Would I be considered a "difficult patient?"

[keeper]

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.

Thanks,

Sarah

[geekgolightly, BSN, RN]

Originally posted by SmilingBluEyes

wow i did not get that at all......physical/sexual abuse????? hmm

i am either very unobservant or just don't see things this way.

i did not get this at all and i did NOT think this person was exerting an excessive amount of inappropriate of control. not at all.

this has been a very exciting thread to read, though. i appreciate all of this information.

[BRANDY LPN]

I beleive keeper has the right to refuse any and all interventions, just last night I had a hispanic couple mom spoke NO english and fob very little after giving them the spanish version of the hep b form I asked dad if they wanted the baby to have the hep b and he looked at me and asked "esta bien?" well I beleive its wonderful and that all newborns should have it and I could have replied Yes and he would have signed BUT... would that be INFORMED consent? Hell No. so I called the doc because my spanish isnt up to dicussing risk vs benefits and the nest time doc was around HE obtained INFORMED consent with his considerably more articulate spanish.

If keeper was not informed I would absolutely beleive that she was a difficult pt (if she would not at least listen to why these interventions are needed) but that is not the case here.

I wish all pts wold take the time to research pregnancy, labor and breastfeeding half as well as she has. We see too many women who want to bf but havent educated themselves at all and expect to just stick the baby somewhere in the vincinity of the breast and let the baby do the rest, or women who want NO pain meds but have not taken the time to learn even simple breathing techniques. THESE women are the truly difficult pts. IMHO

[keeper]

Popping back up here to say that, YES, I was physically and sexually abused as a child. And I actually do think there is a correlation between childhood sexual abuse and the desire for a natural, non-interventive birth.

My own midwife is also a sexual abuse survivor and estimates 90% of her clients who seek homebirth are also, whether they've confided it or not. It may seem like a huge jump, but the estimates I've read are that 1 in 3 women have been sexually abused in some way during their lifetimes. I don't think there's a person alive who doesn't at least know someone who's been sexually abused.

I try to be very careful not to take offense when people discuss my "control issues," because I know there's no other way to say it. The word issue in some ways implies the need for "fixing" or curing. I'm ever aware that my need for control can get out of hand if I let it, for instance, if I attempt to control all the aspects of my children's lives. I just don't put my need for control over my own body in the same category.

What I hope to convey, most of all, is that there are probably many, many more women than you are aware of who have these same issues and needs that are going away from their births feeling scarred and abused by standard medical procedure. Survivor or not, every woman has the right to dignity, information, and control over her own body during birth. For an abuse victim/survivor, birth can either be an empowering and healing experience or a trauma, and a lot of the difference depends on the caregivers and their willingness to allow her to birth her way. (As always, with the standard disclaimer about complications...).

Sarah

[mother/babyRN, RN]

I think it has to do a lot with control or the lack thereof in EVERY aspect of ones life..However the feeling of loss of control arrives or takes over, sexual abuse or not, individuality is all about control and that would naturally continue in such an intimate ( and it is intimate despite all the non intimate intervention and interruption)...Makes perfect sense to me, howEVER, there is leeway or should be with every situation and people should in the best case scenario, be treated as such, and their wishes followed as best possible with the understanding that not always, can that be done to completion.....Thank you for sharing. I would venture a guess that many people have sexual abuse or molestation issues, including myself and have often wondered if that is what contributes to the aspects of nurses who desire most to protect and care for people....But, that is another thread altogether...

[geekgolightly, BSN, RN]

Originally posted by keeper

I've read are that 1 in 3 women have been sexually abused in some way during their lifetimes. I don't think there's a person alive who doesn't at least know someone who's been sexually abused.

and yet less than 1% of women gravitate to homebirthing.

i was not sexually abused and i am doing a home birth.

[geekgolightly, BSN, RN]

I find it interesting that people assume if a woman wants to take some control of the most important experience in her life she must be "abused."

[bagladyrn, RN]

Originally posted by geekgolightly

I find it interesting that people assume if a woman wants to take some control of the most important experience in her life she must be "abused."

I wouldn't "assume" that this were the case, but if a woman seems focused on control issues, I would definitely explore this possibility as that kind of history makes a big difference in how I approach care and procedures during labor as well as how she responds to the process of labor.

[bagladyrn, RN]

Ooops - double post:confused:

[keeper]

Geekgolightly,

Obviously I wansn't saying that all abuse survivors are natural birthers or all homebirthers are abuse survivors...just that there is a correlation related to the need for control and that the numbers are higher than most believe.

Sarah

[SnowymtnRN]

Originally posted by keeper

- 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.)

I just wanted to say that i've done many of the things that you mentioned here. I only pushed on hands and knees, it was what felt right to me. My doc was supportive. I was up and around, drinking fluids until my water broke and i had an epidural (of course which i understand NOT getting free movement then.

I also refused the Hep B vax and erythromycin ointment. MY reasons after much research and soul searching was that the Hep B vax is COMPLETELY unnecessary for a newborn, if not harmful. Both my boys were born and jaundice, extremely high bili levels (one reached 19.8 and the other got up to 17.6)and i can only imagine how they would have been had i given them the Hep B. They've still not had it as we are waiting until they are older. They are not daycare kids, not in school, at home with mom so they are relatively low risk. My Dh is a ICU RN and practices good universal precautions so we feel that at THIS point in their lives (newborn to now, they are 1 and 3) they will be fine.

I also refused the e-mycin ointment because its just plain stupid. FOR ME. I am a married woman with COMPLETE faith in my husband, not only between us but also his faith in his kids and he would NEVER EVER harm them. So the e-mycin is preventative for diseases passed by the mother lady partslly, and would have been passed by her partner. IF that were a possibility i KNOW that my DH would have told me (not to mention we were tested for everything under the sun) and we would have given it to be safe. Why give it if you aren't in the higher risk category???

I also don't see a need for the baby to be removed from the mother UNLESS there's a problem with one or the other. I mean procedures can wait. There's nothing pressing about weights, heights, etc...But as nurses we tend to be task oriented and i think thats' why many nurses and staff get irritated because parents want to bond with their newborn babies. I remember after my son was born (first son) my DH held him for i KNOW at least an hour cuz i was just so exhausted. he also carried him himself FROM the OR to the nursery and watched everything being done, even participated.

We are more AP-naturlist type parents. We aren't crunchy, but we believe in being as natural and normal as we can be, less invasive, and as little interference as possible. BUT we have no problem with intervention if its warranted.

I think given what YOU want, you need to birth at home. lol OR in a birthing center. i don't understand your "no vag checks and fetal monitoring" tho cuz if you HAD to come to the hospital it would be because something wasn't right, so you'd need monitoring. Right? BUT i think that most mainstream hospitals would consider you non-compliant. So if you HAVE to have a back-up hospital, maybe call around and talk to the nurse manager of your OB about your needs/wants. You'd be surprised how many hospitals are coming around!!!!!

Good luck and happy birthing at home!! I wish i could do it, i ended up with c/s and have to have them every time due to CPD. I'm looking at my third in March.