I was reading around, and saw quite a few posters who seem to think kinda badly of birth plans, and just curious as to why? Is it because the patient made one, or because some/all of the requests were unsafe or just plain stupid? I made a birthplan for my daughter, but all it really said was:
*NO ONE was to take her anywhere without either my husband or myself.
*If complications arose that I wanted her safety to take priority over mine.
*No forceps (I saw horrible pictures of babies who had these types of deliveries, and it terrified me!), but vacuum was ok if nessisary.
*NO ONE was to ASK me I wanted pain meds- I wanted to do drug free, and thought that if I had someone ask me, that it might have been too easy to accept.
I like birth plans. I like that people have thought this out and want to be prepared to make this a memorable experience. It is the unreasonable ones that get bad...but, by unreasonable, i should say inflexible. Like not considering that you are writing this plan BEFORE labor,and you dont know how things will go.
We do our best to accomodate them, and when they come in with a plan, I personally go over every one of the items and let htem know what our "norm" is,and how we will accomodate their wishes the best.
(ie-dad wants to cut the cord, this is normal and okay. but, if baby has a tight nuchal, then dad wont be able to do it)
they certainly aren't terribly common around here.
Free-standing birth centers or, under certain conditions, a home birth might be a better option for someone who wants to have every detail approved in advance.
Granted, there are docs, nurses, and facilities that are too aggressive with interventions, but that is something that should be determined long before it's time for the actual birth. If you feel you can't trust your practitioners, keep shopping until you find someone your feel more comfortable with. It's easier to switch docs than get locked into some kind of power struggle.
This is why I encourage birth plans. There is no legal homebirth where I am. There are no birth centers (hoping to change these someday). There is one hospital that offers full-scope obstetrics within a couple hundred miles. So choices are limited here to change practitioners or birth settings. Talking about birth plans during prenatal care really helps educate women on what they can and can't expect.
In the hospital I had my daughter in was a Navy hospital. The rules for our insurance state that IF a military hospital is within a reasonalble traveling distance (I think it's 40 miles...not sure exactly) then we are required to go to that hospital for care or we will have to pay out of pocket...this does NOT apply to a situation with is threatening "life or limb". It was a rooming in hospital, and they bathed her in the room and gave shots and everything else in the room, but I didn't want someone to lose my baby or switch her...or something... May sound stupid, but I didn't want to risk it. As far a saying "no c-sections" do people REALLY do that??? I can remember telling my nurse that if there was ANY doubt about my baby's safety that she should take priority...even if it meant having to preform a c-section before any pain medicines had been able to take full effect. And I was serious! I would much rather deal with TEMPORARY pain of that kind of precedure, than to deal with the LIFE LONG pain of losing my child!!! Oh and it wasn't that I wrote in that I refused pain meds. I just wanted to try to go without anything, and if I did need it I wanted to be in control of that!
Have a Great Day!
Chancie
Kizzykat.. I completly accept your appology! We all have things that come at just the wrong time and rub us the wrong way! I'm sorry that you had a difficult night, and I hope you have a better week!
Birth plans: yes, if they are extensive you can almost bet your next paycheck that nothing on the plan will go as planned. And if the patient is a nurse or doc or doctor's wife, get thee to the nearest Lotto purchasing place and buy 100 tickets!
When presented with a birth plan, I respectfully review it, with the parents. I point out to them that we will attempt to accommodate everything on the plan as far as possible, taking into account hospital policies, JCAHO requirements (such as pain assessment), other factors. I also explain that it's a good thing to remember that the ultimate goal in becoming pregnant was to get a healthy baby and that sometimes there are situations beyond all control, such as a breech delivery, an abruption etc., that might require the plan to be abandoned for a new one. Most people will see the wisdom in that. And many people have never been presented with even the most remote suggestion that there are mitigating circumstances that MIGHT occur, even with their delivery.
If we NEVER ask you about your pain, we are violating one of JCAHO's most sacred tenets! That is another thing I would explain: I won't push pain meds on you, but you have to let me ask you about it.
Non-parent here but have a story to share. My sister-in-law had an extensive birth plan which included pages about how no one was to mention breastfeeding. In any context..no teaching, no advocacy, nothing. She got to the hospital and even hearing breastfeeding discussions with other moms set her off. She thought the hospital would insulate her from that. The unit nurses asked for and got a psych consult based on the plan oddness and her reactions.
It really helped. She had a lot of underlying issues related to body image. She still finds breastfeeding "disgusting", though. (her words, not mine).
I'm sure this has already been said in other ways during this discussion, but I just thought I would add my view too! I don't have birth plans in general, I think its great if the mom-to-be and dad-to-be educate themselves about the whole labor process and make some informed choices beforehand, not just go blindly into labor. At least if they have an idea of how things should progress, and what should happen, they may be better prepped if things start to change, and if things go well and their birth plan is able to followed without difficultly, I love to see how happy the delivery room is after baby comes out, and the whole hospital stay is wonderful for them (and us!). But, I absolutely hate the birth plans that are so rigid, so detailed and the parents-to-be treat the staff like we are evil...it makes everything harder, for them and for us. Those overly detailed birth plans get hard because there are so many things listed, sometimes something gets lost in the shuffle! I would advise anyone who asked me to keep your requests short and sweet, and no more than one page in length, more than a page is too confusing and difficult to communicate to everyone who needs to know.
I think its great to go in with a general idea of what you want, but I think some times people set themselves up for disappointment because they view any intervention that they wanted to avoid having happen as a failure...and as long as there's a healthy baby and a healthy mom in the end, that's not a failure!
