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 think she already said she would allow interventions if there were any signs of distress. I think "birth plan out the window" was mentionned. I think most of the requests are reasonable for a healthy labor
Fergus, yes, she did say she would allow interventions but I was wondering if that meant she would allow any and all interventions the medical staff wanted or would she decline some and allow others. The birth plan would "go out the window" if it's a crash CS situation, of course... but maybe if something less stat was going on she could still have some of her requests met. That's what I'm wondering Sarah, how will you decide what you can still safely decline if the baby's in distress? The WHOLE plan doesn't necessarily have to go out the window.
I am not *yet* a part of the health care team but I have had 3 labors, hospital with ob, homebirth with certified professional midwife (with clinical training in a hospital, also IV certified) and lastly hospital birth with CNMs. Some experiences were better than others of course.
It is a rude awakening when we realize what women use to go through in the scopalmine days and it is unsettling to realize that hospital birth is only recently becoming a tailored event that does not require the numerous interventions of old but I do think that you show a bit of paranoia and it seems *adversarial* simply to come to a board that consists mostly of nurses and present a detailed list of what you will not tolerate as a patient when many of these people are dedicated to their job and just want the best outcome for you and baby. As many of the nurses said alot of your list is doable and some of it isnt even an issue in some situations. In nursing school they teach that attitude is everything, smile, show you care, listen, be respectful of patient and their wishes~ there are many competent nurses out there and if you should need to go to the hospital take your birth plan along with your very best attitude and seek out the answer to this post.
I took my homebirth daughter to the healt dept. the day after her birth to recieve the vitamin k, the pku and the HepB. My midwife did the eye goo an hour after birth. I personally could see no reasons to deny these things. HepB is incredibly important~ just as you have your anti intervention rant because it is something you feel strongly about many health care professionals have their own reasons why they feel things are necessary and this is just to be expected. They would be going against their beliefs if they did not lecture you a time or two before you got out the door without utilizing a benificial service that they were willing to provide. That is their job after all. IMHO careful selection of a healthcare provider and good people skills are worth much more than a birthplan. After all isnt a natural and not a scripted birth what you wanted in the first place?
Interesting. I have always been of the opinion that we do what the patient requests as much as we can, as long as the patient is willing to sign a disclaimer that she won't sue if her infant comes out imperfect or compromised due to an intervention she did not prefer...Just kidding..
Actually, is this your first child? You wouldn't be considered by me to be difficult, only misinformed....
In no manner do I mean that in a negative way, but as Smiling Blue Eyes mentioned, it would behoove you to keep an open mind..
PKU is important as an undiscovered case can and will lead to mental retardation and is easily reversed or taken care of with special formula..
Hep b is in dirt...Babies play in dirt....Horrible stuff for a child to get...
Iv fluids...Hmm, we also like to avoid those, but much easier to infuse fluids through a present lock...So, the hep lock is not a horrible thing...
Some of those tests, such as group b strep, are important....Especially if you have it and your infant contracts it...
Start pushing at 7 or 8 cms because you feel pressure and you will have one whopping edematous cervix and perhaps an unwanted csection...
I certainly wish you well and hope all your requests are honored and you have a healthy baby in spite of some of them...
I think and hope all goes the way you hope it will.....Especially with such a special experience...Good luck! Truly.....
I always consider it a challenge to convince people who come in to the hospital expecting us to be inflexible and controlling that they are wrong about us! Every single person that has come in with the kind of birth plan you describe has ended up staying the entire 48 hours and telling us that they were misinformed about what to expect from us. In fact the last patient I had who had been transferred to us during a difficult attempt at a home birth gave me a big hug before she left and said that if she had known how kind and flexible we all would be that she would have just come to us in the first place!!! I just love turning people around that way! It is a pleasure! :)
Okay, first of all, I'm having the same questions/comments over and over about pushing before 10 centimeters. I went back to my original post and can see that the way I worded that part of it would be confusing. I only meant that I would not begin pushing just because I was dilated to a 10, not that I would begin pushing before that.
To answer a few of the questions: No, this is not my first child. Actually, I'm not pregnant at this point. I have had four natural childbirths, two at home and two in the hospital.
Re: In a complicated birth, would I allow any and all interventions? It depends on the complication. Obviously, if there were a pph, I would have no problem with pitocin. If it were just a matter of a long labor, and my health care professional were getting antsy, I would ask for a couple more hours and utilize natural methods to speed labor, ie: walking, squatting, nipple stimulation, and acupressure on the roof of my mouth. If I continued to make no progress (yes, the lady partsl exam would be requested at this point), I would agree to low dose pitocin, but not to AROM. Obviously, this would mean having an IV and continuous fetal monitoring, as pitocin carries more risks than normal labor contractions.
If the baby were whisked away to the NICU, it would also depend on the reason why. If it were a trauma birth, such as a shoulder dystrocia or forceps or vacuum delivery, I would allow the vitamin K. I can't see any reason to do the hep B or newborn screen at that time, especially when I DO plan to have those done within the necessary time frames, just not at the hospital (another point many here have not remembered from the original post). If the NICU stay were to be extensive, obviously, the hepB and PKU would have to be done there.
Basically, if things began to become complicated, I would expect a full discussion with the doctor and nurses. What are the risks of the procedure? What are the risks if we wait a little longer? What are the risks if we don't do it at all? What are the alternatives? At that point, I would ask to be left alone with my husband (as long as there is time enough to do that), and we would make our decision together and pray for confirmation of that decision.
With baby #2, who did have a shoulder dystocia and meconium, we were more than willing to wait on breastfeeding until she had been x-rayed and had been examined by respiratory therapy. We also consented to the vitamin K. (No shot of pitocin, though, as the placenta came very quickly and my uterus clamped down just fine, and the MD did not believe in routine 3rd stage pitocin.)
