L & D NURSES: rate my daughters birth plan (please) - page 3
*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... Read More
Dec 12, '02Occupation: Level II Neonatal Nurse Joined: Oct '01; Posts: 76; Likes: 11Most of that is standard where I work. (no shave, enema) But definitely shorten it. We often don't have time to read through the long birth plans. It always seems that the longer the birth plan the sicker the baby. Just one question, who is getting the other baby bracelet? If mom can't make decisions d/t an emergency, whoever has the other bracelet might be responsible for any decisions about the baby? This is especially true if the mom is not married. Otherwise, sounds pretty good to me.
Dec 12, '02Occupation: Level III NICU Specialty: NICU ; From: US ; Joined: Oct '00; Posts: 1,605; Likes: 929You all speak of clicking on these on a website... Is this actually a site where you "go shopping" for these requests and then print out the whole thing at the end?
Dec 12, '02Occupation: NICU RN Joined: Oct '00; Posts: 2,537; Likes: 369Originally posted by KRVRN
You all speak of clicking on these on a website... Is this actually a site where you "go shopping" for these requests and then print out the whole thing at the end?
Dec 13, '02From: US ; Joined: Oct '01; Posts: 6,238; Likes: 1,829Thanks for all the input...btw...I just looked closely at it saved in word...the 3 pages have alot to do with her formatting it in a 12 point font (among other things) and pretty little bullets...she has done some editing down most of it based on everyones suggestions. I think it looks better and seems less redundent & picky.
Dec 14, '02Occupation: Women's Health NP Joined: Sep '02; Posts: 107; Likes: 2I definitely agree with the other posters that the birth plan is too long. Some specific things to think about: the more you demand things that we routinely do, as if we wouldn't do that anyway, the more negative the responses tend to be from staff, especially MD's, who tend to look at people who come in with lengthy birth plans as unreasonable and difficult. So it may NOT be better to spell it out, as you said in your post. You also want to be careful about stepping on the toes of the person who you've entrusted your care to. Your Doctor is your doctor because he/she has the training and medical knowledge to care for you in the best way possible. The best thing for your daughter is still going to be the best thing, no matter what the birth plan says. Other things that I noticed are that if she plans to have an epidural, she will need an IV, and not just a heparin lock. In the L&D that I worked in, a patient had to have at least 1 liter of fluid in before the anesthetist would even step into the room. This will take 30-45 minutes at best to infuse, which means if your daughter were to decide quickly that she wanted an epidural, that would not be possible. I think that the Prostaglandin thing should not be placed in a birth plan. That's a medical decision that would be made at the time that the need arose, after discussing it with your doctor. She could make her wishes known at the time that the need arose.
I would remove the first 3 statements in the "Labor" section. These do not have to be spelled out, as they are routine. I discussed the hydration and heparin lock issues above.
Anesthesia/ pain medication is something that should be discussed with the anesthetist at the time that the need arrises. Narcotics only in the epidural is standard for labor epidurals, unless being used for C/Section.
Under "perineal care," she should eliminate the "To help my perineum stretch...". This is standard.
Delivery section is good.
Rather than stating in the birth plan that your daughter feels strongly that she would like to avoid a C/Section, which is true of every first time Mom I have ever seen, I would suggest that you discuss with your Doc what his/her C/Section rate is. That will be the best indicator of how C/S-happy your Doc is. Your statement that you want to avoid a C/Section won't change your Doc's attitude toward when a C/Section is necessary. Now is the time to protect yourself against unnecessary C/Sections, before labor.
Again I would remove the statement under C/section that you want to participate in all decision-making. This is a given.
I can tell you that if your Doc wants to talk while he/she is doing your C/Section, they will. Most Docs talk after the baby is delivered, although in the time prior to the baby's delivery, they're pretty focused on getting the baby out. Most C/Sections, as long as they are not emergency C/Sections, are seen as happy times, and staff will talk while in the room. Chatting in the OR is not disrespectful. It keeps the staff calm and relaxed. I think that this will not bother you as much as you might think. A quiet room is a tense one in surgery. I would eliminate this from your birth plan.
In our hospital as well, strapping arms during surgery is necessary, and for her safety, and is not optional. Under C/Section delivery, you have that your daughter wants to be the first to hold her baby after delivery. This just isn't possible in a C/Section delivery, although you could hold the baby for her, close to her face, if she had a C/Section. This would be appropriate under another heading in the birth plan, though. Breastfeeding immediately after delivery would also not be possible in the case of a C/Section due to the draping. However, it could be done as soon as she arrived in the recovery room.
I would discuss with your doctor the pulsating cord issue. There was a study done a few years ago that said that when the cord is left to continue to flow without being clamped soon after birth, babies were more likely to become jaundiced. The researchers believed that it was because of the transfusion of too many red blood cells from the cord blood after delivery. The RBC's then broke down, causing jaundice. I would discuss this one with your Doc before including it in your birth plan.