For the humor of it, I sometimes imagine what a "trauma ICU" plan would look like. I can't imagine anyone in our unit writing that they not be asked if they want pain meds. Most of our patients aren't volunteering for pain here.
One of my favorite remarks heard about birth plans is that the problem with birth plans is that neither the fetus nor the uterus can read!
Just another way of saying that circumstances can change rapidly and dramatically, making adhering to a rigid birth plan impossible.
I agree with others that I really dislike the adversarial couples who seem convinced that my main pleasure in life is to torture helpless laboring women. As for the no pain med thing - that's fine with me, I enjoy working with moms attempting an unmedicated birth, but if the mom changes her mind and says "I want something now", I'm not going to withhold it just because the significant other says "She doesn't really mean that - see it's in her birthplan!
edited to add - For those of you planning your musical accompaniment for labor - I've REALLY come to hate Enya!
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I feel badly for anyone grieving a traumatic birth experience, really I do. However, I have found, birth teaches us all patience and temperance. At least I hope so. We learn in pregnancy and birth, we are not in complete control, after all. Life changes when we have kids. I honestly believe that is one of the great lessons of childbirth---things rarely go as planned. And anyone who is a parent knows this is so true in raising our children. We can only do our best when faced with adversity.
NOW: if a person feels she was truly and honestly abused or disrespected by her staff, she has the right to redress. It makes the most sense to take that up with the hospital adminstration and management where she gave birth, rather than generalize and ask if "nurses hate birth plans" on an OB nurse forum. It won't net any satisfaction or meaningful change of past experiences, or change how staff treat others in a given hospital, after all. I also feel doctors and midwives have a responsibility here, to communicate to a pregnant lady if there are provisions/requests in a given birth plan that cannot be met due to policy, procedure or their personal inability to honor them for some reason. Ideally, these concerns should be worked out long before the EDC has arrived! Too often, I have patients who come in with plans we cannot meet to the letter, but are unaware even though their doctors had copies of their plans on file in their offices! This makes us out to be the "bad guys" and that is hardly fair. But I digress....
As an OB nurse I honestly believe, most of us have the utmost desire and respect for the best care we can offer our patients. And we do our best to please...but like said above: Healthy mom and baby are our number one goals. And if that means a deviation from a well-thought plan on anyone's part (including ours as nursing staff), so be it. But how we communicate these issues is so important. Respect and understanding on both "sides", so to speak, go a long way to help everyone get along and reach our mutual goals of healthy mom/baby.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
ROFL sounds way beyond reasonable to me. I would have offered you food, one of my cranberry-apple spritzers (I offer these to all my new mommies) and a hug, just for good measure.
Anyone else have the "birth plan phenomena??" Gosh, more times than not, when a mom presents with a birth plan (no matter how reasonable or ridiculous)...THIS mom will have everything happen to them and then some and end up with exactly what they didn't want. I will admit, I have become jaded over so much time that when I see a birth plan, I automatically put a c/s chart in the front pocket to ward off evil spirits.
Some people just have outrageous expectations, and really just read what sounds fabulous from assorted websites and think...this is what I want, with no regard to reality. I don't get up and go to work with the plan to not give my patients a great birth experience. I DO, however, want my patients (both mom and baby) to be well....regardless of what is written on many sheets of paper and considered law.
We just had a birth plan mom (a very extensive birth plan. as a matter of fact) that ended up breech and was scheduled for surgery. Her birth plan dictated that she not have a foley, that the drape be lowered so she can see the baby come out of her abdomen, and so the baby could be put on her breast so she could breastfeed. She didn't want the cord cut right away..the list went on and on. I had to read it again, because I swore she was talking about a vag delivery...but no, this was her birth plan for her c/s. In my institution, c/s are done in the main OR (we don't have OR on our L/D), and cases are totally packed in and there was nothing on that list that could've remotely been accomodated.
Seems like the correlation between elaborate and somewhat adversarial birthplans has to do with a lack of trust at a basic level. The desire to control every last detail most likely has its genesis in fear, whether it be of childbirth iteslf or a deeper distrust of life in general.
Fear is rarely conducive to feeling relaxed. Tight muscles are not labor friendly. Neither are anger, suspicion, and resistance. I'm not "blaming the victim" here. Just thinking that the underlying concerns need to be dealt with long before the onset of labor. Someone, probably in the OB's office, needs to be connecting with patients about the emotional side of the birth process. Asking to see the birth plan and discussing concerns before crunch time might go a long way toward rooting out fear and providing necessary information about what's realistic and what might not be. This approach would also give the parents time to adjust to disappointments about requests which are not likely to be fulfilled. Much gentler that what must feel like a slap of reality during an already challenging time.
In the labor room, a feeling of teamwork--not tension and conflict--should prevail. That's not likely if important issues haven't been addressed earlier.
HappyNurse2005, RN
1,640 Posts
I like birth plans. I like that people have thought this out and want to be prepared to make this a memorable experience. It is the unreasonable ones that get bad...but, by unreasonable, i should say inflexible. Like not considering that you are writing this plan BEFORE labor,and you dont know how things will go.
We do our best to accomodate them, and when they come in with a plan, I personally go over every one of the items and let htem know what our "norm" is,and how we will accomodate their wishes the best.
(ie-dad wants to cut the cord, this is normal and okay. but, if baby has a tight nuchal, then dad wont be able to do it)
they certainly aren't terribly common around here.