I'm sorry if it seems like I came here just to be adversarial. Actually, I've been lurking here for over a year and have posted a few times before this. The "paranoia" is a product of the hospital births I've had. The fact that there are so many progressive and compassionate nurses here is the reason I posted this question. I wanted to get an idea of what was doable where. Again, I'm glad to see there are so many who would not consider me difficult. (Now if they would all just move here!)
Re: Do I have any formal education as a health care professional? I've been waiting for this question. I do not believe a woman needs formal education as a health care professional to make informed decisions about her health. I think it is imperative that all women become more actively involved in their health care. This question was asked of someone in the homebirth community....sorry I can't remember the name. She had written a book one birth and was asked what credentials she had that would qualify her to make the statements she did about birth. Her reply: "I can read." I, too, can read. I hope you will not discount the wishes of your patients simply because they do not have the schooling you do.
NOT THAT YOU ARE N OT INTITLED TO SOME OR ALL OF THESE THINGS YOU REQUEST FOR BUT IT'S A LITTLE DEMANDING. BESIDES YOUR BABY NEEDS THE VIT K ETC. IM NOT SURE WHY YOU WOULD HAVE SUCH REQUESTS BUT YOU MIGHT WANT TO DO A LITTLE RESEARCH ESP REGUARDING BABY'S MEDS
I don't see you as adversarial. I remember a few of your posts over the last year and have never gotten that impression.
Based on the posts you make I can tell you have done allot of reading. I have to wonder what you have read though. I myself have attempted to do research on home birth and natural birth but found little in the way of solid information. What I did find were allot of horror stories about hospitals and people talking about how cruel nurses are. I did find a few hints of things done to easy labor naturally and have found some success with them for my patients ie. pressure points and reflexology, visualization and some other non invasive things.
What does the information you have read say about vit K and erythromicine, pitocin after delivery and other interventions that would make them seem worse then excepting the risk of not using them?
I'd also like to answer one of the questions you asked in a post on this thread.
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Why do they have to accept "help" in the form of routine interventions just because they walked through the doors? Why can't a woman come to the hospital and be left alone, and only utilize the staff in the event that their expertise is truly needed?
Because the minute a women walks onto the labor deck they become the legal responsibility of the RN. I realize this may not be the intention of the patient and that most don't even realize this but it is absolutely true.
I don't think that should mean the patient has to agree to all interventions or that the RN has the right to do things against the will of the patient. However in the eyes of the boards of nursing and the court system RN's must provide care to that patient based on "the standard of care" and that includes all the interventions this thread has discussed. You absolutely have the right to refuse those but if something were too happen to you or your child the RN would still be held accountable for not performing the very interventions you had refused.
Real case: patient came to the labor deck refused all interventions except for FHT with a doppler. The RN and the unit manager tried to explain the rational for the interventions but were told by the patient that she did not want to hear it and that she felt they were pressuring her. The patient signed all the waivers we had on the floor. She labored for 6 hours and the CNM camped out until she allowed her to check her cervix and then began pushing. Baby was born with apgars 8 and 5 and died later that day. (please keep reading this isn't a horror store to scare you into accepting interventions)
It was very sad but what happened next was just as sad. The unit manager and the RN were fired and are still in court fighting for there licenses and worldly possessions. The patient filed a complaint with the hospital, board of nursing and in court. she said "If I had known the risks I surly would have consented to the interventions".
The problem is that we can't say "your baby will die if we don't monitor you" because we don't know that until we do monitor you for hours and hours. It's true that intermittent fht and fetal monitoring have the same statistical outcomes but it is also true that intermittent fht cannot detect late decelerations and that is probably what this baby would have shown on EFM. In this case staff only intervined when their expertize was truly needed and it was too late.
It's not because nurses are intervention happy or that they want to exert power over patient. It's that we are supposed to do the very best we can for them and that includes all interventions that are indicated. It is true that many interventions are not necessary for every patient but sometimes we do them because we think there is a chance they might help and we would only know they aren't needed if we didn't do them and then it would be too late if they were needed.
That was a well-thought out and well-worded answer Dayray. You are absolutely correct. OB is the most litigious area of nursing to work in and we tend to think defensively as a result. People who do not work in health care may not understand that. Thanks for your clear explanation (complete with vivid example!)
I absolutely understand the litigious environment of L&D. This is not the only website at which I lurk. I also lurk on obgyn.net and read the discussions they have there. More often than not, the main reason they state for doing a particular intervention is the CYA policies of the hospital and malpractice insurance carrier.
I don't blame doctors and nurses for wanting to protect their licenses and livelihood. I don't know where a balance could be struck. I seem to feel the only real solution will come from tort reform. We've got to make it so that the waivers are not meaningless in a court battle. I just can't give up my requests because a nurse thinks I might sue.
What do you think about patients signing arbitration agreements prior to birth? I consented to sign one of these with the surgical practice that did my recent gall bladder surgery. I felt it was a fair request by the doctors. I had no problem signing away my right to a traditional lawsuit. I think my words were, "Anything to keep the lawyers from getting richer!"
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
exactly....i would be talking with my risk management folks regarding arbitration to make SURE it WOULD hold up. Even THEN there are NO guarantees. You seem more than reasonable to me, keeper. NOT demanding, just an informed consumer. I have not problem with that...none at all. Just as long as communication is clear and two-way, you and I would work very WELL together.
fergus51
6,620 Posts
I think she already said she would allow interventions if there were any signs of distress. I think "birth plan out the window" was mentionned. I think most of the requests are reasonable for a healthy labor