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.
The dirt thing was a cut and paste exact quote, I can't remember what page - running out the door now but will find it later. The only '1 in 4 babies get it from an infected family member' one was somewhere at the beginning of the thread.
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 curious about this too. I haven't really heard of alot of cases of infant Hep B infection, except in cases of infected mothers. Even then, they are given Hep B vaccine and immunoglobulin, so transmission is decreased.
I also remember the dirt comment. I chalked it up to scare tactics.
I believe I merely mentioned that hepatitis b is present in soil. Certainly it is a low risk, but all of the studies I have read regarding transmission this way have not ruled out its possibility in immunocompromised individuals, which includes children who routinely play in and ingest soil, in which the virus has occasionally been cultured........I am of the opinion for myself and family to be more safe than sorry...
.Various means of hepatitis B and hepatitis C spread and the relevance of
chemical germicides in infection control
Means of spread
Degree of relevance
Comments
Spread from infected mother to the fetus, during childbirth and/or possibly during breast-feeding
Artificial insemination with semen from unscreened donors
Transplantation of organs from unscreened donors
Accidental exposure of healthcare personnel to needles and sharps
Body contact with blood during sports such as wrestling and rugby
Very low
Germicides can play no role in preventing such spread.
Transfusion of inadequately screened blood or blood products High
Germicides, alone or in combination with physical agents, can be used for virus inactivation in blood products.
Sharing of needles and syringes in illicit drug use
Sharing of paraphernalia in using non-injectable drugs
Use of contaminated needles and syringes in administering injectables
Use of improperly decontaminated medical, dental and surgical devices
Use of blood-containing sharps and instruments in ritual scarification, circumcision, blood-letting, tattooing, ear- and body-piercing, acupuncture, hair removal by electrolysis and sharing of shaving razors
Very high
Germicides can play a crucial role in interrupting virus spread through such means. This is especially true in the decontamination of shared needles and syringes. Although bleach is commonly recommended and used for this purpose, there is an urgent need to find an equally cheap, effective yet safer substitute for it. Such objects may pose the greatest risk when freshly contaminated; items such as toothbrushes are not meant to be shared and are also generally unsuitable for chemical disinfection; but, if items such as disposable or non-disposable shaving razors are to be shared, they must be chemically disinfected between different users.
Hemodialysis with shared equipment and in inadequately cleaned and monitored settings Moderate
Chemical disinfection of shared hemodialysis equipment can reduce the risk of virus spread. Use of gloves and other standard precautions would be more useful than the use of chemical germicides alone for the decontamination of environmental surfaces.
Unprotected sexual contact with virus-infected individuals Moderate
In addition to barrier protection, use of germicidal gels may reduce the risk of such spread; however, chemicals that can inactivate the viruses may not be safe for repeated long-term use.
Non-venereal contact in domestic and institutional settings with chronic carriers of HBV or HCV Low
The vehicle(s) for such spread, which occurs predominantly in conditions of overcrowding and poor hygiene, remain(s) unidentified. Sharing of toys and items of personal use such as toothbrushes are most likely to play a role, in which case, use of germicides is unlikely to be useful in infection control.
Nosocomial and iatrogenic spread other than through the use of contaminated medical,
dental and surgical devices Low to moderate
In most settings, hands probably play a minor role in the spread of the viruses; however, regular and proper handwashing with soap and water may be sufficient to virtually eliminate the risk. Use of alcohol-based hand gels between handwashings is also considered effective; residual germicidal activity is not likely to be protective if damaged skin of hands is exposed to blood containing HBV or HCV.
Any HBV or HCV on the skin surface would be readily removed/inactivated during the scrubbing procedure; however, the viruses in any leaked blood during surgery from a chronically infected surgeon's hands would most likely remain infectious.
Skin antisepsis may be helpful only in situations in which the surgical site is contaminated with blood other than that of the patient.
Contact with environmental surfaces Low to moderate
Environmental surfaces rarely act as vehicles for the two viruses, with the possible exception of those in hemodialysis units.
Germicide decontamination of spills of blood and other contaminated fluids before and after their clean up forms an essential part of infection control.
Non-intact or compromised skin, e.g. chapped hands Moderate
Topicals may play a role but proper testing is needed to confirm product potency.
I have worked with pediatricians who have told patients that in this state ( East Coast), where we have a high incidence of hepatitis, that it has been found in soil.....
I believe I merely mentioned that hepatitis b is present in soil. Certainly it is a low risk, but all of the studies I have read regarding transmission this way have not ruled out its possibility in immunocompromised individuals, which includes children who routinely play in and ingest soil,
Means of spread
Degree of relevance
Comments
Contact with environmental surfaces Low to moderate
Environmental surfaces rarely act as vehicles for the two viruses, with the possible exception of those in hemodialysis units.
