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.
the majority of birth plans are written without any real knowledge of what goes on in L&D. sure you can read all the websites and watch all of the episodes of 'the baby story' you want, but still you have no clue about what goes on to save you and your baby's lives. that's why you'll rarely see a L&D nurse write a birth plan... we believe in and trust that everything being done is best for us. there's no need to try to assert control over a situation that you really have no understanding of, no matter how many babies you have had. also, on a side note, if you have a birth plan, you increase your risks of a c-section greatly! it's just the odds... lol, ask any L&D nurse.
Some of the requests on birth plans are clearly difficult to see through. Stating you will never have a c-section, you don't want staff talking, and you want lights really dim isn't going to go over well. You might need a c-section, staff needs tp be able to communicate, and those caring for you need to be able to see. On the flip side having no stirrups shouldn't be an issue at all, you shouldn't be required to have an enema or shave that some antiquated docs might still order, and if the situation allows you should be able to walk, shower, etc. without being hooked up 24/7 to a machine.
Women are educating themselves more in regards to births so most aren't coming in blind to the situation anymore. They are more aware of what is done for convenience versus need. They know some interventions are done because doc orders them for no reason. Some don't want to be forced to induce because the doc wants to go play golf or have an unnecessary c-section so the bill is bigger and the doc can plan. These two things do happen in some hospitals. It's a good thing that women are learning more and asking more questions. We want to keep the babies and mothers safe but we also want to give control and choice to women where applicable.
To state they want control over a situation they have no understanding of isn't the case anymore. They don't know as much as the nurses but they aren't ignorant to all the facts either. And of course people want some control...it's their birth. Meet what you can and explain why when you can't. I wouldn't make this a power struggle. All lose. The more that go in on both sides without a chip on their shoulder the better the outcome for all.
I work in newborn nursery so the birth plan doesn't as much apply to us, although parts do . . . but I will say I dislike birth plans that expect us to act like a birthing center - if someone wants a certain type of birth, a birthing center is a better choice. We do want to use EFM, we do want an IV, we do want you to deliver using the stirrups with decent lighting.
This is part of the problem... in many cities you just don't have that many options to have the birth you want. There may be no birthing center, or no midwives that practice homebirth, etc. etc. So you deliver in a place that doesn't really share your birth philosophy and try to make it work... and it CAN, if there is flexibility and communication on both sides.
Specializes in Med/Surg; Orthopedics; Geriatrics; L&D.
WOW! Reading through all this made me want to laugh (anybody want a sandwich?), cry at times (poor gal w/ the delivery experience from you-know-where!), and just shake my head. Most of us on my unit aren't real fans of birth plans, but it's not because of the percieved PIA factor.
It all boils down to this: a majority of the items on such lists fall under one of two categories 1) things we already do, and 2)things that go against policy/JCHAO standards that we simply can't do. There are a few things that fall between and we can work with our patients if it something that is feasible and wouldn't compromise their or their baby's safety.
Many birth plans I have seen are worded in a very adversarial tone which doesn't promote my basic philosophy: we all are on the same team with the same overall goal. I start my patient contact stating my goals for her to make sure she and I are of the same accord, and trying to break the ice and build trust and rapport as quickly as possible, because I don't know how soon I may need to rely on that bond of trust to get mom's cooperation to help me help her/her baby. I'm all about "Happily Ever After" whatever it takes to get us all there safely. Most of my patients love me, refer me to their friends, and have returned asking for me with their subsequent children, because I do everything i can to make it both safe and fun. I love what I do and feel that it shows.
As for my birthing experiences, that's a different story......
I have been a labor and delivery nurse for 15 years and have run across every kind of birth plan imaginable.....I think they are great!!! Even with the so-called unreasonable ones, at least I know that the patient and her partner have put some thought into what might happen when they get to the hospital. I always make a point of sitting down with the patient and s.o. and going over the birth plan line by line. If there are things that may be unreasonable I explain why this is and usually the patient is okay with this. Above all, I AM MY PATIENT'S ADVOCATE! And not all birthplan patients end up with cesarean deliveries.
I like to read birth plans. I think that they are interesting. I work in postpartum, so I get to see how things play out after the fact. Most of the things that people request are things that are normally done anyway, and I definitely think birthplans are a good tool to communicate expections between the patients and hospital staff.
It only becomes crazy when people become unreasonable. Once someone put in her birthplan that no one was to say contraction or pain, we were supposed to say "energy surge" and "discomfort." That is taking things kind of far.
I'm in Med-Surg but I had a birth plan for my 2nd baby. I didn't have one the first time and ended up with every intervention in the book including a c-section. I wasn't trying to be a PITA. I really just wanted to make my birth special and there were things that my nurse could do to make it a beautiful experience no matter how it turned out. Many of my requests aren't necessarily the "norm" but could be done.
I had a 2 page (double spaced, short bullet point) birth plan that I gave to my midwives (they were the ones that need most of the info!). The I had 1 page plan (same format) for the hospital.
I was careful to start it with "We request:"
- To return home if I am not 4cm. (Some women are adamant about staying the minute they have a contraction. I have no need to tie up an L&D room for the next 3 days. I was admitted the first time at 2cm)
- Saline-lock instead of running IV (already discussed with my midwife but info for the nursing staff since IVs are common)
- Desire for birth free of drugs unless requested (in other words, don't ask me how I am going to manage my pain or when i want my epidural; I will feel better if I make that decision without being prompted)
- plan to use HypnoBirthing (staff was familiar with that technique so I figured it would be good for them to know what I was doing)
- To have a doula, ____, present (how else would they know who that woman was or what her role was?)
