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

parker in arkie · Dec 18, 2002

LACK OF CONFIDENCE IN MEDICAL STAFF??????????

i think she is showing SUPREME CONFIDENCE in her bodies ability to handle labor and delivery!!!!!!!!!!

but hey? i'm just a student...

SmilingBluEyes · Dec 18, 2002

yep...birth is a NATURAL and HEALTHY event most of the time...and I have implicit trust in a woman's body and its capabilities....which is why I respect what birth plans mean to our patients. But I also agree.......flexibility must go BOTH ways.....and communication lines must be WIDE open. It goes BOTH ways.

mark_LD_RN · Dec 20, 2002

took me a while to reply Shay caught me by surprise we agree :). now i don't feel like I am so far out there:)

But seriously birth plans or good. I think a lot of nurses and other medical personel look down on them and take them the wrong way. yes some birth plans are ridiculous and are miss informed. but I do not think it is all out of mistrust for the medical profession. but on that note I think the medical profession has it self to blame for some of the mistrust that is out there. I know we have all seen unnecessary procedures and interventions done to patients who trusst us to do what is right. I know on occassion I have been tempted to do things to speed the process up or to just to have a little extra saftey cushion especially when i am tired or to busy like i have been lately. but we need to remember one thing. we are here to help the patient have a safe birth, a happy experience and the birth of their CHOICE as much as possible.

I am for ever the patient advocate and will try to honor their birth plan as best as possible. Funny thing is my patients come to trust me, and if i tell them something different from their birth plan 99.9% of the time they will do it for me.

lets all help the couples have the birth of their dreams and earn back their trust if any has been lost! birth plans are not meant to be a problem.

another thing to remember is that the patient has a right to refuse treatments and who provides care for them.

shay · Dec 20, 2002

Thanks, Mark. :) I thought her plan was pretty reasonable, didn't you? :)

SmilingBluEyes · Dec 20, 2002

it WAS reasonable. To those who are able to see it.

vegicat · Dec 23, 2002

I also agree with the statements to have every Dr within your practicing group sign on the birthplan and would like to add: Make sure to make copies of your SIGNED plan and have them put in your Drs records, as well as take a copy before D-day to the hospital for their records. Then give copies to friends and family as well as mailing one to yourself and keeping it unopened. If your plan is simply to reassure yourself that the staff will be considerate, fine, but many Drs have standard actions they like to take, and will find a "reason" to make it a necessity. Also, talk with your partner about supporting your decisions throughout your labor to help you keep on track, as once you are in the middle of the process it is difficult to think clearly and stick to your original goals or to disagree with, perhaps, a fill-in Dr who doesn't tell you until he's in the middle of it that he is performing an episiotomy against your wishes. I know these things from experience from my (ignored) birthplan, which can be read at http://www.vegicat.com, or email me with any questions. BTW, you might want to get your partner to sign their own version of your birthplan.... I had to send my hubby out for some chewable vit c and a couple other errands as after several requests he could not stop chatting and being too "jovial" during my marathon... lol!

DIPLOMATICRN4HIRE, MSN, RN · Dec 23, 2002

Overall it sounds pretty good but I do have a few concerns when it comes to the surgical aspects of the form.

Do you know of the reasons why you arent given juice and such during the process of the birth of your child.

I understand this is a standard form but I think if you understand why such is going on you wouldnt need to state such.

If in the event of an emergency c section, (which I so dearly hope you will not have under any means) if you have taken anything other than ice chips the chances of aspiration increase. Also the chatter that most hear in the OR isnt a conversation about the days events its about your care and the best way to come about that care with less aggrivation to your self or to your unborn child. As far as others in the OR at the time of the birth. Yes there are times where family has been in there but there are also times where family have hastend the abilty of the staff during an emergency situation. Understand that should be at discretion of your Dr and the Anasthesia in your case.The reasons in which your hands are strapped to the armboards during the case is for better access if needed. To be able to place your hands on your child while or during the time that you are having a c section is not possible unless your sterile at the time which the human skin can not be sterilized, and to have your hands near or around a surgical wound is just asking for an infection I dont think you wish to have.

Man Im sure Im going to be nailed for saying any of this but thats ok

There are reasons why the care plan is like it is... It is for your best interest and the interest of your Unborn child which I know you want to have as much interaction as possible. But instead of a checksheet that can be printed out from some site , if you sit down and speak with your Dr's and your Nursing staff that are there when you go to deliver they will do thier best to fullfill your needs and the needs of your Unborn child in a safe and caring way inwhich they do for every patient that comes through thier doors.

I do however admire your thoughts and the way you went about getting them together and ready for when you deliver, Im glad that your informed and above most during this special time of your life. Your placing your life and the life of your unborn child in the best hands of all Your own, it sounds like you have done much reading and research on the subject and you have a large support system from the looks of it. I see patients when it is an emergency so I cant speak from a normal birth, I dont see that many but I know they exsist, and many without drugs and very little surgical interventions. Congrats on the upcoming birth and even more congrats on placing your care above the norm that is accepted amoung so many.

