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.
Betsy, you misunderstood my wishes. I have never said I would refuse intermittent monitoring altogether. What I refuse is the external fetal monitor, which would require me to remain immobile. I have no problem with intermittent monitoring with a dopplar.
Beepers, I never questioned whether a formal education was important and beneficial to nurses. Of course it is. I simply stated that formal education was not necessary for patients to be informed about their options. I was the one being questioned, not the other way around.
betsy are you a member of the perinatal listserve? i see a lot of GREAT posts from a betsy in conn. there. just wondering. WELCOME TO ALLNURSES!!!!!!!!!!!!!!!!!!!>.
betsy are you a member of the perinatal listserve? i see a lot of GREAT posts from a betsy in conn. there. just wondering. WELCOME TO ALLNURSES!!!!!!!!!!!!!!!!!!!
Deb, Betsy and I are both members of the Perinatal Nurse List. We are both from CT and work in the same facility. I came to this forum looking for info on jobs and locations is Florida but I found it such a nice forum that I decided to post in some of the other topics (like this one) and I told Betsy that she might enjoy "visiting" here as well!
Karen in CT (the way I usually sign on the listserv).
I am not trying to persuade you one way or another, however, in response to the fetal monitoring. You would actually be able to more mobile with external fetal monitoring than with hand-held dopplers (at least the ones I am familiar with). If EFM is positioned right I have put women in rocking chairs, birthing balls, standing, squatting, knee chest, left side right side, whatever the patient wants to do all while maintaining a tracing with EFM.
You had mentioned in another post about having to lie flat on your back in order for the EFM to trace. You are absolutely right about the untoward effects of lying on your back while pregnant. I am sorry that was your experience with EFM, but I can tell you this, That shouldn't have been done and wouldn't have been done in any of the hospitals I have worked in. If that in fact if this was your experience with EFM I can totally understand the aversion to it.
Exactly. You do NOT have to be anywhere near flat. If someone had you that way, it was due to their inexperience. We are lucky enougfh to ahve telemetry so one can be out of bed and even out of the room and still be monitored.
You know, we just had a couple with a birth plan and the wording was great....It was Ellen and Jim would like.....At the end, it thanked everyone in advance and mentioned how happy they were to have us all participate in their plan and help them through it...It was the first birth plan of many zillions I have ever read that didn't come off as either defensive or impossible, and as much as we do try to do whatever we can to accomodate people, the wording and approach of this couple made us all really HAPPY they came with a plan....
My daughter requested the same as what you want, Keeper, and she got it. The RN kept telling her she would come back and start her IV. My daughter went to the BR and stayed during contractions, using the squat method. When she came out she called for the nurse, was complete, ready to push, Dr. came, she pushed TWO times and we had a baby. This was her second. Oh did I forget to tell you I am an OB nurse and had coached her.
I think that is WONDERFUL! Maybe the nurse purposely stayed away and delayed the IV in order to afford your daughter what she wanted instead of what protocol or some doc wanted..I can dream can't I? Lovely when labor is quick with no complications....Too bad it can't always be that way, isn't it????
Just wanted to say thanks again for this fun discussion. I have enjoyed all the points of view, even when I haven't personally agreed.
It seems my path into the work of birth is beginning. My midwife has offered me her next apprenticeship. Her apprentice is set to begin her own practice within the next year! Much study and mighty prayer have told me the time has come.
I'm planning on a Bradley instructor certification as soon as I can get to one, and a doula certification to follow. Both will help with income during my 2 year apprenticeship.
Funniest thing: I may actually be pregnant. Ha ha. I won't find out for another week and a half. We spent the Labor Day Holiday camping......does it to us every time. :chuckle
I'M VERY SORRY I CALLED YOU 'NUTS' AND WANTED TO WISH YOU AND YOUR BABY (IF PREGNANT) A HAPPY AND HEALTHY 9MO AND UNCOMPLICATED LABOR AND DELIVERY. HOWEVER IF YOU DO CHANGE YOUR MIND ABOUT ANYTHING PLEASE RECONSIDER THE FETAL MONITORING. IT ISN'T HURTING YOU OR BABY TO HAVE THIS DONE AND AS MENTIONED EARLIER YOU DO NOT HAVE TO STAY IN SAME POSITION TO BE MONITORED. LOTS OF LUCK.:)
keeper
65 Posts
Betsy, you misunderstood my wishes. I have never said I would refuse intermittent monitoring altogether. What I refuse is the external fetal monitor, which would require me to remain immobile. I have no problem with intermittent monitoring with a dopplar.
Beepers, I never questioned whether a formal education was important and beneficial to nurses. Of course it is. I simply stated that formal education was not necessary for patients to be informed about their options. I was the one being questioned, not the other way around.
Sarah