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.
Specializes in Case Mgmt; Mat/Child, Critical Care.
Just to add my .02 cents worth; being an L&D Rn for 10yrs, now in NICU... You may very well be labelled as "difficult" even where I work, which is VERY non-intervention oriented! Why? Because, as another poster pointed out...your TONE, perhaps in real life, with the verbal cues, facial/body language, you would come across differently...
I work in an environment where MOST of what you desire is the norm. I guess my pet peeve with pt.s who come in w/a "birth plan" often come across as we/the medical staff are "out to get them". That simply is not true. Your nursing staff are going to be your greatest advocates. Many times the physician/CNM's are more resistant to your requests. Also, take into consideration the actual hospital you will be delivering at. Hospitals have policies, procedures and protocols we have to maintain. WHY? Again, due to the high risk nature of OB, licensing organizations, etc. Once you walk through the door and become a pt., you have to understand WE have an obligation to YOU...to deliver the best care and hopefully, provide the best outcome(healthy baby and mom) we can. Do things sometimes go "wrong"? Sure. More likely, things don't go according to the "plan" (ER c/section, for instance). Of course, the pt. is unhappy and feels "robbed" of their experience. But, ultimately, what is MOST important, is that you are taking home a healthy newborn. There is no disappointment in a newborn regardless if he comes by way of vag delivery or c-section!
So, I hope you understand that nurses are NOT out to "get" you. Most of your requests are reasonable...and, certainly, we LOVE as low intervention birth as possible, it's a wonderful experience. I would only advise you to re-think:
1) 3rd stage pit...IF your "placenta under the tongue" doesn't work...it's better to be alive to take care of your children than to die from a PP hemorrhage (just happenned where I work a few mos ago d/t refusal of emergency intervention).
2) Vit K shot for the baby. This is not some conspiracy or drug co "scam". Babies really do lack certain factors necessary for blood clotting, this is NOT made up. Just coming through the birth canal is "traumatic". This is where I totally disagree w/you...don't risk your babies life!
3) Actually, I don't know one L&D nurse that would have you flat on your back, should monitoring become necessary. We completely understand and know what position is better for you, if you have to be in bed. At worst, you should be "wedged" or propped, so you are NOT flat on your back.
4) Finally, you can't believe everything you read on the internet. Some of these "medical" sites are full of it! Best advice...choose an MD/CNM who thinks like you, choose a hospital/birthing center that is low intervention oriented...ask to take a tour, talk (informally) to some of the nurses/staff, just to get a feel for the place. And please remember we want to HELP you, not "push" unwanted/un-needed interventions on you! Just please be open to the possibilities...
I understand your desires for few interventions. I went to the hospital to deliver my son with some of the same ideas. I was COMPLETELY against internal fetal monitering because it sounded like torture to me, even though everything I had read said it was relatively painless to the baby. I also opposed forcep or vacuum extractions. But when my continuous EFM showed late decels, I was very glad to have it. I WILLINGLY allowed the nurse to initiate internal fetal monitoring. My son had shoulder dystocia and had a nuchal cord x2. The vacuum extraction was necessary to provide adequate oxygenation to my son. Had it not been for the continuous fetal monitoring and the vacuum extraction, my son would have died. After that experience, I can assure you that I would never refuse fetal monitoring. I just don't see how a mother could risk her child's life like that. My labor began low-risk and ended up complicated. The expertise of my L&D nurse and the quick interventions she initiated saved my son's life.
Keeper- I just wanted to restate that you sound very well informed, and I hope your experience goes well. Could you post some web sited that talk about reflexology to advance labor and the "placenta under the tongue" thing? I would love to know more non-interventional ways to progress labor or stop a bleed- although I'll bet there aren't too many moms that would chew on a placenta- even if it WAS hospital policy. :)
Yes Canoehead . . .you can count me as one who would rather have a shot than chew on placenta. Seen too many doggies and kitties born to EVER want to give birth like that
I have to say that all of these impassioned and compassionate and reasonable and intelligent responses from the nurses here have been a JOY to read. The stereotype of the grumpy nurse who forces an enema and shave on you and then straps you down to a bed attached to a fetal monitor not allowing you to move for the rest of your labor all the while insisting that you DO need that IV and fluids and who then jams her hand up your wazoo whenever the heck she wants needs to finally be laid to rest.