Just my thoughts

Zoe

mark_LD_RN · Dec 24, 2002

Shay-- i thought it was pretty reasonable my self ,have seen much worse.

Justmezoe-- yes the ice chips only is a precaution main for csection,but the new guidelines say before surgery upto 2 hours a pt may have clr juices. and even then the risk of aspiration is small,.another pont is they still may have stuff in the stomach at the time of c/section even with ice chips only.

we do emergency surgery on trauma pt all the time and they are not NPO or ice chips only.just a thought

June55Baby · Dec 27, 2002

In 1999, my 20 y/o daughter had her first baby at the hospital where I worked. My daughter was well read, knew what she wanted and had discussed EVERYTHING with her OB who had agreed to the birth plan, was on call during labor, and delivered the baby.

The first thing that was done to my daughter was that an IV was inserted and she was given pitocin to "enhance" her labor. The whole time she was asking why was this being done and was told it would "help" her labor proceed more quickly.

While she and her husband were trying to cope with pitocin induced contractions, her OB came in to "Check" her progress, told me to leave, and artifically ruptured her membranes and screwed a scalp electrode.

AFTER all this was done, the RN came in with the consent papers for my daughter to sign for the aminotomy and scalp electrode. ! ! ? ? ! ! All of this was against the agreed upon birth plan and the MD and Nurse DID NOT have consent to perform these procedures.

The attitude of the OB and Nurse was "this is standard operating procedure". When my daughter was handed the consent to sign neither she nor my son-in-law or I knew the waters had been ruptured and the electrode inserted. She calmly said, "No, I won't sign this now, I don't want this if everything is OK like you told me." I thought the nurse was going to drop her teeth..... that was when I realized what had been done! It was too late.

Needless to say, my daughter was VERY upset and felt betrayed by her doctor and the nursing staff.

After a reasonably short 1st labor (7 hrs) my daughter delivered a 7 lb, 2 oz baby girl over an intact perineum with NO ANESTHESIA.

She was terrified to take pain medicine or even dose betwen contractions because she didn't know what else might be done to her or her baby and after that I NEVER LEFT HER SIDE... even when the OB told me to.

Even though she was handling the labor well, the RN kept encouraging her to have an epidural. When my daughter finally agreed to the epidural, I asked the nurse to check dilatation... she was 10 cm and ready to push. Had I not asked, would she have had an epi that could have delayed pushing resulting in forceps delivery or Cesarean Section? Who knows....

Fortunately, the shifts changed and the night shift RN began perineal massage, spoke encourgingly, and told Daddy how to help. This nurse stayed with her. As the head was crowning, the OB rushed in pulling on scrubs over her evening clothes and booties over her spiked heel sandals and "caught" the baby.

When she went back for her 6 week check up, the OB was "bragging" on my daughter telling the clinic staff that here was HER pt that had this baby over an intact perineum with NO ANESTHESIA. After the check up was when my daughter gave the OB a piece of her mind, told her how close she came to being sued, walked out the door, AND NEVER WENT BACK!

Due to insurance snafus, my daughter and son-in-law had to pay for the delivery out of pocket. Unfortunately, the delivery had been paid for in full before the baby was born.

I felt as if I failed my daughter. Even though I worked at the hospital, I should never have left my daughter and should have reported to somebody that the OB and Nurse carried out a procedures without a signed consent. Loking back on it, it seemed as if because everything turned out OK, my loyality to the hospital, not my daughter.

I think your daughter is VERY wise to have a birth plan and to have YOU help her make decisions. My suggestion is for you to read up on standard procedures and hospital policies. Find out what the OB's practices are and NEVER LEAVE HER SIDE. Laboring women are so vulnerable. They need the support of someone who knows and cares for them.

kids · Dec 28, 2002

I do want to explain/clarify a some things:

Andrea has been fairly closely involved in the pregnany, labor and deliveries of 10-15 of her female family members and a friends. She does not distrust the medical profession, she has some fairly reliable & varied observations to draw from and has seen how quickly & easily a birthing experience can be turned into a medical procedure. In her early teens she wanted no children, ever, around 3 years ago she decided she wanted one, she may change her mind again but for now I have no doubt this will be any only child. I cant blame her for wanting to do it as close to her way as she can.

We have both been involved in a couple of home births. I agree that childbirth is a natural occurance and usually things go fine but this is her first baby and is it worth the potential risk to both of them to do it? Anders doesn't think so (and I agree 100%)

Yes she has had classes: Covering L&D, PP, breast feeding and infant care as a 6 week package that included tours of the L&D unit, nursery etc.

