Okay, let me start by saying that I don't actually plan on birthing in a hospital again, and if I did, it would be because I risked out of homebirth, so the risk itself would probably make me more willing to compromise. So the question in my case is moot, but I have a lot of friends with the same desires.
I'm really just wondering if I came to your hospital as a healthy woman with an uncomplicated pregnancy and had these desires and a willingness to refuse the interventions to the point of signing off AMA, would I be labeled difficult or uncooperative. (Of course, with the disclaimer that if things became complicated to the point of danger to the baby, I would have no problem agreeing to intervention. For the purposes of this question, we're assuming all goes well).
- Heplock access, but no fluids. (I have bad veins, so the heplock is something I know is important for me.)
-Eating and drinking during labor, including herbal teas, such as red raspberry leaf and nettle tea.
-Intermittent monitoring with a dopplar. Initial twenty minute strip for baseline, but no monitoring with the actual fetal monitor after that. I would refuse the usual 15 minutes per hour rule.
-Complete freedom of movement. I would do whatever feels good and probably not ask first before bathing, squatting, etc.
-Initial lady partsl exam, but no others except at my request. I would refuse lady partsl exams offered or "required".
-I would not push at all until I had the urge, regardless of cervical dilation. (This is where refusing the lady partsl exams would work to my advantage).
-Hands and knees pushing position. I would absolutely not push in the semi-reclining or lithotomy positions.
-Immediate breastfeeding and no third stage pitocin. Baby in my arms for the first hour.
-I would refuse the hep B shot, vitamin K, eye ointment (I know I'd have to sign a waiver on that) and would choose to complete the pku at a health dept, rather than the hospital. I would require all newborn procedures to be done at my bedside, or I would refuse them.
-Discharge 12 hours after birth (or less) with the consent of the attending physician. (understanding that well established nursing, controlled bleeding, voiding, and urinating would all be prerequesites.)
Okay, that's my list. I really do want your honest opinions, and I don't mind at all if you would classify me as uncooperative. I'm willing to own the title if I earn it.
I have been reading this discussion with great interest. I'll be giving birth to our first child in January and have decided that a natural childbirth with as few interventions as possible is the route for me. However, I do want a hospital birth because, as some have pointed out, you just don't know what will happen.
What's been very frustrating to me, and it's probably why so many of you have had to face adversarial patients, is that the information I'm getting is either one extreme or the other. Many of the natural childbirth instructors are very anti-doctor and anti-hospital (Saying that they aren't and then going on to point out that an anesthesiologist magazine contains ads for private jets doesn't mesh). So, it's up to me to cull the information that my doctor provides to me and the information received in my childbirth class and find the middle of the road. It seems that each one claims the other is ignoring key research. Any advice???
I think what I'm going to do is bring a basket with goodies and copies of my birthplan - possibly written up from the point of the baby (also approved by my doctor prior to the birth). It'll be cute and hopefully not confrontational. However, as illustrated by the two quotes below, it will likely depend entirely on the outlook of the nurse in charge.
And isn't the newborn screen required 24 hours after first feeding?? There are minimal interventions, and then there are necessary interventions. Why no vag exam unless YOU feel necessary???? Then why not stay at home and give birth on the kitchen table.
I would next ask you to reconsider a home delivery. I know that 99.9% of the time things go great at a home delivery, but I have seen a 45 min shoulder dystocia with a home delivery that ended in a xaphinelli (sp?) and emergency c-section 10 min after arrival to hospital by ambulance with the head hanging out-amazingly the babe survived but has severe problems.
Thanks from a lurker to those who have provided some great advice. Hopefully down the road concern over lawsuits will become second to a concern over providing women and babies with the best birth for their individual situations!
Just bring your birthplan. The problems some patients encounter is often due to their confrontational position. It's one thing to be assertive and another to be aggressive. You also need to remember that things may not go exactly as you planned. It's those who are rigid in their desires and wishes who are usually the most disappointed. It's unfortunmate but it's seen all over. When I see this happen, it reinforces more and more that the mind is a powerful thing (both positively and negatively).
As a L&D nurse, I would not label you period. I have worked with the Navajo women who have births just as you described. I do not see any problem with what you have asked.
