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.

[klone, MSN, RN]

The unfortunate thing about this hostility towards medical intervention is it's driving women to consider delivering at home which can be very dangerous.

See the thread in nursing news regarding homebirth. More women choosing homebirth is not a bad thing, as long as they're appropriate candidates.

[SanDiegoCaliRN]

See the thread in nursing news regarding homebirth. More women choosing homebirth is not a bad thing as long as they're appropriate candidates.[/quote']

I guess that's a matter of opinion. I happen to think choosing to birth at home is extremely risky even for "low risk" women. They put themselves at the mercy of their midwife and her assessment skills and willingness to "throw in the towel" and finally admit this is a more critical situation than she can handle (and trust me, many throw in the towel way too late). But will there be time to get to medical help? Sometimes, no.

No one ever sees shoulder dystocias or thick mec coming. And yet home births are usually post term, larger babies at increased risk for both). Add to that another unforeseen, a tight nuchal and you could have a deadly situation that spirals out of control very quickly.

I'm sorry, I just don't see the wisdom in potentially risking yours and your baby's lives and for what? To deliver in the comfort of your own bed? Apparently these women don't know how bad things can turn in the blink of an eye. Maybe I've just been in this business too long and I've seen too many bad things. Birth may be a natural part of life but it can also be deadly. Death is a natural part of life too. Why take chances?

[Elvish, BSN, DNP, RN, NP]

I guess that's a matter of opinion. I happen to think choosing to birth at home is extremely risky even for "low risk" women. They put themselves at the mercy of their midwife and her assessment skills and willingness to "throw in the towel" and finally admit this is a more critical situation than she can handle (and trust me, many throw in the towel way too late). But will there be time to get to medical help? Sometimes, no.

No one ever sees shoulder dystocias or thick mec coming. And yet home births are usually post term, larger babies at increased risk for both). Add to that another unforeseen, a tight nuchal and you could have a deadly situation that spirals out of control very quickly.

I'm sorry, I just don't see the wisdom in potentially risking yours and your baby's lives and for what? To deliver in the comfort of your own bed? Apparently these women don't know how bad things can turn in the blink of an eye. Maybe I've just been in this business too long and I've seen too many bad things. Birth may be a natural part of life but it can also be deadly. Death is a natural part of life too. Why take chances?

You know, women who birth in the hospital throw themselves at the mercy of whatever L&D nurse she gets, whatever OB happens to be on call, or if they aren't private, whichever resident happens to be there. There are plenty of residents who don't know when they're in over their heads, plenty of L&D nurses who rely on the monitor rather than actually hang out with their patients and labor them, and plenty of **** that happens in the hospital that's way less likely to happen at home. The numbers just don't bear out the assertion that homebirth is extremely risky for low risk women.

Again, this is a great argument for making midwife-assisted homebirth legal in all 50 states so that women feel that they can freely choose and not be sanctioned (or risk exposing their midwife to jail time). What we have right now in my state when there is a homebirth transport is that either she dumps laboring mom at the hospital way too late and bad things happen, or she comes in pretending to be the doula. Make it legal, and it's a whole lot easier for a midwife to call an OB/hospital and say, "Look, I've got this patient and I suspect a breech, so I'm transporting to you," instead of going it alone at home ending up with entrapment. Or "She just ruptured and the fluid looks like pea soup, so we need to come to the hospital," instead of a baby with MAS on head cooling. Right now? Can't happen, and as a result there are poor outcomes that turn so many folks against home birth.

I have two friends who between them had three home births in my state, with different CPMs attending the births (illicitly) and each time things came up that were unforeseen. All were able to be dealt with at home using emergency equipment that the midwives brought along, as they should. Two births (same patient) were postpartum hemorrhages r/t atony, managed by IM Pit and PR cytotec. Her third pregnancy was risked out because she was too anemic. My second friend's emergency was shoulder dystocia. Because she didn't have an epidural, they were able to Gaskin her, get baby out, and give him PPV when he came out depressed. He did beautifully. Ina May Gaskin, for whom the maneuver is named, reports never ever being unable to get a shoulder dystocia baby delivered when Mom is on all fours.

It's okay to be personally uncomfortable with the idea of homebirth, but skilled birth attendants (and that is the key....skilled) do make the difference, whether at home or in hospital.

[TexRN, BSN, RN]

I guess that's a matter of opinion. I happen to think choosing to birth at home is extremely risky even for "low risk" women. They put themselves at the mercy of their midwife and her assessment skills and willingness to "throw in the towel" and finally admit this is a more critical situation than she can handle (and trust me, many throw in the towel way too late). But will there be time to get to medical help? Sometimes, no.

No one ever sees shoulder dystocias or thick mec coming. And yet home births are usually post term, larger babies at increased risk for both). Add to that another unforeseen, a tight nuchal and you could have a deadly situation that spirals out of control very quickly.

I'm sorry, I just don't see the wisdom in potentially risking yours and your baby's lives and for what? To deliver in the comfort of your own bed? Apparently these women don't know how bad things can turn in the blink of an eye. Maybe I've just been in this business too long and I've seen too many bad things. Birth may be a natural part of life but it can also be deadly. Death is a natural part of life too. Why take chances?