I think at most hospitals, the removal of the IV/heparin lock routinely occurs asap after delivery, so this would not be necessary to put in the birth plan.
Other posters have commented on the eye meds, so I will leave that one alone.
Your daughter would never be catheterized without plenty of time to urinate on her own.
The access to your baby's chart...this is a sticky situation. Yes, according to HIPPA regulations, you always have access to your chart, but stating that you want access to your chart will put people on the defensive. It makes you appear to be distrustful, and likely to sue for anything. This will not go over well. If a situation arrises that you felt like to needed to look at your chart, you could discuss that at the time, but I wouldn't put it in the birth plan.
And one more thing and I'm done... Your daughter states that in the event that she is unable to make decisions for herself, you are designated to act on your behalf. Unless she is a minor (in which case you and her father would automatically be the designated persons to make decisions about her care), having this in the birth plan does not legally give you any rights. If you want something like this written up, it has to be a legal document. Some libraries have books on how to write up your own simple legal documents. You may be able to find something like this (power fo attorney, it's called) in a book at the library.
I know this has been long, but I think it will help you get a better reception. The attitudes of your Nurses and Doc will go a long way toward making this either a good or bad experience for your daughter. Best of luck to the both of you, and to your soon-to-be Grandchild!
Dec 14, '02Joined: Feb '02; Posts: 63; Likes: 1If she has a c/s, the nursery team will be the first to get the baby. Most places will not let you breast feed while you are on the OR table, might contaminate the OR field. I agree, the paper is toooooolong. If you don't put the eye ointment in within the first hr, it is pointless to do it at all. Does she know how they obtain the fetal blood gases?? She might want to reasearch that. Is she doing a private donation for cord blood?? Some places here in town won't do it for the pt because of the liability of it getting messed up Most private places charge for the kit and a monthly charge to store it. Sounds like she needs to call the hospital she is delivering at and check out whether they will even do it for her. And while she is at it, she might run the birth plan by the head nurse/nurse manager/charge nurse, and see if anything is afoul of their policies. Might save heartache on admission if she has her heart set on something and they can't do it. Like the pt I had yesterday that was devastated we would not let her have lit candles all over the room. If she would have called, she would have adjusted to the idea and maybe come up with another plan that did not involve open flames.
Dec 14, '02Occupation: RN, MS home health Joined: Aug '02; Posts: 7,472; Likes: 49I think it is alot to ask and read for staff. The eye drops I was concerned with. Alot of those things happened to me as the way it is done. I had no meds. What do you think? Heather where are you???????
Dec 14, '02Joined: Oct '00; Posts: 10,236; Likes: 64While I don't see alot of birth plans in post partum/nursery, I will agree that it is awful lengthy. Also, most of this is stuff we already try to do, our standard of care. When you present it like this, it does tend to sound a little condescending.
How many docs are in practice with your daughter's doc? I agree with the other posters that this is something that should be shared with all of them. It's an extremely detailed list of things to present to a doc at the last minute (which, let's face it, is about when the doc walks in).
I think that if your daughter has a good, honest, and open working relationship with her doc(s), alot of this is unnecessary. I also hope that your daughter is not afraid to ask questions and make suggestions along the way. I guess I just never understood why it all had to be written out like a will. Like once contractions start you'll no longer be competent enough to speak up for yourself.
I sooooooo can't wait for the "I'm a Grandma" announcement!
Dec 15, '02Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14it may be a little lengthy but i have found it a necessary thing at times and with certain doctors.
a couple of examples, 1) enema one hospital i work at 2 docs routinely order enemas and expect them given. 2) allow perineum to strech before cutting : again some docs cut first I have been told that you can not deliver a baby with out one and streching causes damage,i say b******T on that thought3) rupturing of membranes how often have we seen people ruptured because doc was in a hurry?
were i work now unless you have a birth plan you get routine treatment,(unless you are lucky enough to have me for your nurse ) iv fluids bedrest with bathroom privleages only confined to bed otherwise. full time fetal monitoring, arom at 2 cm pitocin augmentation,etc. perineal prep with betadine or hibacleans before delivery,put up in stirrups lights on, episiotomy,etc
as far as what happens if you dont present your plan, its the same as not having one.
I highly reccomend she review her plan with her doc or midwife and have them sign it, leave copy with her and bring several copies with her to hospital. I also like the doula suggestion .then of course i would since i am a doula my self
well hope this helps some. hope it makes since just had a minute at work to type a fast replyLast edit by mark_LD_RN on Dec 15, '02
Dec 15, '02Joined: Jul '00; Posts: 11,351; Likes: 385Jeez 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?
Dec 16, '02Occupation: RN Joined: Nov '01; Posts: 1,487; Likes: 70Very 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.
Dec 16, '02Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14Originally 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
Dec 17, '02Occupation: L&D registered nurse Joined: Sep '02; Posts: 21At 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!