The most ridiculous birth plans you've had the pleasure of reading

Kayla.J.RN · Oct 26, 2012

I find this subject amusing because, so far, I have never encountered a couple with a written birth plan. I'm a very new nurse and have only been a nurse in L&D for 3 months, but even while I was working in L&D for a year as a patient care associate, I had never heard of such a thing at my hospital.

I work in a large teaching hospital in an urban city in New Jersey.... the most frequent request is an epidural... but I'm also finding that most nurses on my unit push for pt's to get an epidural and are not very supportive of women who want to labor naturally...

Sorry if I strayed off topic lol... But I think it's interesting to hear people's false/high expectations for their labor experience. I had a patient the other day who cringed every time the resident came in to give her a lady partsl exam... apparently she thought that we could tell how far along someone is dilated just by looking down there ( as if we have x-ray vision or something?) and she also had a major fit when she found out she couldn't eat anything but ice chips, could only have 2 people in the room with her, and the biggest fit of all happened when she found out we weren't going to allow her outside to smoke a cigarette.

klone, MSN, RN · Oct 27, 2012

Our hospital, especially the midwife groups, encourage birth plans, and I tend to like and appreciate them. It opens the door to dialogue with the woman and her partner on expectations, SOPs, etc.. At the hospital at which I work, most of the things on the birth plan are things we would do anyway. My hospital is pretty progressive, though, and tends to be pretty flexible with patient requests. They do draw the line at lotus birth, though.

Fyreflie · Oct 27, 2012

I don't mind birth plans at all--if you take away the ridiculous language some of them are couched in, the expectation is that you will be using evidence based practice (low intervention, good coaching and labor support, skin to skin at birth, delayed medications, delayed cord clamping and support of exclusive Breastfeeding) unless it is medically necessary to deviate from that. It's a good reminder that while one might prefer to do the tasks first, the bonding and transitioning should take precedence and the discussions you have about interventions should be informed and thorough.

When I encounter a lengthy birth plan I sit down with the couple and go through it (point by point if there is time) and explain what we already do and what alternate scenarios might be (mec, fetal distress interfering with skin to skin etc). I've never run into a completely unreasonable couple!

It's a good reminder for us to take the time to find out what the fears are and explore those as well.

PeepnBiscuitsRN · Oct 27, 2012

I should clarify- I don't have a problem with birth plans themselves- it's a nice way to sort of think things out on what you want to ideally have happen- it's the defensive sort of language they're written in that gets to me. Or maybe it's the overall way that I'm seeing hospitals and OB's and nurses and even midwives who operate out of hospitals becoming somewhat demonized. Like if you don't have a homebirth, or a freebirth or go to a birthing center (I don't have a problem with homebirths or birthing centers as long as someone has some idea of what they're doing and knows when something isn't okay and is okay in telling the patient that something is wrong and they need to transfer care to a hospital) that if they don't do their birth those sorts of ways, then they're terrible and they're going to be tricked and taken advantage of. Natural is great. But nurses and docs aren't out to bully anyone (not all docs and nurses anyhow) I'm sure there are some scalpel happy OB's out there who are only too happy to convince a woman to have a section for something that's not really a good reason to have a section- but going to a hospital to have a baby doesn't always mean that you're doomed to have a section or even be induced, and that's what I'm seeing in a lot of the birth plans- stuff like "Don't you DARE come near me with an IV or an EFM or I'll sue the hospital!!"

Fyreflie · Oct 27, 2012

Yeah the language can be funky-I try to defuse it a bit by just addressing it directly. I haven't run I to the "I'll sue" mentality up here which I'm glad for--but I find that nurses get defensive reading a birth plan and then carry that with them into the room, assuming the client will be that way too!

melmarie23, MSN, RN · Oct 28, 2012

Like klone, I appreciate them. For me, as their RN, it helps me help them. Opens the dialogue. Exlpores their fears and gives me idea on how to comfort and encourage them. And I am that patient who had a birth plan (actually plans) for the births of my two. Its good to have all parties on the same page working for the same goal....a positive birth exprience with a happy, healthy mom AND baby.

klone, MSN, RN · Oct 28, 2012

As far as ridiculousness goes, I always internally roll my eyes at "I would like to wear my own clothes. I would like to listen to music of my own choosing. No unnecessary internal exams. No unnecessary C/S." I think to myself "Girlfriend, you're in a hospital, not prison."