I would think that you are rather demanding, BUT I have taken care of several patients with, dare I say, Birth plans just like this and was absolutely delighted with being able to care for them. (of course several of them had c-sections after hours of pushing) I believe that the majority of your "requests" are legitimate and only thing I see "iffy" is the Vitamin K because newborns need it to help with blood clotting.
You however you should know that so many nurses have been trained where you HAVE to HAVE the external monitors and vag exams... people get set in their routine and their comfort levels... I believe that some of the nurses I work with and have worked with would find you as a challenge and would try to over ride your requests. And frankly with malpractice insurance going at the rate it is going I don't think you will find a doctor that would care for you with all these demands.
Here is my take...I am of the opinion and tell the patients that "natural" is any way they get here safely....To those of us who think we don't "label' patients, of course we do..That 'nice' couple is every bit a label as that 'nut' ball...( just for example)...
Demanding is not a bad thing...It is your body and hopefully your wonderful experience ......Unreasonable is where we run into some trouble.....
I don't think I would label anyone as a difficult patient, even if I disagreed with them. It isn't my job to force my ideas or thoughts upon a specific patient or event unless medically warranted or requested...Even then I do try to keep it neutral...You bring yourself into the care of the patient as the nurse....
Ask for what you prefer, but be informed...There are extreme degrees and to those people I say anyone or any idea which is extreme and does not provide for the occasional disaggreement or division, is both unreasonable and just plain wrong...Extremists are often dangerously close to having me believe they are forcing their ideas on people,whether consciously or unconsciously...Any idea that doesn't have a reasonable amount of wiggle room to accomodate specific and individual patients and circumstances, is not the plan for me..But that is just my opinion. I want someone who will listen to what I prefer and try to work with me to achieve that end, with intervention as needed...Sort of like trying to explain to a new hair stylist exactly what you would like your hair to look like at the end of the session...As close as possible to your idea but with the understanding that it is possible it might not go that way..
Have no idea where I came up with that analogy but you must understand I am still awake after two night shifts from hell and 3 hours sleep overall, waiting for the little critters to come home from school, have lunch and then go trick or treating! :)
this has been a very enlightening thread. i have been following it for a while.
my question: how come you can go to bk and say "i don't want pickles" but heaven forbid you say "i don't want something" to the medical establishment and you are labeled as difficult.
sounds like the medical establishment wants to dictate what tx a person is to have and not listen to any other side of the story.
i am all for open communication but don't call me difficult because i don't want to abide by the recipe (protocol) that is called policy.
There would be a lot less difficulty if parents didn't expect perfect infants and sue the textiles off nurses and doctors who either couldn't or wouldn't interfere with an intervention because no intervention was wanted or anticipated because of things such as a lack of at least occasional monitoring...A label is only that..A patient and family are so much more...Sign a waiver that you won't sue and I will never label in my own mind ANY patient "difficult" ever again...
Amen to that! Few people seem to be aware that OB is the most litigious area of medicine nowadays. We can do every intervention there is and be sued if there is a bad outcome in spite of it. So imagine how nervous people are about being sued when they aren't allowed to do the interventions recommended by the experts in the field and backed up with research. Sign a waiver and let people know up front, and few families will have problems. Just don't show up to a hospital without notice and expect us all to be thrilled to take the legal responsibility of caring for you without following any of our standards of care and assessment.
Asking to hold the pickles doesn't offer the threat of a lawsuit as readily as a birthing experience and outcome does. While I would certainly agree that there are too many policies and procedures, our litigious sociaty and the "everyone owes me something" mentality has lead to this.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
HOLD THE PICKLES???
see it *is* true!!!!
they think they are at BURGER KING when they come. (or the Hilton).....
and then they wonder why we get upset at this thinking. yes, we all want it our own way........
and i am happy to make this a safe, satisfying experience while you are my patient, but if/when the poop hits the fan SEE how fast you sue me when you don't get the hamburger cooked exactly as you want.
THIS AIN'T BURGER KING, people! sometimes, we are talking life or death in minutes, and that is no exageration. Obviously, tonchito, you don't do OB nursing????
