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 Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by pittsburghRN
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 obviously are not reading KEEPER's POSTS thoroughly or you would not have asked if it was her first baby. Just for your info, SHE HAS 4 kids and she IS NOT PREGNANT AT THIS TIME. SHE PLANS TO BIRTH THE NEXT AT HOME if and when she become pregnant.
She IS being hypothetical in her questions, polling if you will, what nurses think when patients refuse interventions. I hope this attitude is NOT prevalent out there. I know it's not where I work, thank goodness.
I really see a problem here. If all nurses were like this---out and out rude and judgemental, then no WONDER women would consider hospital birthing an unpleasant and threatening experience. To call a person "nuts" for her beliefs, even if they are radically different than your own, is just plain ignorant and unprofessional. Many people object to interventions based upon religious reasons or even on research done on their own (some patients are so well-read, it's amazing. good for them).
This lady's refusals are reasonable for the most part. She also stated she planned on getting Hep B at the first wellchild checkup. She also planned to get the PKU/State-required newborn screen in the recommended time frame at her doctor's office. She is saving money that way. She is also getting it at a better time----at 48 hours' age versus less than 24 most hosptals are forced to do due to early discharges. All of that is reasonable to me. And refusing vitamin K is not a death sentence, either. There is evidence showing ESPECIALLY breastfed babies are getting this very important vitamin IN THE MILK in quantities sufficient enough to keep them safe. She is talking about HEALTHY low risk situations here, not women at risk for serious complications or compromised newborns.
Please, we can agree to disagree, but to attack ANYONE for her principles and beliefs, not matter how different from our own only makes the situation worse. Even if there is evidence backing up my view, I won't argue with them or force my views on them. I WILL EDUCATE THEM AS TO WHY WE DO WHAT WE DO ---Of course, I want my patients to understand the rationale behind each and everything done for them and to them in the hospital. If they refuse, they have that right without my calling them names or immediately judging them as "weird" or "nuts". We are not communicating once we start name-calling and without communication, proper nursing care can never be rendered anyone. Let's at least be professional here, and disagree if need be.
I was considering how I might want to reply to some of the vitriolic posts that have appeared in this thread when lo and behold someone did it for me and far better than I would have done! Thank you SmilingBluEyes for being the voice of reason. Nursing needs to focus on evidence-based care and stop defending things just because that is the way we have always done it. If we are ever to truly become a respected profession in our own right we have to stop being so defensive and respond to each and every situation with our critical thinking skills instead of our emotions.
I can't really fault Pittsburgh RN or TenderTee either because nursing has a long history of this kind of response to challenges to its authority. I think they just need help to see things from another perspective. Your reply will go a long way toward opening the eyes of these nurses and others. Thanks!
in my opinion this is not healthy for her or baby to refuse all of these things. nuchal cord could go around baby neck cause loss of oxygen. her 15 min strip might not catch at right time then she'll want to sue cause baby has brain damsge from her own wishes. but whose license should have prevented this mine--my knowledge should advise her againest this. she asked for opinion and this is mine. vit k should def. be given erthromycin to eyes should be done hep b could wait but not above mentioned. fetal monitoring is essential to know how baby is reacting to birthing process. to deny it is ridiculous. like i said this is MY OPINION AS A NURSE AND MOTHER WHO HAD MANY COMPLICATIONS THROUGHOUT MY PREGNANCY AND DELIVERY . and i do believe she would be adifficult patient sorry if i offended anyone but i strongly disagree and i am speaking for her future baby who has no choice or voice in this matter:)
This is the problem though, you are speaking from personal opinion and not evidence-based knowledge.
I understand that this is how you see things and this is too bad because some really good information has been shared in this thread that should convince you to at least stop and think about the source of your beliefs. You speak with a lot of emotion, it shows that you really care about what you do and the mothers and babes that you care for. That is something that you can be proud of.
We, as nurses, have a responsibility to keep ourselves updated and educated on the most current knowledge in our field. Keeper has done her research, we need to do ours as well.
I think it is great that we can have this kind of conversation in this forum. We can all learn so much from each other.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Oftentimes, emotion and passion threaten our ability to think critically and take each situation as individually as the individuals we are caring for. Using personal situations is NOT the best way to approach nursing others. Using evidence-based practice IS. Taking into account each person and her situation IS. Keeping our minds open IS. Communicating effectively and clearly without letting emotion get in the way IS. Calling names is NOT. Accusing others of endangering their lives and babies without taking into consideration the individual(s) and their circumstances is NOT.
But you see, that is the beauty of our work. We CAN learn from others, we CAN listen with open minds and hearts and we CAN agree to disagree. Once we have educated people on why interventions are considered necessary and HEARD WHY THEY REFUSE, we can move on, after the person refusing has acknowledged she has been given the information and take responsiblity for her choices.
