is to be flexible. Who knows what might happen? You might get to the hospital 10cm and pushing and all of this might be mote. (heres hoping for that!) You might have a long, slow labor and end up wanting drugs/epi. Don't feel like you have to follow a regimented birth plan and then feel guilty when it doesn't work out. Give yourself permission to do what you feel is best for you and baby when the big day comes, what ever that might be. Good luck!
The problem is not that "your doctor won't approve your birth plan", but that your doctor thinks that you need his/her approval!!
It is YOUR body. If you don't want an IV or even a heploc THAT IS YOUR CHOICE!!!!!!
This is exactly why I ended up having a total UC water/homebirth with my third, because my healthcare provider (a certified nurse midwife) tried to talk me into a heplock and I didn't want one. I knew that I would be happier at home not having to reiterate my wishes.
I wish you a happy birth that goes just the way you want!
I have only heard one doctor tell a patient that she had an unrealstic birthing plan. BUT hers outlined that no matter how much she begged, we were not to give her pain meds.IN addition, she only wanted to give birth in a certain position, etc.
I think the first thing is that ANY birth plan and mom to be realize that something can change due to unforseen problems during the labor and birth, and the safety of the baby and mom must come first. This is not to say you cannot give birth without continuous monitoring, and IV fluids. The main reason they don't go for the SL is that most hospitals restrict fluids and food during labor, while most midwifes will tell you this is a stress on your body, and FEED IT, and have popsickles, protein, etc, till you get to transition. I always wanted a water birth, but lived in a rural area and gave birth in 1977,1980,1990 , 1991 and 1993, and doctors here thought I WAS CRAZY. I went to be"induced "for being a week overdue, and as I went to the BR to get the urine spec. my water broke in the toliet. 12 hours later, while I was in transition, I was taken by cart from one building across a huge tunnel to another building to have an xray to see if the baby was breech(before US) and then back. Turns out baby had had not up or down, bu t sideways. I did deliver her no pain meds, with forceps, and tore all the way. I never had pain meds with any of te 5, not sure it was always by choice, as I was promised an epidural for my last, as tey predicted her to weight 10-11 pounds, but unfortunately I got one of the births I am sure you are trying to avoid, where the nurse strapped me to monitor, told me to lie still and not mess up monitor, they broke my water, and I lay there for hours. Not allowed up to BR. AND no pain meds or epidural.
I think that you have a good plan, but must be realistic, in that should FHT drop, contractions have to be augmented, forceps, vacumn, etc, you may want to have the opportunity for pain meds, and epidural. If you are open to what might happen, explain to the dr, that you realize nothing can be predicted 100%, and you are open to what is necessary at the time for a safe delivery, but want to try it your way, and that the SL will be available for whatever meds, deemed necessary at the time. A straightforward, non confronting discussion would be your best bet. IF the DR absolutely refuses to listen or compromise, ask if he has a partner or associate who is comfortable with a plan smlar to yours. GOOD LUCK
Don't know where everyone else practises, but I have worked in 3 different states and many hospitals and almost every one has different orders for each Dr. You need to check out your Dr. The nurses follow the Dr. orders. Every hospital I have worked at will do saline locks, and encourages walking around, showers, using the ball, whatever to help with early labor. We all are looking for the best outcome for the mom and baby. Most have telemetry, but not always enough to go to each patient. The Dr. is the one the person needs to get on board with her birth plan. The nurses will follow if the Dr. allows them to.
Also I want to remind all those that we are talking about 2 patients here, the mom and the baby. We also have to worry about a safe outcome for both. There are reasons for continuous monitoring, (although not as much as we see today). If there is meconium in the fluid, if the mom has a condition that necessitates closer monitoring, if the baby is preterm. The hospital needs to be flexible but so does the mom when things happen that makes it unsafe to continue with her plan. She needs to trust her Dr. and caregivers to give her honest and pertinent information with which to make decisions. This is an emotional time for everyone and what we all want is the safe delivery of a healthy baby.
As for eye gtts, vitamin K, and all the rest. You can sign a refusal ahead of time and just make sure that every one is aware of it. I am not sure why you would't want to protect your baby from infection and bleeding problems, but that is your choice and I would follow that. It is an order on each of our babies, so you must sign a refusal before hand, otherwise the order is followed.
I noticed your profile said something about Korea. Are you giving birth in Korea? Maybe their physicians aren't as customer-geared as American MD's and facilities? Just a thought.
Get a different doctor pronto. If he is claiming hospital protocal find a different hospital. I would say, "Thank you for your time but I can see now that you are not going to be able to meet my needs"
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862 Posts
These are not unusual requests and that doctor knows darn well that it is not up to the nurse whether you can have those things, it's up to his orders. Sounds like he is trying to avoid discussing it with you.
As for fetal monitoring, it doesn't improve outcomes, just increases the number of c-sections. Intermittent monitoring is just as effective without unnecessary surgeries. Telemtry units are better than being wired down but are still constricting and uncomfortable IMO.
I would recommend a midwife to you since they seem to generally have more respect for the natural process of labor. Sounds like your doc cannot handle patients being active in their plan of care.