I still don't seen anything about dirt. And simply being a child who plays in dirt, doesn't make you immunocompromised. We all make choices for our families based on what we feel is "safe". Personally, I'll take my chances with the dirt rather than submit my child to the toxins present in the Hep B vaccine. An unnescessary vaccine for infants, IMO.
I would definitely be interested in that docs source of Hep b in dirt. Do you think perhaps he was mistakenly referring to Hep A or exaggerating for a scare tactic or misinformed or confusing it with something else? I could even possibly see Hep A in dirt before Hep B (even though it's transmitted through feces, not dirt, I know that it is more casually transmitted in general through lack of sanitary conditions in restaurants, etc... I could theoretically see it in dirt if there were maybe a sewage issue, unclean water by the dirt in question etc... especially in a poor area or in poor countries).
I've looked around a little bit and I don't see anything that indicates that it's in dirt. Hey, it's a scary enough disease just being in bodily fluids! I found "Hepatitis B is NOT transmitted casually. It cannot be spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with hepatitis B. Everyone is at some risk for a hepatitis B infection, but some groups are at higher risk because of their occupation or life choices." http://www.hepb.org/02-0173.hepb (hepatitis b foundation) (I'll admit, I'm not sure if I'd be comfortable with an infected person sneezing on me!)
I've enjoyed reading this thread while I should be doing a million other things
(had to edit because I realized I don't know how to spell 'exaggerating')
I've been following this thread with great interest. I think the intention of the original poster was to get us thinking and talking about a controversial subject for we L&D nurses, and she has done that.... whether or not I agree with everything she has said.
I also have a feeling that there may be pregnant women following this thread who are trying to find out more about presenting an "unusual" birth plan, and I wanted to address a problem that I've run into many times over the years, and it is this: if you have a birth plan that you know is requesting things that are 'out of the norm', make sure you talk to one of the L&D nurses at the hospital you will be delivering at. Your best bet is probably to talk to a charge nurse, NOT the manager or other administration people. What you want to ask is, here is what I would like, this is my doctor, what are the realities of making this happen? I have found that many OB doctors, like anyone who is providing a service for a fee, want to keep their pts happy. You may show them your birth plan in the office, they say "sure, that looks fine, no problem." Then, when you show up at the hospital in the middle of the night, they - from the comfort of their beds at home - give the RNs all kinds of orders over the phone that are contrary to what you want, hoping that you will just cave in under the stress of labor and do things according to 'policy'. I'm not saying ALL doctors or even MOST, but I have seen this happen over and over. And of course, geuss who gets to be in the middle:rolleyes: That would be ME.
**BIG SIGH** I just want happy moms, healthy babies, and no doctor yelling at me. Is that too much to ask?
OH MY GOD! I have been reading this thread for about an hour now.....Basically agreeing with much of what is said.....and all the while thinking in the back of mind about this "keeper" person and who she is. I knew from the very first post she was a victim of sexual abuse, and much of her "issues" were related to "control" I can almost guarantee you, that anyone with these similar "control" issues have been sexually or at the very least physically abused. Having a baby brings about many emotions and one has to give up much of their modesty and control over their body, so therefore you grab onto as much control as you can. This is the key, allowing the pt to have as much control as possible even simple things such as which way she wants to lay, which arm you want your hospital bracelet on, which lights you want on, which arm do you want me to take your bp on, etc. I have found that allowing pt's like these to have the absolutely most control is the best way to deal with them. Needless to say, I often get letters, cards, gifts, flowers from all the "bradley" pt's I take care of because I just seem to "click" with them. I say "bradley" because it's usually the pt's that choose this method and especially the hard-core bradley believers that have suffered sexual abuse.
Anyway, I'm a firm believer and letting our bodies do what needs to be done and I enjoy taking care of someone that is well-educated and informed and will respect her wishes to the best that I can and "compromise" when we are not in agreement.
Keeper, I sincerely wish you the best for you and your (future) family.
Shelley
WHAT???
I am happy that you cna click with the Bradley patients, but do you REALLY belive what youa re saying? Dop you really think you can make that leap in judgement about someone because she wants to have a natural and low key birth with few interventions? Me thinks you read too much Freud.
SmilingBluEyes
20,964 Posts
who said Hep B is in dirt?
I have read in the posts, and cannot find it????
very confused. It's bloodborne, every healthcare provider KNOWS this........
fungi and bacteria are in dirt, these viruses (hepatic) are in BLOOD and are transmitted THIS way.