L & D NURSES: rate my daughters birth plan (please) - page 4

*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

  1. by   mark_LD_RN

    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.
  2. by   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!

    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!
    Last edit by HubbywifeRN's on Dec 17, '02
  3. by   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.
  4. by   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.

  5. by   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!
  6. by   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.
  7. by   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.

  8. by   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! :d
  9. by   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.
  10. by   parker in arkie

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

    but hey? i'm just a student...
  11. by   SmilingBluEyes
    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.
  12. by   mark_LD_RN
    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.
  13. by   shay
    Thanks, Mark. I thought her plan was pretty reasonable, didn't you?