Circumcision was covered in the classes, when the questions of to-do or not-to-do were raised the response was very through, info both for and against and various other things to consider, Anders based her decision on: is there/will there be someone in the childs life who can/will take responsability to teach him to care for and clean him self? In her case the answer is no.

Allergies and asthma run in our family, Anders has both. She would like him to get mothers milk for the first year. She has mixed feelings for the physical act of putting a baby to breast but has committed herself to doing it for the first 8-10 weeks before switching to pumping and bottle feeding so she can return to work. She has formed the opinion that they will both be more successful if he is not given an artificial nipple. Yes, she knows he may have to be given bottle feeding if her milk supply "doesn't work" or if he needs fluids or sugar. Plan 'B' is to pump and bottle feed (and babies sooth very well if someone has the time to give them a finger to suck on).

The instructions for the cord blood are not clear and her OB has never done it-but is willing to try, she ended up calling the HSU it is going to and had them send additional info to the OB...more blood for the donation if done while still pulsing, she and the OB will decide how to proceed based on her HCT near the time of delivery (having problems).

Her OB agrees that massage and breastfeeding can be very help for placental delivery and will let her attempt it before administering Pit.

Our local hospital is her only option unless things "go bad" in the next 6 weeks. "Routine" at this hospital is pretty dark ages. You get an enema unless you refuse and possibly a shave..really depends on the nurse. The "old" L&D nurses come in equiped to do it and treat it like it is part of the "procedure", the younger ones ask if you want any of it before they gather the supplies. "Everyone" gets an IV site...and gets IV fluids unless you tell them you want ice chips. "Everyone" gets EFM...unless you say you want intermittant.

The birth plan (1 page printed in 10 pt font with 1" margins (the little squares are bullets in Word):

Birth Plan for:

Due Date: February 5, 2003

Patient of:

December 23, 2002

I am looking forward to sharing the birth of my son with you. I appreciate your reviewing this plan and would be happy to do so with you. It is not my intent to replace the medical personnel or discount your experience; I have created this birth plan to express my preferences for the event. I understand that there may be situations in which my choices may not be possible, but I hope that you will help me acheive as many of my goals as possible and to make this labor and birth a great experience. Please feel free to discuss any questions or comments with me.

Thank you!

Labor

 I prefer intermittent external fetal monitoring during early labor unless continuous or internal monitoring is medically indicated. I would also like to be free to walk, change positions and use the bathroom as desired.

 I would like to wear my own clothes, rather than a hospital gown. I understand that they may be rendered unwearable due to soiling or by being cut in the event of an emergency.

 I would prefer to have a heparin lock instead of an IV during early labor

 I would like to have moderate amounts of fluids (water, juice, ice chips) during labor.

 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 do not permit observers such as interns, students or nonessential staff into the room without my permission. Interns and students may not perform lady partsl exams.

 I would prefer to labor with my membranes intact until at least 5 cm unless manual rupture sooner is medically indicated.

Anesthesia/Pain Medication

 I would like the option of having narcotic pain medication if needed until active, productive labor is established.

 I would like to try a lightened dose anesthetic in the epidural. It is my personal goal is to have my pain managed at a tolerable level and to be able to more effectively push during the delivery.

Delivery

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

 I would like a soothing environment during the actual birth with any bright lights directed away from my face and quiet voices. I will respond better if cued using a clear calm voice.

Cesarean Section Delivery

 If it appears that a cesarean is necessary, I ask that my mom also be involved in discussions with me 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 have chosen my mom as my support person 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 this is not possible the baby should be given to my mom to be the first to hold him.

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 (if present) are to be given the option to cut the cord.

 I have made arrangements for donation of the umbilical cord blood, my Physician has been provided with instructions for obtaining and a kit in my name was delivered to the lab on (date).

 If possible would like to hold my baby and breast feed through delivery of the placenta and any repair procedures, please return my baby to me as soon as possible after he has been evaluated and eye medication given. Please delay bathing until I feel the need to rest/sleep.

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

Newborn Care

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

 Please do not give my baby a pacifier or supplements without my consent, unless there is an urgent medical necessity.

 I am planning for my baby to be circumcised before we check out of the hospital.

Additional notes

 I would like to have still photographs taken during labor and after the birth as space and circumstances permit. No photographs will be taken of the staff without asking first or of the delivery.

 Should unforeseen circumstances arise and I am unable to make decisions for myself or my baby my mom is designated and is authorized by way of both medical and durable POAs legally executed for myself and on behalf of my baby on December 23, 2002.

SmilingBluEyes · Dec 28, 2002

works for me. all i can add to this is:

MY best WISHES FOR A HEALTHY DELIVERY AND BABY!

anitame · Dec 28, 2002

Kids-r-fun: I like this much better. Good luck, I can't wait to hear the details when this little guy is born!