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'm a new grad working on postpartum (still on orientation) and I surprised by the negative attitude towards birth plans. The nurses I work with automatically assume that the patient is going to be a PITA just because she has one!
Most of the nurses I have precepted with don't even bother reading them, even though a lot of the time they cover postpartum issues as well as labor and delivery ones. They say that if the patient wants them to know, she will tell them (I believe that was the whole point of the birth plan, wasn't it??).
Anyway, the thing that bothers me the most about their attitude is that the majority of the birth plans we see are pre-printed, multiple choice/fill-in-the-blank forms that the patients received when they attended our hospital's childbirth classes. So, WE are providing them with the birth plan, telling them to use it, and then holding it against them when they do!! These are very standardized birth plans and say right on them that we will try to accommodate the patient's wishes, but that the safety of mom and baby ALWAYS come first, so the staff may not adhere to the birth plan.
The other day I pointed out to my preceptor that our patient's birth plan stated that they wanted the baby's hearing and newborn blood screens to be done in their room, not the nursery (this was the pre-printed hospital birth plan and we do have portable hearing screen machines for this purpose). She said "Oh. Well. I guess when we go to take the baby to the nursery, she'll stop us if she still wants to do that." I asked her if we should just offer to do it in the room (instead of trying to be sneaky or pretend like we didn't read the birth plan) and she responded with "When you're on your own you can do that if you want, but I never do." How is that advocating for the patient???
There was another patient who didn't want to be asked about pain medication repeatedly (it was in her birth plan and she was very frustrated that no one was honoring it) and made it known that under no circumstances was she to be asked if she wanted something for pain - she would let us know if she changed her mind. To get around the charting requirements, the nurse documented word-for-word what the patient said, and then did pain behavior cues, instead of the 0-10 scale, for her required pain checks after that. Legally, she managed to cover her butt, but still adhere to the patient's wishes.
Specializes in Nurse Leader specializing in Labor & Delivery.
There was another patient who didn't want to be asked about pain medication repeatedly (it was in her birth plan and she was very frustrated that no one was honoring it) and made it known that under no circumstances was she to be asked if she wanted something for pain - she would let us know if she changed her mind. To get around the charting requirements, the nurse documented word-for-word what the patient said, and then did pain behavior cues, instead of the 0-10 scale, for her required pain checks after that. Legally, she managed to cover her butt, but still adhere to the patient's wishes.
That's exactly how I do it, too.
I always try to adhere to birthplans, and if it's something that I can't do (such as allowing FOC *and* doula in the OR in case of C/S) I always talk about it with them up front.
suezan59
20 Posts
I'm a new grad working on postpartum (still on orientation) and I surprised by the negative attitude towards birth plans. The nurses I work with automatically assume that the patient is going to be a PITA just because she has one!
Most of the nurses I have precepted with don't even bother reading them, even though a lot of the time they cover postpartum issues as well as labor and delivery ones. They say that if the patient wants them to know, she will tell them (I believe that was the whole point of the birth plan, wasn't it??).
Anyway, the thing that bothers me the most about their attitude is that the majority of the birth plans we see are pre-printed, multiple choice/fill-in-the-blank forms that the patients received when they attended our hospital's childbirth classes. So, WE are providing them with the birth plan, telling them to use it, and then holding it against them when they do!!
These are very standardized birth plans and say right on them that we will try to accommodate the patient's wishes, but that the safety of mom and baby ALWAYS come first, so the staff may not adhere to the birth plan.
The other day I pointed out to my preceptor that our patient's birth plan stated that they wanted the baby's hearing and newborn blood screens to be done in their room, not the nursery (this was the pre-printed hospital birth plan and we do have portable hearing screen machines for this purpose). She said "Oh. Well. I guess when we go to take the baby to the nursery, she'll stop us if she still wants to do that." I asked her if we should just offer to do it in the room (instead of trying to be sneaky or pretend like we didn't read the birth plan) and she responded with "When you're on your own you can do that if you want, but I never do." How is that advocating for the patient???
There was another patient who didn't want to be asked about pain medication repeatedly (it was in her birth plan and she was very frustrated that no one was honoring it) and made it known that under no circumstances was she to be asked if she wanted something for pain - she would let us know if she changed her mind. To get around the charting requirements, the nurse documented word-for-word what the patient said, and then did pain behavior cues, instead of the 0-10 scale, for her required pain checks after that. Legally, she managed to cover her butt, but still adhere to the patient's wishes.