We have your best interests and your baby's best interests at heart. And I've not heard of enemas and shaves since my first-born over 20 years ago. I did have both and completely agree that they are disagreeable and torture (the after-the-shave-hair- growing back in period).
I do not understand not applying antibiotic ointment and not giving Vit k. Seems a minor intervention to have to put up with to make sure your baby is safe.
My first birth experience was not good . . (already mentioned the shave and enema). I was induced. Got an episiotomy. Laid in bed most of the time unable to move. This was with a female ob/gyn.
The next two were way more laid back in a rural hospital.
The last one two years ago was an emergency cesarean due to large amount of thick green mec and fetal distress. I have to agree with what someone else said about the goal being a safe delivery of a healthy baby and that my philosophy is that whatever the heck gets the baby out safely is ok with me.
I would also like to add (though it may be said already) to do a thorough check on your midwife at the birthing center. Remember that she is trying to earn a buck, as well. And she doesn't have the technology to save a baby that a hospital does. There are a few scary midwives who take dangerous risks in the patients they take...I know of some personally, one of whom is a family member.
You sound extremely well-read on the subject, and that is commendable. From some of the clarifications you made in your posts, your requests sound reasonable. Good communication is key.
Sorry, but I would definitely call you difficult.....I understand you want to have an input in your labor and delivery, but we as professionals are trained in this situation.....Say for instance you would refuse the intermittent monitoring of the fetus, what if something goes wrong....Even if you agree to the fifteen minute strip every hour, what if something goes wrong during the forty-five minutes that the baby is not monitored.....Then you would want to sue us!!! As for the eating during labor, why would you want to throw up all over the place.......stick to "clear" liquids.....As for refusing lady partsl exams only when YOU deem it's necessary and allowing you to take baths whenever YOU think it's necessary....Well, what if you refuse a lady partsl exam and you're close to delivery and you decide to take a bath........what then? Are we to follow you around and allow you to drip water, blood, and Lord knows what else!, everywhere? Please......be reasonable.....Why don't you just stay home with all these stipulations.....You have to give a little.....
"Sorry, but I would definitely call you difficult.....I understand you want to have an input in your labor and delivery, but we as professionals are trained in this situation....."
I want more than an input. I want control over my own body. I want my rights as a patient respected.
"Say for instance you would refuse the intermittent monitoring of the fetus, what if something goes wrong....Even if you agree to the fifteen minute strip every hour, what if something goes wrong during the forty-five minutes that the baby is not monitored.....Then you would want to sue us!!!"
The safety of intermittent monitoring in a low risk mother is not up for debate. It has been proven and is the recommendation of ACOG.
"As for the eating during labor, why would you want to throw up all over the place.......stick to "clear" liquids....."
Thanks for the suggestion. I prefer to keep my strength up and clear liquids is not quite enough for me. I don't mind throwing up during labor. It lets me know I'm close to the end. And I've never thrown up "all over the place." (Funny story: My brother in law is very, very talented at pottery and chastised us for putting all of his pieces around the house as art. He wanted them to be useful to us. Guess what I threw up in?)
"As for refusing lady partsl exams only when YOU deem it's necessary and allowing you to take baths whenever YOU think it's necessary....Well, what if you refuse a lady partsl exam and you're close to delivery and you decide to take a bath........what then? Are we to follow you around and allow you to drip water, blood, and Lord knows what else!, everywhere?"
I don't follow your argument here. Are you saying I should stay in bed and submit to lady partsl exams so YOU won't be inconvenienced with a mess???? I've had nothing but respect for most of the arguments and questions thrown my way in this thread, but this one is ridiculous. By the way, Depends pads go a long way in protecting the floor after rupture of the membranes. You might try it sometime.
Sarah
P.S. to Dayray, I haven't forgotten your request, I'm just out of time!
