L & D NURSES: rate my daughters birth plan (please)

[kids]

*cringe* she discovered epregnancy.com...amazingly she is willing to let me post it and ask the opinion of experienced L & D Nurses. Most of the stuff seems like basic care and patient rights to me but I guess its better to spell it out than assume.

So, tell us what you think...

Birth Plan for:

Due Date: February 5, 2003

Patient of:

December 8, 2002

I am looking forward to sharing my birth experience with you. I have created this birth plan in order to outline some of my preferences for birth. I would appreciate you reviewing this plan, and would be happy to do so with you. I understand that there may be situations in which my choices may not be possible, but I hope that you will help me to move toward my goals as much as possible and to make this labor and birth a great experience. I do not want to replace the medical personnel, but instead want to be informed of any procedures in advance, and to be allowed the chance to give informed consent. Please feel free to ask if you have any questions or comments.

Thank you!

Labor Augmentation/Induction

 I would like to avoid induction but if induction is necessary, I would like to attempt it with prostaglandin gel or another means before pitocin is administered. If induction is attempted, but fails, I would like the option to come back at another time rather than pursue further intervention (assuming my membranes are intact and that waiting presents no danger to my baby or myself). I will base the decision to continue on the results of my baby's biophysical profiles and on my own personal discomfort.

 Please do not rupture my membranes artificially unless medically indicated.

Labor

 Please perform no routine prepatory tasks (shaving, enema, etc.), unless requested.

 I expect that doctors and hospital staff will discuss all procedures with me before they are performed.

 I would like to be free to walk, change positions and use the bathroom as needed or desired.

 I prefer to wear my own clothes, rather than a hospital gown, I realize that the birthing process will likely render them unwearable.

 I will remain hydrated by drinking moderate amounts of fluids (water, juice, ice chips).

 So I can stay as mobile as possible, I would prefer to have a heparin lock instead of an IV.

 If fetal distress is suspected and time permits, I would like confirmation of this with a fetal scalp blood sample before proceeding with other interventions.

 Please allow me to vocalize as desired during labor and birth without comment or criticism.

 Please do not permit observers such as interns, students or unnecessary staff into the room without my permission.

 Interns and students may not perform lady partsl exams.

 To preserve my privacy and dignity, I would prefer that everyone knock before entering.

Page 2

Anesthesia/Pain Medication

 I prefer an epidural to narcotic pain medication.

 I would like to try having narcotics-only administered in the epidural line before progressing to full anesthesia.

Perineal Care

 I prefer not to have an episiotomy unless it is medically indicated.

 To help my perineum stretch, please help guide my pushing efforts by letting me know when to push and when to stop.

Delivery

 I would like the freedom to push and deliver in any position I like.

 I would like a soothing environment during the actual birth, with dim lights and quiet voices.

 I would prefer not to use stirrups while pushing. I would appreciate help from my mom and the baby's father and staff supporting my legs as I push.

Cesarean Section Delivery

 I feel very strongly that I would like to avoid a cesarean delivery

 If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making. I also ask that my mom also be fully informed so that she can assist me in the decision making.

 I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery. I would prefer general anesthesia in an emergency only.

 I would like to have a respectful atmosphere without chatter during any part of the surgical procedure.

 I would like my mom to be present during the surgery.

 If possible, please do not strap my arms to the table during the procedure.

 If conditions permit, I would like to be the first to hold my baby after the delivery. If my condition does not permit my being the first to hold my baby, the baby should be given to my mom immediately after the birth.

 If possible, I would like to breastfeed my baby immediately after the birth.

 I would like our plans outlined here for after the birth to be followed as closely as possible.

Immediately after the birth

 Please place my baby on my stomach/chest immediately after delivery.

 I would like to breastfeed my baby immediately.

 My mom and the baby's father are to be given the option to cut the cord.

 Please allow the umbilical cord to stop pulsating before it is cut.

 I have made arrangements for donation of the umbilical cord blood.

 I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.

 Please remove my IV/Heparin lock/catheter as soon as possible after delivery.

Page 3

Newborn Care

 I would like to hold my baby through delivery of the placenta and any repair procedures.

 Please evaluate and bathe my baby at my bedside.

 Please delay eye medication for my baby until we are well past the initial bonding period (a couple hours after the birth).

 If available, would prefer erythromycin eye treatment or other antibiotic eye drops instead of silver nitrate.

Postpartum Care

 I would prefer not to be catheterized until I've had some private time to attempt urination on my own.

 Once I've had time to recover, I would like my baby to room-in with me.

 I would like permission for access to my chart and my baby's chart.

Breastfeeding

 I plan to breastfeed and want to nurse immediately following the birth.

 Please do not give my baby supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.

 If I am unable to give my consent to any aspect of my baby's care my mom is designated and authorized to speak and act on my behalf.

 I would like to know more about breastfeeding.

 I would like to meet with the staff lactation consultant.

Additional notes

 I am planning for my baby to be circumcised before we leave the hospital.

 I would like still photographs taken during labor and after (not during) the birth as space and circumstances permit.

 In the event that unforeseen circumstances arise and I am unable to make care decisions for myself or my baby I designate and authorize my mom to act on my behalf including the giving of informed consent.

