I am a new poster here and I have read a lot of debates on birth plans....controling dads....refusing this refusing/that ect....so here is my 2 cents.
When presented with a 14+ page birth plan I politely expain that "this is a hospital and not a jail" you have the right to refuse and and all procedures/interventions ect.
For example...That the hospital's policy is that you only eat ice chips during labor . However I can not stop you from physically drinking fluids and eating, I can only inform you of the hospitals policy and rational. If you choose to not comply with this policy that is your choice and I will need to sign this AMA form that states you have choosen not to comply with the doctors orders.
This speech can be altered to fit any request.....this is all done very politly and with professionalism....
I inform the pt/couple that her health and safety and that of her baby's is the hospital's number one priorty. I inform the patient that refusing to comply with hospital policy does not change the "excellent level of care that she and her baby will receive" It only minimalizes the risk of liability to myself and the hospital. (which may or not be true depending on the circumstances)
For example.....having a patient refuse continious monitoring....I once had a patient sign an AMA form in which I wrote...
I_________ am declining continious monitoring. I have agreed to intermittent monitoring in accordance with AWWON guideline. I understand that in some circumstances my baby's heart rate may increase or decrease and go undected for 5-30 minutes depending on my stage of labor. I am aware that these changes could result in the injury or death of my baby.
I have done this on more that one ocassion....place a sticker on the form....witness it...and put it in the chart. My managers are aware of this and have never commented....I have had 1 doctor thank me and say....good thinking!! I have no idea if this would be legaling binding or not. But something is better that nothing....
I addition to the "do not offer me pain meds" or my personal favorite...."my husband/coach and I have a secret code...he will let you know if I decide to get an epidural"
I states the following...
"I am leagally obligated to inform you that you have IV pain meds and an epidural avaliable to you, and after this conversation I won't bring up the E word again unless you bring it up first....IF at any time you ask for an epidual we will change positions, take a trip to the BR...or just take a moment to regroup. Then if you ask for an epidural again in 15 minutes I will make that happen. The rules are....you have to ask for it twice 15 minutes apart"
I have always had this agreement welcomed!! I have been thanked...send cards, flowers, and letters saying from patients "That nurse supported my decision to go natural"
These are just some tips I have developed through the years...
I agree, Most women in labor have a hard time dealing with the whole hospital setting and being strapped to monitors for no medical necessity is a hassle. Its much worse when they have to deal with internal monitors especially in healthy pregnancies just because the OB "prefers" to have an IUPC to have a clearer idea of the ctx pattern. Its sad to see that a lot of these pt.s come in uninformed and uneducated. Many do not have a birth plan and go along with everything that their caring physician says. I love it when my patient is informed and is in natural labor, she's term and ready to deliver her baby without the aid of any prostaglandin or labor inducing agent.
Specializes in Nurse Leader specializing in Labor & Delivery.
I do that all the time. I explain options and treatments and tell them I am not a legalized drug pusher. If they choose to change the plan, all they need do is ask me. I will not discuss them (pain meds/epidurals) again, unless they or their family members/loved ones ask me to.
That's exactly what I say too. "These are your options. I will not mention them again. If you would like pain medication, all you need to do is ask me."
nansap
3 Posts
I agree, Most women in labor have a hard time dealing with the whole hospital setting and being strapped to monitors for no medical necessity is a hassle. Its much worse when they have to deal with internal monitors especially in healthy pregnancies just because the OB "prefers" to have an IUPC to have a clearer idea of the ctx pattern. Its sad to see that a lot of these pt.s come in uninformed and uneducated. Many do not have a birth plan and go along with everything that their caring physician says. I love it when my patient is informed and is in natural labor, she's term and ready to deliver her baby without the aid of any prostaglandin or labor inducing agent.