Seething over Failed 'Birth Plans'

[adventure_rn, MSN, NP]

Lately I've been feeling a lot of inner turmoil and unresolved frustration at work. My unit has seen a huge upswing in HIE kids. The vast majority are freak accidents (abruption, uterine rupture, etc.), but we've also seen more children of failed 'natural births' with brain damage, blindness, seizure disorders, and death that were entirely preventable. I'm talking about the 11 lb LGA mom who refuses to sign consent for anesthesia because c-sections are 'unnatural,' or the mom with a history of shoulder dystocia who is insistent on home birth because it's more 'meaningful.' When these birth plans have catastrophic outcomes, I want to be supportive but I can't help feeling some judgment and contempt. So many NICU parents did everything they could to support their kiddos, and yet these parents knowingly put their children at higher risk for poor outcomes for the sake of having the 'ideal birth experience.' I can't help but feel that it seems selfish and reckless.

I'm having a hard time letting this go. Any advice on coping mechanisms, or just general commiseration? I'm feeling a bout of burn out coming on. (At least getting all of my thoughts out on AN is therapeutic )

American Journal of Obstetrics and Gynecology article on Neonatal Mortality in Home Births: Early and total neonatal mortality in relation to birth setting in the United States, 2

[BrandNewBabyNurse]

Oh man, I don't have any advice, but I certainly feel ya! Living in a part of the country with a decent sized "crunchy" population, we see our fair share of home birth gone wrong kiddos. I really am not against home births, but it's in those like you mentioned (hx of difficult birth, or failed to transfer when signs indicated danger) that I get frustrated. Luckily the hospital that I work at has started staffing CNMs, so I'm hoping that by giving those devout natural birth-ers an in between option, maybe some of the higher risk women will choose to go with a hospital birth if they can still see a midwife and keep things as natural as possible. Might be wishful thinking, but I'm gonna run with it lol!

[adventure_rn, MSN, NP]

Luckily the hospital that I work at has started staffing CNMs, so I'm hoping that by giving those devout natural birth-ers an in between option, maybe some of the higher risk women will choose to go with a hospital birth if they can still see a midwife and keep things as natural as possible. Might be wishful thinking, but I'm gonna run with it lol!

One of the areas where I used to work had a ton of birth centers, which was awesome. They're basically stand-alone facilities located near hospitals that staff CNMs, nurses, and a couple of supervising OBs. Some even did water births. They can't perform C-sections, but they have resuscitation equipment readily available. It seems like a very good compromise. We also had a ton of trained doulas in that area who provided in-hospital services, which helped moms having hospital births to have a more family-centered experience.

[prmenrs, RN]

We had a Birthing Center (midwives, doulas, etc.) IN the hospital. If things went south, the OR, OB Docs, NICU resources, were 2 floors away. The rooms were very home like, big family size beds, cradles. So, it was a comfortable place to give birth. And, safety was not far.

That said, the few times NICU team got called up there--you have never seen a nurse, doc, resp therapist, and their equipment move that fast in your life!!