[shay]

Very reasonable, Nancy. She's covered all the bases, including unexpected complications which is always wise. I would definitely NOT stamp the c/s papers if I read her birth plan. (that's a good thing, btw)

Very reasonable, well thought out, professional.

[mark_LD_RN]

Originally posted by fergus51

Jeez Mark, where do you worK? That doesn't sound like a very nice place to have babies. I assume any woman even without a birth plan could refuse any of this?

well Fergus, it is actually the best one in my area with in a 100 miles or so. the other hospitals are more uptight than theses two. I think we are a little behind the times here:). may now you'll see way i am such an advocate of birth plans:).

i hate seeing perfectly healthy moms in normal labor, stuck in bed and monitored full time. but that is the way the nurses here were trained. so you can see i catch hell from them some time. things are better now they are a little more used to me.

I personally think realistic birth plans are an excellent idea. we had one for all our births and it was a great help. some of the nurses my not have liked it but to bad. we had the birth of our choice, mom and babies were happy and healthy,and did not even end up with a c/section

[RNMom1969]

At first, I really thought this was a joke of sorts. Obviously not. Yes, I have seen my share of "birth plans" as well. None quite so demanding as this. Most of what is asked here is routine, but I personally have some problems with quite a few items, most of which have been addressed. PLEASE!!! Get a doula! On our labor floor.....IV's are standard, as is 10 units pitocin after placenta. AROM....all for it! I get quite nervous when a pt refuses and they are 9cm, bulging, only to rupture spont to find thick mec. It's happened to me on WAY too many occasions.

Are home births legal in your state? Might consider that! Remember, we don't just DO things just to DO them.....every intervention has a rationale.

Sorry if I seem a bit snippy here but I sense a whole lot of trouble brewing with this birth plan! I truly hope all goes well!

Joyce

[mark_LD_RN]

RNMOM1969

yes AROM has it purpose but as I am sure you are aware of it is done routinely very early on, I have seen inductions as well as laboring moms ruptured at one cm which is very inappropriate.

as well as IV's being the standard and 10 of pit after placenta, that is not always neccessary. in place of the IV I encourage moms to at least let us put in a hep lock in cas we need venous access. but I can just as well live with out that even. the 10 of pit is not needed in most cases and can be given IM if no iv access is available. fundal massage and nipple stimulation works just fine in the majority of cases.

I beg to differ thing do get done for reasons other than medical neccessity.IE docs convenience,docs schedule, to hurry things along . at what cost and discomfort to the mom? I have seen more problems created by unneeded interventions then they have prevented.

I can do deliveries as high tech as they get as well as natural, If i had my choice it would be natural as possible. my wife holds the same opinions as me, I have seen many different methods of managing birth, personally our first one was high tech all the way iv pain meds AROM epidural episiotomy forceps etc. last one completely natural and delivery done by me with doc standing by watching. wife wants another one and wants it the same way. she found the first birth horrible from the way it was managed the pain she had, not to mention lack of quality nurses. that was one of the reasons we both became nurses but that is another topic anyway.

back to topic your birth plan looks fine,and GOOD LUCK with the birth. let us know how it goes.

[HubbywifeRN's]

Originally posted by HazeK

First: Did she attend formal birthing classes?

Second: Has she contacted a lactation consultant prior to delivery?

Third: she should review her plan of care with the L&D unit manager to see what unit policies might conflict with her plan of care!

Fourth: if her MD is part of a group, she had better get EACH ONE of the group to SIGN off her birth plan, prior to laboring! Yes, this may mean extra office visits and extra expense! Otherwise, another MD might not accept her birth plan kindly! (I've even had MD's refuse to care for pt's with birth plans, saying: "if the patient doesn't trust my judgement, they need a different doctor!"

Fifth: does she realize how silly it sounds for her to go through this lengthy birth plan to protect herself and her baby from unwanted medical interference....and end it by saying she wants a chunk of her son's flesh cut off, against the recomendations of the American Academy of Pediatrics?

Sixth: she needs to understand that some nurses will take this as a sign of lack of confidence in the care they provide....others will just put the cesarean section papers on the chart when she is admitted!

I'll "PM" you with some other ideas!

Happy Grandmothering!

Hugs!

Haze :-)

PS How old is this daughter, that she has such "control issues" and lack of confidence in the medical and nursing professions????

I've read through all of the responses, and this one really caught my attention. HazeK has made some excellent points, especially regarding the circumcision, and the statement in her PS.

Re the circumcision-- I understand that in the United States, circumcisions are done more frequently than here in Canada. Has the mom-to-be researched circumcisions at all? Might be something she would want to look into. I've worked high-risk postpartum for more than 12 years now and the most frequent reason for wanting their son circumcised I've heard moms give is: "We want him to look like his dad". Well, there's a sound decision!

I've also found that some patients with birthing plans have almost set themselves up for failure, by having too high expectations of themselves, their baby and the entire labour and delivery process. Countless times I've seen a birthing plan state...."24 hour rooming in, don't want baby in the nursery,no supplements, no soothers," etc. These moms are the ones who are in tears after about a day, telling us to "just take the baby to the nursery and give it a bottle, I want to sleep and I don't want it back in my room for at least 6 hours!!!".

