Do you guys read birth plans?

Specialties Ob/Gyn

Published

I'm putting together a birth plan to give my OB in a couple of weeks. I had one for my first, but I never had a chance to give it to my OB when I PROMed @ 36 weeks.

So I'm wondering, would I be wasting my time and paper? I do want to have things explicitly known by the nursing staff, like no e-mycin gtts, no bottles, ect.

I know I read living wills on charts, but that's a differnet slice of cake.

Thanks for any feedback!

Since I replied to this post earlier, I had a patient with a birth plan who didn't want hep b vaccine for the baby and when I asked her husband about it, he informed me that he didn't have to discuss that with me. Of course she wanted the dim lights and the no noise and the no pain meds and no iv. She ended up severe preeclamptic with pit and and epidural and eventually a c-section. The dad stood in the hallway bawling when informed of the need for the section. Just be reasonable and keep in mind the outcome every mother wants-a healthy child and a healthy mom. The way I look at it, when things go wrong, patients should just thank God there is someone in the vicinity who CAN perform a section, and that we have the technology to overcome bad outcomes. In the good old days of all home births, there were many funerals after 48-hour labors, shoulder dystocias, and breech babies, not to mention eclamptics, and babies who died in infancy from childhood illnesses for which we now have prevention.

Sorry to ramble. This is obviously a concern for me, since we have had so many people come in to us in horrible shape after home birth went bad.

My main point is don't become so set on the PROCESS of giving birth that you lose sight of the result you want, which is your baby in your arms.

Good luck.

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Oh yeah, and does anyone know where that "don't cut the cord till it stops pulsating" thing comes from in birth plans? Is the nursery getting a kickback for exchange transfusion admissions?

Or what?

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Originally posted by rdhdnrs

My main point is don't become so set on the PROCESS of giving birth that you lose sight of the result you want, which is your baby in your arms.

Good luck.

Yes ma'am. Go ahead, girl! EXACTLY.

People kill me with how obsessed they get over their birth plans....I just want to scream, 'what is more important here, your UNBORN BABY'S HEALTH, or your selfish need for absolute control???' That dad crying in the hallway was probably 1/4 crying because he was worried about his wife and baby and 3/4 crying because they had to deviate from the holy BIRTH PLAN. Sorry. Raw nerves.

The cord pulsating thing is based on the philosophy that it will be easier for the baby to transition to extrauterine life this way. Hmmm...........YOU'RE NAKED, COLD, AND THERE PEOPLE RUBBING BLANKETS ALL OVER YOU AND SHOVING BULB SYRINGES UP YOUR NOSE...but we'll not cut your cord yet, since we don't want you to have a rough transition to extrauterine life. WHAT-EVER!!!

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There are also reports that infants who have their cords cut 'to late' end up with more red blood cells than needed, which results in higher bilirubin (spelling?) and jaundice! So, good meaning folks, who believed the "don't cut the cord until it stops pulsating" idea, sometime end up going home alone, leaving Junior under the lights! Crazy world huh? People beleave Redbook and some childbirth instructor over their OB doctors!! I know this because I taught Childbirth classes (while also working L&D) and whatever I said they really took to heart! It's almost an "Us against them" mentality. I wonder why? No OB doctor or nurse is going to do ANYTHING to harm a Mom or a baby, not in this legal climate! What a shame, it could be so nice and cooperative, rational, and still what the couple wants! It's not the couples fault really, it's only what they read / hear about etc.

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I always read birth plans especialy ones that have been approved and signed by the doc or midwife.I disagree with a lot of the commentss here about birth plans. Ours was very long and detailed , it even talked about the length of each phase, in that there would be no arbitrary time limit place on the different phases as long as baby was fine. we had no iv hep lock pain meds or pit. no episotomy .Also allowed to eat and drink with in reasonable limits baby stayed at our side, no bath immediately after, no warmer just on mom skin to skin and covered, no suctioning was required. mom allowed to walk and use what ever position she liked. no full time monitoring vag exams only when requested, best of all i delivered our baby while the doc watched. So I am quite sure most L&D nurses would laugh at and not want to go along with our plan. But it is not their birth and should be supportive anyway. Of course I know all the things that could go wrong and if at anytime intervention would have been needed, we would have went along with it, only a fool would deny it at that time.

As far as not cutting the cord till it stops pulsating, there are lots of theories out there about it. we choose to do it that way with our last one and low and behold baby did fine.

So come on L&D nurses don't be so judgemental, support your patients wish with out laughing at them. Our knowledge base is always changing, the latest trends seem to be headed towards more natural approaches at least in my area. Well I hope no one takes this the wrong way,:).

By the way did I say I really love my job.

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Specializes in cardiac, diabetes, OB/GYN.

I don't see the responses as judgemental here. Maybe its me, but understand that it is ok for us to be amused and even not happy that a birth plan is in place. We ALWAYS read them and respect the rights and desires of the patient. It IS a legend (an oft proved one, I might add), that it seems that those people most resistant to any intervention end up with complications.

It is all in the way nurses approach the family, and it is the doc or midwife job and obligation to inform these people that as much as possible, and hopefully, in EVERY way possible, they will be complied with. It is my position that those least open to any intervention are the ones most fearful of loss of control.

