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

[PeepnBiscuitsRN]

I don't know when I became so jaded- I had a birth plan with my son...every single thing went the opposite of what we had wanted (induction, ITN with subsequent pukefest and finally stat section for non reassuring heart rate and suspected chorio). But when I see that a patient has a birth plan I cringe! Maybe it's because every couple I've encountered with a birth plan have turned out to be the biggest PITA's I've had to deal with as patients- this last couple...sheesh, the dad interrogated my every action as though he thought I was going to hog tie his newborn daughter and assult her with formula and vaccines.

Their birth plan read as though it was copied out of a book...one of those ever popular "the medical industry and hospitals are EVIL and nurses are bullies and will bully you to do everything you don't want to do!!" Why are nurses and hospitals getting demonized so much? Do they really think we went into nursing because we like to harm babies and mothers and pi** off patients?

Ok, back to the birth plan thing: I've read plans that state "We require a private room" (good thing we have private rooms). "We demand immediate skin to skin and breastfeeding initiation" (gee, I was looking forward to poking your baby and letting him/her starve). "We do not want ANYONE in our room during labor except our accupuncturist and chiropractor".

I suppose these "requests" are not totally unreasonable, maybe it's just the way the plan is worded, and the defensive vibe I get from the patients who copy them from a book or author them themselves.

[losbozos]

So, what's the problem? Or the harm? Sometimes it seems a little strange but is more that we perceive it as confrontational & questioning our skills? If so, why? And if you think the patients can't see how you're feeling, think again. Birthing is an intensely personal experience that has become increasingly medicalized in the past 60 or so yrs. Welcome the birth plan; invite the parent(s) to detail it for you. Finding common ground is so important & will help the parent(s) have confidence in you. However, I do think it would be helpful for all if the providers could better inform the parents-to-be of the hospitals general routines. All of our babies go skin-2-skin & bf unless they need special attention.

[allthingsbright]

pt requesting "clitoral stimulation" from nurse during induction on birth plan=not gonna happen

that said, most birth plans i am coming across lately have been okay--usually printed off the internet --and i wonder if pts even have any idea of what they are requesting! i just think pts are not educated enough coming into the process and have no idea what they are talking about in 75% of the cases. i'm a childbirth educator, BTW--so biased, here.

excuse the lack of caps and punctuation--recovering from 3-in-a-row

[allthingsbright]

plus, i always say in my childbirth classes that birth plans are like Christmas wish lists--you may or may not get everything you want on the list. that seems to lace the idea with some reality! ok, back to bed--

[dariah]

So, what's the problem? Or the harm? Sometimes it seems a little strange but is more that we perceive it as confrontational & questioning our skills? If so, why? And if you think the patients can't see how you're feeling, think again. Birthing is an intensely personal experience that has become increasingly medicalized in the past 60 or so yrs. Welcome the birth plan; invite the parent(s) to detail it for you. Finding common ground is so important & will help the parent(s) have confidence in you. However, I do think it would be helpful for all if the providers could better inform the parents-to-be of the hospitals general routines. All of our babies go skin-2-skin & bf unless they need special attention.

The only 'problem' I have is that patients read online all the things that they "should" want, and then they come into the hospital with unrealistic expectations because we have admission orders and policies we have to follow. Like someone wanting to waive erythro and vit K? Not gonna happen in my state. Someone wants intermittent monitoring but their attending's not around to write the order? Again, not at my institution. So I feel like it kind of sets up an "us vs. them" mentality, and that patients lose site of the fact that the nurses are on their sides (usually) but we are still bound by policies, laws, and our licenses (as well as the fear of litigation!) I don't mind the idea behind a birth plan, but most of them belong in a birthing center, not at my busy, high-risk facility.

What I've started doing (I think as a result of advice from this board!) is just reviewing the birth plan with the patient at admission. I try to let her know that many of the things she wants, we want too (immediate skin-to-skin, infrequent SVE, her partner in the room the whole time, etc) but if there's something that's just not going to happen I let her know (Only your primary OB can change that order, so talk to him/her about that; I can only delay the eye drops an hour after birth). That seems to smooth things over and helps to manage expectations.