I am IN NO WAY saying forget monitoring fetuses or just stop giving prophylaxis to newborns at birth. I am saying let us examine why we practice as we do and try to see opposing points of view. I AM saying at least HEAR WHY PEOPLE refuse and PERHAPS help them overcome the obstacles that make them feel the way they do. There is a lot of misinformation out there----on the public's part and on ours. We all stand to learn alot from each other and our patients if we just LISTEN first.
smilingblueeyes and kmrm42 - both of you wrote what i have been thinking as i have been following this thread. most of what is done in ob is a cya policy not based on anything credible. also, i am sure if you look at the different policies of each hospital you will find many differences. so i wonder who is deciding on the "standard of care".
only a few of the nurses here are "enlightened". the others i dare say are bound by their hospital policy and are not questioning why things are done. they are going by "hospital knows best".
the most annoying thing was having to defend myself to every nurse who was trying convince me to bow down to hospital policy. yes, i was labeled as difficult because i had an opinion based on research.
keeper - i commend you for keeping your cool and defending your opinions. you sound more informed than many of these other posters.
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.
A birthplan is a great thing! The only thing that I would have second thoughts on is the Vit K. I didn't have the Erthro ointment put in until later and I also didn't get the Hep B vaccine until she was 2 months old. There was no risk factor for her to get Hep B, I am neg, my DH is neg, she wasn't leaving the house to a sitters for at least a few years. I went home in under 24 hours and a visiting nurse came and did the PKU.
As long as you are informed and understand all the pros and cons, then no, you aren't difficult!
Neither I or my hospital policies would have a problem with keeper's birth plan. However, I WOULD like an explanation on the "piece of placenta under the tongue" to stop bleeding that she is advocating. I've heard of nearly every use for placentas in my 20 plus years of OB nursing including making placenta prints to hang in the home! However this is new to me. Keeper or Anyone---rationale?
Neither I or my hospital policies would have a problem with keeper's birth plan. However, I WOULD like an explanation on the "piece of placenta under the tongue" to stop bleeding that she is advocating. I've heard of nearly every use for placentas in my 20 plus years of OB nursing including making placenta prints to hang in the home! However this is new to me. Keeper or Anyone---rationale?
You will see references to the use of placental tissue to stop pp hemorrhage in many natural birthing and midwifery websites. I believe the rationale is that there is enough endogenous oxytocin within the placenta that it can be accessed this way. I have heard of tomato juice drinks blended with placenta and smoothies made with placenta besides the sublingual use. Animals often eat the placenta after giving birth and it is thought to give them needed sustenance but I wonder if it doesn't work to stop bleeding as well?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
This is NOT unheard of, especially among homebirthing experts and midwives. I could NEVER do this, but if it works, and people are willing ---it's their show. But I do not think hospital policy where I work would allow this, really. Infection control issues, I am thinking.
Thanks for sticking up for me. It's been really important for me to keep this conversation civil, so I chose not to respond to the "nuts" comment. Actually, I had a good laugh instead. I think it's funny in a sad way that some have automatically assumed that I am a first time mom with no idea what's going on. I hope maybe they'll think twice before putting that on one of their patients.....even if she is a first time mom.
As for placenta, obviously, I wouldn't be doing this in the hospital. This is mainly a homebirth intervention. And it's usually a last resort, because of its nature. My best friend actually had to do this at her birth, and she didn't have a problem with it. Just though it was a somewhat large piece the midwife cut for her, lol.
SmilingBluEyes
20,964 Posts
You obviously are not reading KEEPER's POSTS thoroughly or you would not have asked if it was her first baby. Just for your info, SHE HAS 4 kids and she IS NOT PREGNANT AT THIS TIME. SHE PLANS TO BIRTH THE NEXT AT HOME if and when she become pregnant.
She IS being hypothetical in her questions, polling if you will, what nurses think when patients refuse interventions. I hope this attitude is NOT prevalent out there. I know it's not where I work, thank goodness.
I really see a problem here. If all nurses were like this---out and out rude and judgemental, then no WONDER women would consider hospital birthing an unpleasant and threatening experience. To call a person "nuts" for her beliefs, even if they are radically different than your own, is just plain ignorant and unprofessional. Many people object to interventions based upon religious reasons or even on research done on their own (some patients are so well-read, it's amazing. good for them).
This lady's refusals are reasonable for the most part. She also stated she planned on getting Hep B at the first wellchild checkup. She also planned to get the PKU/State-required newborn screen in the recommended time frame at her doctor's office. She is saving money that way. She is also getting it at a better time----at 48 hours' age versus less than 24 most hosptals are forced to do due to early discharges. All of that is reasonable to me. And refusing vitamin K is not a death sentence, either. There is evidence showing ESPECIALLY breastfed babies are getting this very important vitamin IN THE MILK in quantities sufficient enough to keep them safe. She is talking about HEALTHY low risk situations here, not women at risk for serious complications or compromised newborns.
Please, we can agree to disagree, but to attack ANYONE for her principles and beliefs, not matter how different from our own only makes the situation worse. Even if there is evidence backing up my view, I won't argue with them or force my views on them. I WILL EDUCATE THEM AS TO WHY WE DO WHAT WE DO ---Of course, I want my patients to understand the rationale behind each and everything done for them and to them in the hospital. If they refuse, they have that right without my calling them names or immediately judging them as "weird" or "nuts". We are not communicating once we start name-calling and without communication, proper nursing care can never be rendered anyone. Let's at least be professional here, and disagree if need be.