There are ways to approach patients when additional interventions are indicated. It does not have to be judgemental, thought may appear so when people are at the opposite end of what normally occurs...If they are not open to suggestion, THAT is judgemental also. No one wants to take away from the idea of a birth plan..Blaming all nurses for being judgemental is unfair. We do our best to accomodate all, but when intervention is warranted or some sort of life threatening situation presents itself, it is our obligation as nurses to provide the best, most skilled care possible, immediately....That is not only our duty morally, but legally and ethically. These same people are usually the first ones to sue if something goes on...

It is no crime to be amused by birthplans. They are usually funny. Think of it as innocence confronting experience. That doesn't detract from the respect afforded the patients entering with expectations which are high. However, they MUST be informed also...Thats life....And thats what WE are here for...To assist, support and save lives...I am not judgemental in that area, but I am realistic...And THAT is the quality someone with a birthplan ALSO needs to bring with them along with a copy of the plan...

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That's so funny you mentioned the loss of control issue. In my experience the nurses most bitter about birth plans are the ones the most afraid of not being in control!:)

Disclaimer: I am not trying to say all RNs are judgemental or non-supportive, just commenting about the ones that aren't.

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ROCK ON, MOTHER/BABY NURSE!! Exactly. You go girl.

Since when is having an opinion on this board 'being judgemental?' Gimme a frickin' break....loosen up!!! :rolleyes:

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Specializes in cardiac, diabetes, OB/GYN.

I think it's scary for just about everyone when it comes to either a real or imagined sense of loss of control..I didn't mean to imply any one was actually being judgemental or accusing anyone else of that. And, I KNOW there are nurses with control issues..It's that damn human thing...

We all have different approaches to things...Thats why is a good thing to have nurses with different and even opposing view points..If we were all the same we would probably miss something crucial and not get a whole lot done..

Am I right? Please SOMEONE tell me I might be...With three toddlers and a teenager, you KNOW I am rarely right! :)

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Yes...

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Birth plans, whether formally written out or verbally expressed at admission, have their place. I think we run into trouble when there is a lack of understanding as to the risks these Mom's assume--if I know they fully understand all the risks and benefits of treatments/interventions then I'm more comfortable (and these families are reasonable when the need to intervene becomes apparent).

I think that anyone who has been around awhile has had that "dumber than dirt" family with rigid demands and beligerant attitudes. Mine was our lay lactation consultant who insisted on putting her blue, breathless baby to breast as soon as he was delivered--OK, if you're not breathing, you're not going to latch on (am I right?)--it was a struggle to get her to hand this kid over--stimulation on the abdomen was not working and I remember thinking--we're losing IQ points as we stand here..........

Oh, and it's greatly known that the more rigid the birth plan is the more complications will arise and create deviations from said plans.................thereby making the nurse AND family unhappy campers :}

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Specializes in cardiac, diabetes, OB/GYN.

Ok, Just when I thought I had seen the most bizarre birth plans, along comes this couple who asked all the nurses to gather in the room so they (ahem, he) could tell us our services would be minimally required and we were to intervene as little as possible. In fact, they really would prefer if only the doctor did hands on anything (ha ha ha ha ha ha ha ha).....Well, we tastefully tried to mention that the doc isn't always available during the day due to office hours and other patients, and on the off shifts especially, other doctors might be covering.....No, daddy insists, that is not the way it will be. I ask, Is moms doc aware of this part of the birth plan as it isn't actually written in and there is no documentation indicating the doc intends to come in when she isn't covering...No, he says, but she will if I say so. (do you THINK there is a control issue here??). I suggest they make a call to their doctor, but in the meantime it appeared that the mom was uncomfortable and if it was ok with him, I would love to attempt to make her more comfortable. HE says (she has said nothing so far).. WEREN"T YOU LISTENING??? I, surprisingly, politely tell him that I understand what he said and respect their wishes (I glance at mom and ask if she is in agreement but she isn't saying anything), but, as there are only the nurses there, we just would like to get a look at the baby's heart rate...He isn't happy but he agrees and then asks if I have called the doctor yet...I tell him no, mom has only been on the monitor for 10 minutes...He sighs in disgust and says, right in front of me "THIS is the reason nurses shouldn't be involved in deliveries! (Hello!)...So, I mention he certainly can call the doc any time he would like and he has the audacity to tell me that is MY job...( I am about ready to throw him through the roof now, by the way and it takes a LOT to get me in that mode...) My plan was to call the supervisor and let her intervene, as we had 4 other patients in various stages of labor, when the patient in the next room had a major decel and we ran in, did all the right stuff and managed to stabilize things in a calm manner...Birth plan daddy watches all this and is sort of impressed and kind of tells me so by allowing me back into the room to see how his wife is doing... About an hour later, after I have filled the doctor in ( and thank you delivery God, THEIR doc was on overnight), when birthplan mommy's membranes burst and of course it is thick mec...Doc is at home (not too far away but far enough away that I have to mess up the birth plan by actually intervening in some manner.) Birth plan dad stands up and gets ready to say something (my look of admonishment and fear must have made him think twice), fh takes a dive and we have a freaking prolapsed cord. Guess what happened???Yep, stat c/s with the doc just making it...Daddy fainted..Mom and baby ok and nurses to the rescue, again....

Too bad we don't know what we're doing....:)

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