- To use the shower and tub (so they would know I was interested in that option and they could suggest that for pain management, something the nurse at my first birth did not do!)
- No loud coaching during birth. Please use calm, gentle tones (the 1, 2, 3 shout-counting really bugs me and I didn't want to punch my nurse in the throws of labor!)
- Use mirror to see crowning and birth (some women are grossed out by this; I wanted it!)
In the event of a c-section delivery, we request:
- to avoid a cesarean delivery unless the baby's life is in imminent danger (sounds obvious but my 1st baby was a "failure to progress" c-section)
- to have at least 1 arm free/not strapped down to table (I understand the arm for the pulse-ox but I didn't want to feel like I was being crucified!)
- for anesthesia to be monitored/adjusted to prevent feelings of suffocation (I had a really bad experience with the anesthesia the first time and I wanted my nurse to know so that she could advocate for me with the anesthesiologist)
- To have screen lowered during baby's birth (so I could see!)
- to see the baby immediately following delivery in order for us to announce the sex (this was the part I really missed with having a c-section! I didn't think it would be a big deal for them to hold the baby up and let me announce. Again, this was a way for my nurse to advocate for me)
- to have baby placed on my chest immediately following birth (I know hospitals don't love this but it can be done)
- To have baby in recovery with us (checked with the hospital ahead of time and they were cool with that but I figured this was a good way to let my nurse know I wanted that!)
We also wrote that we didn't consent to circumcision, erythromycin (no need) or the Hep B shot (that can be done later)
Anyway, that was my thought process behind my birth plan! Maybe it was annoying but it was important to me. :)
Specializes in Med/Surg; Orthopedics; Geriatrics; L&D.
So many people talk about pain meds like they're a "potty word". I discuss things with my patients up front and let them know that if they want something, let me know. I explain the ins and outs of both IV pain meds and epidural for pain relief. If I have an order for it, then I'll make the necessary arrangements, if I don't already have an order, I'll call and get an order. It's that simple. If they don't want anything, that's fine: I'll huff and puff with them all they want (I'm actually one of the best huffers and puffers on my unit :)) BUT if I offer, I ask that they please don't be offended, it simply means that they don't seem to be managing their pain well and I'm offering whatever I have orders for that might help. I make sure they know that no matter what I, their doctor, their S.O., their mom, or whoever else wants, it is ultimately up to them and I will not twist their arm. I feel my patients enjoy their pain management better when they feel like it is their call and done when they are ready if that is what they choose. If I see my patient isn't dealing with it very well, despite all the coaching they're given, they usually don't grudge me when I offer, because I touched that base before we got there and htey know where I'm coming from. Now about that cockamamy 'power surge' stuff.......lol
The best birth plan I ever saw was the one that went through all the preferences with the flexibility necessary for baby and mommy safety. The last item on the list was: And I would like the L&D to be over in 10 minutes! We all had a good laugh over that one!
Specializes in Nurse Leader specializing in Labor & 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.
I was told that documenting "Pt. wishes to labor without pain medication and has asked that the RN not ask her about pain. Pt indicates that she knows her options and will ask about pain management if she needs it" covers your bases as far as requirement of assessing pain.
If the pt has requested that I not ask her about her pain, then IMO her request overrides JCAHO requirements, especially since JCAHO requirements are hospital wide, and doesn't take into consideration the uniqueness of L&D.
In those situations, I will also assess pain based on pt cues (such as moaning, crying, restlessness, muscle tension) and put in a number I think is appropriate. For "acceptable pain scale" I will put in 10.
Specializes in Nurse Leader specializing in Labor & Delivery.
Where I used to work, it was a small community hospital with only OBs. Doulas and natural childbirth were regarded with skepticism and suspicion, and as a result, the "natural minded" parents came in with an adversarial attitude, and those birth plans often read like a list of demands.
Where I work now, the midwives encourage birthplans, and most of the stuff on them is stuff we do anyway. I enjoy going over the birthplans with the parents, and I love working with most doulas (there are a few that blur the boundaries of appropriate behavior).
My doctor with my first baby was very sweet and he asked me if I had a birth plan, I said "yes, my husband is to bring me to the hospital asap and I want you and your highly trained nurses to take over and take great care of me and my baby." He said "I love it!"
Of course I wanted to hold my baby right away and nurse her, most health care professionals want this too if possible. My daughter came out not breathing and needed to be stimulated and was given a little O2 then brought to me to love, hold and nurse... it was perfect :redpinkhe I will always be thankful for everyone involved in the births of my beautiful healthy children.
Sometimes I think the looser birth plans will let you enjoy the wonderful and sometimes unexpected journey the birth turns out to be. You really never know what the day will truly be like till you experience it.
We all had a good laugh over that one!
1996RN
74 Posts
the majority of birth plans are written without any real knowledge of what goes on in L&D. sure you can read all the websites and watch all of the episodes of 'the baby story' you want, but still you have no clue about what goes on to save you and your baby's lives. that's why you'll rarely see a L&D nurse write a birth plan... we believe in and trust that everything being done is best for us. there's no need to try to assert control over a situation that you really have no understanding of, no matter how many babies you have had. also, on a side note, if you have a birth plan, you increase your risks of a c-section greatly! it's just the odds... lol, ask any L&D nurse.