Shoulder dystocia? Maybe if women weren't stuck flat in bed with an epidural and pitocin, they'd be able to get up and move to prevent that. Not only that, but hands and knees is very very crucial to getting out of that situation, which oh by the way, can't really happen all that great when she's paralyzed from the waist down.

Shoulder Dystocia - Spinning Babies

BTW, you've probably seen too many bad things because you're probably in a hospital that is part of the 1 in 3 c/s epidemic. No wonder you're scared. birth isn't a medical emergency. If I ever have another I can't wait to have it in the comfort of my own home, surrounded by knowledgeable supportive people with the right qualifications to remedy that very slim chance of something going awry.

[SanDiegoCaliRN]

I am not afraid, I'm cautious. There's a difference. If I'd had my son at home as I had planned, he would have died without a doubt, and I had a picture-perfect pregnancy and labor with no risk factors. The delivery is where things got very scary, very fast. I was thankful for the NICU team who resuscitated my son and saved his life. Yes he was sick and I had to leave the hospital without him but he's alive and well today because I listened to my gut and chose to play it safe and switched my care from a midwife to an OB/GYN and delivered at a hospital with an excellent NICU.

The link you posted is a breakdown of maneuvers already used in hospitals (by skilled staff) to resolve dystocias. If a laboring mom doesn't have a dense epidural, she can still maneuver on hands and knees with assistance and yes, we use this technique and the others in our hospital. Why so much disdain for hospitals and medical personnel? We're not looking for a reason to cut you, we're looking for reasons NOT to. We support your efforts to exclusively breastfeed and don't even stock formula except in the NICU for emergencies and HIV+ moms. We don't even have pacifiers and won't bathe your baby, instead preferring its natural vernix layer of protection. We welcome your birth plans and will sit with you and go over it line by line and do our best to make it the delivery of your dreams. We don't harass you if you decline the erythromycin and Vit K, you simply sign a waiver stating you're willing to assume the risk of declining them. You may take your placenta home with you for encapsulation if you wish. You can walk and shower with our wireless monitors, I'll get you a birthing ball, provide you with aromatherapy, turn off the lights and play music and turn on electric candles and give you counter pressure on your back when needed. If moms desire a drug-free delivery, I review her pain control options only once upon admission in case she changes her mind then never bring it up again. Most moms (the vast majority) have uncomplicated lady partsl births. The preterm mom I took care of last week who was going to deliver at home until her water broke at 30 weeks said, "wow, this was an awesome experience! I don't know why I didn't plan to come here in the first place." I followed her birth plan to a T (other than the unexpected NICU admission and thus, delayed skin to skin). We're not evil or your enemy. We're here to assist and empower and advocate for you on the most special day of your life. Why demonize us? Yes, I take it personal. If you don't want our help and in the event of an emergency, our life-saving interventions, please, by all means, stay home. I prefer clients who appreciate our assistance and isn't suspicious of us like we have some self-serving motives.

[klone, MSN, RN]

It's really NOT a matter of *opinion* that homebirth is as safe as hospital birth for low risk women. There are DOZENS and DOZENS of peer-reviewed studies over several decades that prove it. Over and over again. In Europe, most pregnancy care is given by midwives, and a good portion of them are at home. Yet...these same countries have LOWER maternal/fetal morbidity and mortality rates than the U.S.

[SanDiegoCaliRN]

Klone, low risk women have babies who crump for no reason at all at or shortly after birth. Low risk women hemorrhage, have shoulder dystocias that DON'T resolve, no matter what maneuvers you perform and develop preeclampsia in a day when the day before they were just fine. Being very close (like across the street at a birthing center) or in a hospital is the only thing that will save some of these women. Why take a chance? You or your baby could be the next statistic.

In your downtime, read hurtbyhomebirth.blogspot.com to see real faces, real names and real stories if you don't believe me.

[klone, MSN, RN]

I've seen it.

Surely you know that as a professional of science who has studied evidence based practice and research, you know that anecdotal stories should not be taken into consideration when looking at statistical risk. I'm sure that for every homebirth horror story, there is a story for things that went horribly wrong due to the interventions of anxious care providers in the hospital setting.

STATISTICALLY SPEAKING, homebirth is AS SAFE (if not safer) than hospital birth for low-risk women. Like I said, studies have proven that fact. Over and over.

[sadiemae1123]

Klone,

You are aware that the vast majority of midwives that do home births in the US have nowhere near the amount of education and training that European midwives have. In most states literally anyone can advertise themselves as a midwife with little to no repercussions and if anything goes wrong they can simply move to another area and start over again. You simply cannot compare the two.

[SanDiegoCaliRN]

I've seen it. Surely you know that as a professional of science who has studied evidence based practice and research you know that anecdotal stories should not be taken into consideration when looking at statistical risk[/quote']

You're kidding, right? There's a direct relationship between statistical risk and anecdotal evidence. One answers the what and the other answers the why

[klone, MSN, RN]

Which is why I am in support of all homebirth midwives being certified. Preferably, CNMs. Of course, for that to happen, homebirth needs to be decriminalized, with OBs and hospitals being willing to collaborate with them (like they do in Europe).

[klone, MSN, RN]

You're kidding, right? There's a direct relationship between statistical risk and anecdotal evidence. One answers the what and the other answers the why

No, I'm not kidding. Everyone has a story about a friend or family member. Negative bias and confirmation bias.