HazeK sums up the perception of birthing plans best with "lack of confidence in the medical and nursing profession". Unfortunately this is how I view birthing plans, as do many of my colleagues. It comes across as being mistrustful of the hospital staff, as if we are out to do as many nasty things to the patient as possible, and keeping her totally in the dark as to why we are doing them. We really only want the best for the patient and the baby, and we don't do C-sections for the fun of it, and we DO give patients options and input as long as the situation is safe. When complications arise, the medical and nursing staff are the ones with the training and experience, and the patients need to trust us a little more. Sorry that this turned out to be such a negative response but birthing plans make me cringe!

[shay]

Yanno, guys, knock me over with a feather, but I totally agree w/Mark on this one (breathe, Mark.... ).

Lay off the birth plan. It's reasonable. Yes, some things on there probably are on there b/c that's what she's read on a birth site or whatever, like the cord to stop pulsing before it's cut.

I gotta be rude, but where the hell do you people work? In a cave? I have had many many many laboring women have babies without AROM, IV's, meds, and whom have had the baby remain in the room with them the entire time. Their babies didn't have vitK or e-mycin in the eyes, they didn't have soothers. They breastfed exclusively. It is NOT that odd. I for one think birth has become too freakin' techical and medical and we intervene WAY too much.

Look. Maybe it's because I have PMS, maybe it's because it's late at night and I'm crabby, but dang y'all........her plan is NOT unreasonable. I have seen many many birthplans, and at least hers includes things like the need for internal monitoring, scalp ph's, and c-sections. This birth plan is obviously written by a woman who has educated herself. Lay off. It's not a bad plan. And Mark can tell you, I am NOT a huge birth plan fan, either. So for me to say it's reasonable means it's pretty dang reasonable, y'all.

Back me up here, Mark. :)

[shay]

Oh yeah, and one more thing. She can say no to anything she wants, "hospital policy" be damned. If she doesn't want it, they DON'T DO IT. To do otherwise is assault and battery. :)

Smoochies!

[RNMom1969]

I DO agree with you in the respect of advocating for our patients. No, I do not think AROM should be done at 1cm, nor ANYTHING done for doc's convenience. High tech does have it's place, although I prefer natural myself.

I guess my point here is do not have unrealistic expectations with a "birth plan". I am not going to put a patient in danger....mom or babe, nor will I risk my license or go against policy, just because it's in someone's "plan".

The best advice I can give anyone regarding "plans" is to keep an open mind. Things can....literally....change in a heartbeat!

Joyce

[SmilingBluEyes]

Like I said before, respect the birth plan for what it is. People often feel stripped of their power and decision-making capabilities in the hospital. Having been on "both sides of the sheets" more than once, I can certainly respect what patients/families are doing when they make such plans. They wish to assert some control and authority over what happens to them in the care of others......and medical personnel (nurses AND doctors) CAN be intimidating and often DO NOT LISTEN when they SHOULD be. Obviously, these people feel they need their wishes expressed or such plans would not exist. Respect it for what is and represents to the best of your abilities and explain any deviations from it as you can...and you and the patient will make out ok.

[finallyRN]

I think we as nurses need to respect the patients wishes. I usually will read over a birth plan first and then discuss the what if's of her birth plan. I let the family know that we will try to follow the birth plan as closely as possible, but that my first and foremost concern is mom and baby's health. If the health of either is jepordized the doc and I get to start making some calls (explaining it as best as we can as we go along).

The patient needs to come into the situation with the realization that things changed. If they are stuck in the idea that everything on her birth plan is set in stone and has to be done exactly as it dictates than she is setting herself up for failure.

Both nurse and patient need to be flexible when it comes to birth plans.

Meg

[parker in arkie]

i live in arkansas and can definitely identify with mark!

routine is a sentence here.

with my first child i didn't use a birth plan and her birth was the most powerless, degrading experience i have ever had. i had to poo and the nurse wouldn't let me up...had to do it in the bed....husband wasn't allowed to come back to labor room after he complained that they wouldn't let me go to bathroom, etc, etc...i delivered without husband, flat on back for entire labor and delivery, iv, pitocin, internal monitor....on and on and on....

with my 2nd child, i studied the bradley method. didn't take classes. there are none available here. i am working on my bradley teacher certification now. i filled out a birth plan..because this was my birth. doctors and nurses do this many many times in their lives.

for a mother, it is a special maybe one time thing. with a birth plan, i had 2 completely natural childbirths. one was 7 lbs 10. the other 8lbs 12.

i never thought ill of the hospital staff but a birth plan shows the patient is being proactive and is informed about her choices.

btw, i think it should be noted that according to the american academy of pediatrics statement...there are no drugs proven safe for the unborn baby.

and the knocking on the door was an excellent idea!

[parker in arkie]

OH! if she has doubts that the staff will go along with her wishes and is COMPLETELY LOW RISK, she should consider staying at home as long as possible. i was at 9 centimeters with each of my 2nd two when i arrived at the hospital.