[CEG]

What I don't understand is, if these women do enough research to learn what steri strips and saline locks are, then how come they don't research the hospital's policies to know if that's a place they'd like to give birth?

There's really no way for anyone to do this. How would a patient go about finding out if intermittent monitoring is possible or if iv fluids are required? Especially considering that a patient has the right to refuse anything, even if we coerce them into it. If I call the desk and talk to a nurse I will likely get a different answer depending on who I talk to. Often if a patient asks their provider, the provider will give them an answer they want to hear rather than the truth.

Many patients are limited in where they can go due to insurance. ACOG and local OB/GYN groups have made it very hard to have birth centers in most places so it is not an option for many people.

It's oversimplifying greatly to say people should just do their research and pick a better place. It's simply not possible for most people.

[dariah]

Well, plenty of women I know swap birthing stories and recommend OBs and/or hospitals.

Ideally, a woman should present her birth plan to her ob/gyn PRIOR to going into labor. They should really be the ones to work through it so that it doesn't all fall on the nurse the day of.

But, that's also assuming the docs are fully aware of hospital protocol, which sometimes they aren't. :-/

And it's also assuming patients and docs actually get time to discuss the labor/birth process in their 15 minute prenatal appts. :-/

[allene24]

Far to often the patients have NEVER discussed their birth plan wishes with their provider. When they get to the hospital their plan entails things that our hospital does not even offer- water birth, walking around (we dont have cordless monitors), birth balls. I ask- have you talked about this with your OB? ...NO, never. Their OB could have easily told them that our hospital isn't the place where their wildest birth dreams would come true. Maybe a birth center or home birth or another hospital would better suit them- since most of them had perfectly normal, wonderful, healthy pregnancies.

[FutureCRNA?, BSN, RN]

our hospital does not even offer- water birth walking around (we dont have cordless monitors), birth balls[/quote']

I'm a student and taking OB next semester, so I only have personal experience to go on here. Your hospital really doesn't allow a laboring mother to walk around or to use a birthing ball?!? I understand that there may be exceptions, but to not allow it at all? Is this normal for other hospitals? I spend almost my whole labor (and a good portion if my pregnancy, I even took it to work with me) the first time around (second was breech) on my birthing ball and highly recommend them! I was also a high risk pregnancy with a perinatologist.... Just curious!

[morte, LPN, LVN]

dariah...are you really serious that you would force Vit K and eye gtts on a patient with explicit parental denial? Have to borrow one of my mom's sayings "you try that, you gone to be pullin back a nub", refering to what would be left of your hand/arm.!

[dariah]

I wouldn't be forcing it, but New York State law would. If a parent vehemently denies, the protocol is to call child services. :-/ We have to give it within an hour of birth, so I can delay it, but I can't skip it.

[Fyreflie]

I wouldn't be forcing it but New York State law would. If a parent vehemently denies, the protocol is to call child services. :-/ We have to give it within an hour of birth, so I can delay it, but I can't skip it.[/quote']

Are you serious? That's awful!! I've rarely had parents decline newborn meds but if they do they have to sign an AMA waiver after talking to the doctor caring for the baby. There's certainly no CPS involvement. What a waste of resources!

[dariah]

Yep, totally serious.

"....both these interventions are required in New York State by both the sanitary code and the hospital code (Sections 12.2 and 405.21(e)(4)(v)(b), 10 NYCRR). Neither regulation exempts infants whose parents object to the practice. Since these treatments are mandated by state regulation, informed consent is unnecessary, and hospitals and individual providers cannot be sued for administering them. Conversely, a provider’s failure to administer these treatments could result in a citation. A parent’s refusal of these treatments can be reported to Child Protective Services"

My only real problem with birth plans is that many things just aren't feasible at my hospital.

Back on topic....

...the other day I saw a line in a birth plan that stated "I would like to be reminded to remove my clothing before delivery." *head scratch*