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.
Kayem, I appreciate the article, but I am sure you can understand the limitations of such a tiny study. 60 women between 20 and 35, 30+ hours pp, who exclusively breastfeed and take no meds is not the most representative group where I work.
The reason a birth is different than buying a car is that the outcomes are life and death, and you aren't going to sue your car saleman. If mothers make an informed decision not to give Vit K, I am fine with that, but I do have to tell them the rationale for it being hospital policy. No one can force an intervention on a woman (rightly so, that would be assault), but can't you understand why we would be concerned about women who come to the hospital and don't want ANY monitoring or interventions, and we would need to talk with them about it? At the very least, common courtesy would suggest that they let the hospital know before they come in...
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by kayem
I do agree with you that birth can be a difficult time for mom and baby, the vast majority of deliveries go just fine.
It is a shame when all hospital staff see it as something that needs to me "managed."
It causes me great frustration when the medical profession spouts misinformation about breastfeeding.
It is not difficult to stay on top of recent information.
I think moms and babies deserve to have the benefit of educated Drs and RNs.
I agree with you for the most part BUT I have to say, we are educated, if you read **all** the posts. (not the just the incendiary ones). Giving birth is NOT to be likened to a trip to Burger King where we "hold the pickles" to please people. I bend over backward to make folks comfortable and honor their beliefs and desires.
And as RN's, We read MANY MANY studies regarding birth, newborn health and post-partum care. Not just one or two......and one other thing:
Using "all" in reference to anyone ina group, is unwarranted and unfair, on either side of a debate. It really weakens your side.
Unfortunately a lot of women are not able to breastfeed well every 2 hours right from the start. For those women, vit K can be an important intervention. I don't consider myself uneducated as far as breastfeeding goes, and I am a big advocate of it.
We who do a lot of lactation work deal with this issue a lot (I am a nurse as well as a lactation specialist). Even though we want and encourage a baby to nurse every 2-3 hours (or more) the average baby nurses only 4.3 times in the first 24 hours and 4.7 times in the second 24 hours. That's where a lot of people run into difficulties. Babies get sleepy ( a normal thing) and then nurses and peds get nervous and that's where we start to fail our mothers by pushing the supplementation when it is clearly not necessary. Just my added rant.
I think we also have to look at what mothers want. I worked in a hospital where we were not so affectionately know as breastfeeding nazis. I try to be careful not to go too far one way or the other.
You know, although I definitley prefer and promote breast feeding and did breast feed all four of my children, being reasonable is certainly the best approach...I just went to the S.T.A.B.L.E. program and was reinforced as to how quickly babies can crash, especially when cold stressed or dehydrated...I have seen, as have most of you, babies die from both those things...They are just not geared to always come back....I even have moms who don't routinely submit to the test to assess group b strep, which is devastating when it colonizes and NOW we have the Group B covered but ecoli colonizing because it is resistant...
If it means the blood sugar is going to plummet, the baby should get some formula if breast milk isn't available or the baby is too compromised to nurse..
My great great aunt told me in the old days if a baby couldn't or wouldn't nurse, it was supplemented so it wouldn't die....
And we just had a baby nearly die whose parents elected not to have the vitamin K...His circ oozed slightly but continually (as they do), he went home, and came back bleeding with platelets of 7...7000 and not 70,000....Who knows why BUT, we don't like to push things on babies or their families, but we would be the first ones to be blamed if the correct intervention wasn't done....
Exactly. That's when it becomes important to discuss it. Not because I want to force my will on the patient, but because I need to know that they are making an INFORMED choice
Specializes in Case Mgmt; Mat/Child, Critical Care.
Originally posted by tonchitoRN
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.
Sorry, but I really have to reply to this. I just can not understand this mentality of "drive thru" healthcare! We are NOT Burger King, Circle K or any other enterprise seeking to "beat" our competition by giving you everything you want "your way"!
Our focus and priority should be delivering safe patient care....MOST patients have no clue of what that entails, sure they want to be treated like they're at the Hilton, but it is up to us, the healthcare professionals to educate them and ultimately work within the framework of our standards and prorocols!
And, the last time I checked, I wasn't gonna get sued if I worked at BK and DIDN'T "hold the pickles"!
Sorry, this mentality riles me up also, everything in this world is not always gonna be "your way", and this "drive-thru" attitude of healthcare really sucks, if you ask me!
Good for you, Moondancer. I don;t think the general public has much of a clue about how things are in healthcare. You can't sue Burger Kig for those pickles but healthcare providers can certainly be sued for a poor outciome even if whatever happened was unavoidable or beyone our scope of abilities. Things happen (for instance) in utero and we have absolutely NO control over what might have happened before labor even began. Yet, if something bad happens, the healthcare system will take the blame no matter what.
Occurs when blood or body fluids from an infected person enters the body of a person who is not immune.
HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission), by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth."
Someone else said "Hepatitis B transmission is extremely high in infants, regardless of the lack of presence of the disease within the family (Only about 1 in 4 infants with documented HepB had a family member with HepB). "
I am just a BSN student, but I am definitely interested in more information on this - if the mother isn't infected, then how are the 3 of 4 of babies getting infected?
Am I or these posters misinformed? I know that I certainly may have it all wrong but I've got to say, if I'm right on this I'd find it pretty shocking at such misinformation on a nurses part- and that they would be relaying this to patients. If this were the case, this would be exactly why some "difficult" patients try to counter this kind of misinformation, you know?!
fergus51
6,620 Posts
Kayem, I appreciate the article, but I am sure you can understand the limitations of such a tiny study. 60 women between 20 and 35, 30+ hours pp, who exclusively breastfeed and take no meds is not the most representative group where I work.
The reason a birth is different than buying a car is that the outcomes are life and death, and you aren't going to sue your car saleman. If mothers make an informed decision not to give Vit K, I am fine with that, but I do have to tell them the rationale for it being hospital policy. No one can force an intervention on a woman (rightly so, that would be assault), but can't you understand why we would be concerned about women who come to the hospital and don't want ANY monitoring or interventions, and we would need to talk with them about it? At the very least, common courtesy would suggest that they let the hospital know before they come in...