Elvish, BSN, DNP, RN, NP · Oct 28, 2012

The ones that are fourteen pages long and spell out every minute detail are irritating....probably as much because the tone seems to be that I am incompetent and incapable of using common sense to treat people like individuals.

Other than that, a lot of what people want is SOP at my place anyway, like skin-to-skin immediately after birth, delayed shots/drops, walking/position changes during labor, informing people before doing things both during labor and postpartum. No one I work with is a nipple-happy bottlemonger just waiting for you to turn your unsuspecting back so we can fill your baby full of poison AKA formula. (Yes, that was full of hyperbole, not meant to be offensive, just pointing out the defensive tone some birth plans contain. Most of us just want you feed your baby, we'll respect whichever method you choose.) Even still, when faced with a defensive sounding birth plan, I find that when people are defensive like that, it comes from a place of fear. People won't always admit that, or even realize it. It is a good opportunity to talk through stuff. Most people, even ones that can be 'difficult', can be reasoned with. Most people.

What I love, though, are the birth plans that go like this: "We are John and Jane Doe, and we are so excited about the birth of our first (second, seventh) baby. We'd like X, Y, and Z to be done, but we realize things don't always go as planned. If things need to be done differently, we'd like to know what you're doing and why, and we trust your judgment. Also, Jane wants to eat as soon as she can after delivery." (I know, I know....why do we starve women in labor anyway??)

dvsbec · Oct 29, 2012

I agree with previous posters - birth plans help open the dialogue between the couple and the RN. However, I do get a chuckle when I see the 10 page typed documents detailing their every wish and desire. And its more fun when they get the words wrong. I had a couple that wished to avoid having an "epidermal" and medical staff were not to offer "epidermals" at any stage! LOL Then there was the couple that brought in a *laminated* birth plan! What I love more than birth plans though - the visitors and grandparents-to-be who constantly ask "so how much longer do you reckon it'll be?" Wait while I get my crystal ball...... :)

Fyreflie · Oct 29, 2012

Haha laminated? Rotfl!

When people ask me "how long" I now say "ask your baby"--I get 10-20 seconds of completely vacant and then they usually start to laugh like I've made a joke :)

Jolie, BSN · Oct 29, 2012

Like previous posters, I welcome a birth plan as a means of opening a dialog with a couple I've just met and understanding their preferences and desires. All good.

But I draw the line when those plans involve "demands" that would prevent me from delivering quality nursing care, and I explain this to the couple. For example, "I do not wish to have IV pain medication (OK so far), and no one is to offer it to me at any time or under any circumstances (no longer OK). I understand and admire a couple's desire to avoid IV pain medication and will go to the ends of the earth to provide other comfort measures. But we all know that there are times when other measures don't work, the patient is bordering of loss of all control due to pain, and would benefit from pharmacological measures to help her remain composed and able to focus on laboring and/or pushing effectively. I have had patients at that point give their consent for a trial of IV pain meds, only to have a partner step in and try to prevent me from administering it.

To avoid a possible scene at this point, I let the couple know at the beginning that I will honor their wishes and not offer pain meds frivolously, but if I believe that there is a dire need, I will discuss the option with the patient. If she consents, I will not be deterred by the partner, who (with all due respect) is not my patient, and will not be allowed to interfere with the necessary and appropriate care of my patient.

Unfortunately, I have had more than one experience with overbearing men demanding that their partners not receive pain medication despite the woman's request. They have gotten a social services referral toot sweet.