Me too....I think non OB nurses should work a few months in our field with the sort of situation we are attempting to describe WHEN the poop hits the fan.....you just KNOW what would happen then.....
K doesn't cross the placental membrane well at all, and is not transmitted well via breastmilk after birth (prepared formulas are required by law to include VK). ..................
Where do you get your information?
The research into vitamin K and breastmilk has been widely challenged by those who say that it was carried out at a time when women were told to restrict their babies' feeding in the first few days of life. This meant that the babies did not receive the fatty hind milk, which is the milk at the end of a feed. Sometimes, babies were not given colostrum (the milk that is in the breasts immediately after birth). In fact, the richest sources of vitamin K are in colostrum and hind milk. If the level of vitamin K was measured in babies who were not being allowed this milk, their levels would obviously be low.
Researchers set out to assess the average total daily amount of vitamin K in colostrum and breastmilk of mothers who exclusively breastfed their infants. The study also sought to determine how much the mother's daily consumption of foods containing vitamin K (VK) affected the VK content of her colostrum or milk.
The women participating in the study were healthy nonsmoking mothers between twenty and thirty-five years of age who were not taking birth control pills, antibiotics, other medications or megadoses of vitamins. They were divided into four groups of fifteen participants each, determined by number of days postpartum. Colostrum was collected at between thirty and eighty-one hours postpartum, breastmilk was collected at one month, three months and six months postpartum. Only mothers who exclusively breastfed their infants at least five times a day were included in the study. Although the concentration of VK was found to be slightly higher in colostrum than mature milk, the authors point out that the total daily intake of VK in infants increases over time due to the fact that milk volume increases substantially over time. There did not appear to be any pattern between the number of hours postpartum that a colostrum sample was collected and the concentration of VK.
The VK content of many foods has not been adequately studied to accurately determine the maternal intake. Despite this, the authors went on to say that they could find no correlation between dietary VK intake and the VK level in breastmilk or colostrum. Dietary fat is essential to the absorption of VK, and VK concentrations in breastmilk tended to be greater in women who had a higher fat content in their diet.
A further conclusion of the study points out that VK appears to be found in the fatty portion of breastmilk. Since the fat content of breastmilk increases with the length of time spent at the breast per feeding, I would theorize that the practice of limiting the number of minutes at the breast per feeding could be decreasing the amount of vitamin K that exclusively breastfed newborns receive.
-Vitamin K in colostrum and mature human milk over the lactation period--a cross-sectional study American Journal of Clinical Nutrition, 1991, 53:730-35, abstracted by Althea Seaver
I respectfully suggest you take some time to educate yourself about breastmilk and breastfeeding.
To the OP.. you are in charge of your own body.Every person who works in the hospital you are paying.You have a right to demand to cared in a manner that you expect.
If you ordered a blue car with a stereo and you got a pink one with out a stereo would you settle for it?
Why should a birth be any different?
Oh and who ever said why not just stay home and have the baby on the kitchen table?
MarriedCoug
1 Post
I have been reading this discussion with great interest. I'll be giving birth to our first child in January and have decided that a natural childbirth with as few interventions as possible is the route for me. However, I do want a hospital birth because, as some have pointed out, you just don't know what will happen.
What's been very frustrating to me, and it's probably why so many of you have had to face adversarial patients, is that the information I'm getting is either one extreme or the other. Many of the natural childbirth instructors are very anti-doctor and anti-hospital (Saying that they aren't and then going on to point out that an anesthesiologist magazine contains ads for private jets doesn't mesh). So, it's up to me to cull the information that my doctor provides to me and the information received in my childbirth class and find the middle of the road. It seems that each one claims the other is ignoring key research. Any advice???
I think what I'm going to do is bring a basket with goodies and copies of my birthplan - possibly written up from the point of the baby (also approved by my doctor prior to the birth). It'll be cute and hopefully not confrontational. However, as illustrated by the two quotes below, it will likely depend entirely on the outlook of the nurse in charge.
Thanks from a lurker to those who have provided some great advice. Hopefully down the road concern over lawsuits will become second to a concern over providing women and babies with the best birth for their individual situations!
SP