HazeK, lol! I'm sure the surgeon who recently removed my gall bladder had this thoughts when I laid out my "surgery plan." Nothing in writing....just a request the everyone in the operating room introduce themselves directly to me and that my arms not be strapped down until after the anesthesia took effect.
I do know that a lot of this comes down to control. It won't surprise many of you to know that I am a survivor of childhood sexual and physical abuse, so control of my body is very important to me. I also understand that it can be taken too far, and I hope I don't come across that way.
Hmmmmm.....maybe it is time to schedule another appointment, ha ha.
YOU MUST BE NUTS I AGREE 110% WITH TENDER TEE. DO YOU WANT COMPLICATIONS DURING BIRTH OF YOUR BABY OR WITH BABY AFTER???? WHY DEPRIVE HIM OF MEDICINE THAT HE/SHE NEEDS?? IS THIS YOUR FIRST CHILD????
YOU MUST BE NUTS I AGREE 110% WITH TENDER TEE. DO YOU WANT COMPLICATIONS DURING BIRTH OF YOUR BABY OR WITH BABY AFTER???? WHY DEPRIVE HIM OF MEDICINE THAT HE/SHE NEEDS?? IS THIS YOUR FIRST CHILD????
i just don't understand how you could be againest so much!!! i still agree with tendertee's comments. some is fine and some is just totally beyond me as to why. best of luck to you and whatever you choose to do but i wish you would reconsider some things you mentioned.
gypsyatheart
705 Posts
Just to add my .02 cents worth; being an L&D Rn for 10yrs, now in NICU... You may very well be labelled as "difficult" even where I work, which is VERY non-intervention oriented! Why? Because, as another poster pointed out...your TONE, perhaps in real life, with the verbal cues, facial/body language, you would come across differently...
I work in an environment where MOST of what you desire is the norm. I guess my pet peeve with pt.s who come in w/a "birth plan" often come across as we/the medical staff are "out to get them". That simply is not true. Your nursing staff are going to be your greatest advocates. Many times the physician/CNM's are more resistant to your requests. Also, take into consideration the actual hospital you will be delivering at. Hospitals have policies, procedures and protocols we have to maintain. WHY? Again, due to the high risk nature of OB, licensing organizations, etc. Once you walk through the door and become a pt., you have to understand WE have an obligation to YOU...to deliver the best care and hopefully, provide the best outcome(healthy baby and mom) we can. Do things sometimes go "wrong"? Sure. More likely, things don't go according to the "plan" (ER c/section, for instance). Of course, the pt. is unhappy and feels "robbed" of their experience. But, ultimately, what is MOST important, is that you are taking home a healthy newborn. There is no disappointment in a newborn regardless if he comes by way of vag delivery or c-section!
So, I hope you understand that nurses are NOT out to "get" you. Most of your requests are reasonable...and, certainly, we LOVE as low intervention birth as possible, it's a wonderful experience. I would only advise you to re-think:
1) 3rd stage pit...IF your "placenta under the tongue" doesn't work...it's better to be alive to take care of your children than to die from a PP hemorrhage (just happenned where I work a few mos ago d/t refusal of emergency intervention).
2) Vit K shot for the baby. This is not some conspiracy or drug co "scam". Babies really do lack certain factors necessary for blood clotting, this is NOT made up. Just coming through the birth canal is "traumatic". This is where I totally disagree w/you...don't risk your babies life!
3) Actually, I don't know one L&D nurse that would have you flat on your back, should monitoring become necessary. We completely understand and know what position is better for you, if you have to be in bed. At worst, you should be "wedged" or propped, so you are NOT flat on your back.
4) Finally, you can't believe everything you read on the internet. Some of these "medical" sites are full of it! Best advice...choose an MD/CNM who thinks like you, choose a hospital/birthing center that is low intervention oriented...ask to take a tour, talk (informally) to some of the nurses/staff, just to get a feel for the place. And please remember we want to HELP you, not "push" unwanted/un-needed interventions on you! Just please be open to the possibilities...
Good luck to you!