October 12, 2008

The birth plan

I'm all about a natural birth. It is a natural, beautiful process that when left alone, usually, goes great. Labor progresses, a baby is born, cries and we have a happy family. But something that can strike a nerve with many people is a birth plan. No, I'm not opposed to a birth plan at all, and neither are the nurses I work with. I actually think it's a very good idea to think about how you want to labor and deliver, and to visualize that labor. Do you want intermittent monitoring, do you want to use the tub for labor and/or delivering? Do you want pain meds?, etc. I am a firm believer for intermittent monitoring, ambulating in labor, using the tub to help ease the pain of contractions, allowing mom to hold her baby skin to skin immediately after birth and breastfeeding exclusively for 6 months. I think continuous monitoring leads to more interventions that cascade down to an operative birth, whether that be forceps, vacuum, or c-section. And research says it does not lead to better birth outcomes, it just increases incidence of operative births. But, here are just a few things I think you should consider when writing your birth plan. We are all working in OB because we love childbirth and when you have a great experience, we have a great experience. First, be open to letting things happen that will lead to a safe delivery. Sometimes, interventions are necessary, and no nurse I work with would intervene just for fun. Second don't just print one off the internet. Most of the things I've seen on those we don't do anyway, like enemas and pubic shaving. And at least where I work, no baby is given formula or a pacifier unless the parents request it. We are all for helping you get the best start to breastfeeding. But if you are breastfeeding, and you send your baby to the nursery to sleep but won't let us give it a paci, and it screams, we have to bring you're baby back to you to feed it. If you don't want pain medication, etc, then stay home until you absolutely have to come in. That way you are in active labor, if not in transition and it will be only a matter of time before you deliver after arrival. Probably most importantly, TALK TO YOUR DOCTOR!!!! I can't say this enough. I'm perfectly fine with no IV, drinking fluids, and ambulating and using different birth positions other than lithotomy, but if your doctor hears about all this for the first time when I call them at 3:00 a.m., they won't be happy and I can't guarantee that they will agree with your plan. Which when this happens, all involved will be unhappy. I am your biggest advocate and will do everything I can to ensure that you have the birth experience that you want. One thing to keep in mind is I am not the one who decides whether or not things are done or not. I get orders from your physician. We also do not like doing bloodwork and IV's and tests on your baby. We don't enjoy causing a baby pain and discomfort. We do these things to ensure the health of your baby and under the direction of the physician. I'm a little testy right now, I guess. I have a house infested with fleas, those damn yellow and black lady bugs and I've spent a lot of money to rid my home of these pests, to no avail. Several people I work with have the same problem right now. And work was a wee bit stressful. We had a couple who came in with an extensive birth plan that they hadn't discussed with their doctor. Biggest problem: they wouldn't let us do ANYTHING. No vag exams during the course of her 2 day labor, no doppling of heart tones at all, no newborn resuscitation of their blue, floppy, baby. I guess it was ugly in the delivery room for quite awhile. No vaccines, no tests at all, no assessments, and that baby never left their sight. And they treated everyone who came in contact with them like we were out to cause harm to them and their baby. Fine, you don't want interventions, but if you won't let us do anything, why deliver at the hospital? The state I'm in sucks because there are NO birth clinics and it is very midwife unfriendly, especially midwives who do home deliveries. There aren't too many done, but there is a midwife that will do homebirth around here. They were obviously miserable the entire time they were there and wanted to be at home. We were miserable because nothing we did could make them happy. Again, I'm not anti-birth plan, and I'm all for an all natural birth, and keeping your baby with you. I'm so hoping tonight will be less stressful.


Mrs. Spit said...

That would be terribly frustrating for you.

I think having a plan is great. I had a plan. And then I got sick, and my baby died. Plan flew out the window, by in large. But, the nurses were incredible. They were kind and compassionate and explained what was happening. I was so thankful for them.

I've never understood the arrogance of not listening to experts.

AwkwardMoments said...

still bugs..YUCK.

Sounds very frustrating. I think birth plans are kind of unnecessary .IMHO. I mean my plan was to get baby out safe .. Whatever that entailed was what i was willing to do. I mean, I went hte medically assisted route to conceive, why start throwing out all the medical advances now. My plan was more of a go with the flow and see where that leads me - I had some suggestions and ideas but nothing that was a definate. I think that is partly why my birth experience was as great as it was for me

admin said...

thanks for posting this. after being on bedrest for so long, there will be no birthin classes for me. I am totally clueless. I have done some reading and have a kind of "wishlist" of how I would love it to go - but with IC and preterm labor, i don't know what to think. After a rough preganacy, I think it is easier to say, "let's just get everyone here healthy."

And, after a month in the hospital i know a lot of the &D nurses and trust they will do what is best for us. I can not iagine how hard your job can be. But i am grateful you do it.

Anonymous said...

Would saying NO to the yucky stuff for the babies eyes, daddy cutting the cord, and momma to breastfeeding or having skin to skin be too much to ask in a birth plan and if not how would you word that????

In a NST what would the Dr. call - scar?????lta orbe lookin 4 neg. ________?

As for the bugs, call a professional, stay gone for a day or 2. We had ours prof. done in aug because ticks were carrying us off and last week honey bees broke into our garage and invaded our aluminum can collections and then l by 1 they jsut started dropping like flies!! Good luck with those pesky pest.

Nurse Lochia said...

Anonymous - all of those things are perfectly fine for a birth plan. All of that really should be done in every birth, with the exception of thy erythromycin ointment for the baby's eyes. You can decline that but you will probably be asked to sign a refusal of medical treatment because, at least where I live, the state mandates that it be given. As for the wording, anyway is really fine, when if comes time to delivery, we like to have a copy of your plan on the chart and you can remind us and the doc at delivery of you wish to not do the eye goop and that you want skin to skin. Most docs will offer to let dad cut the cord. As for what the doc was talking about in the NST, I'm not really sure.

AtYourCervix said...

No dopplers in two days? And NO resuscitation of a floppy, blue baby? Were they expecting Divine Intervention? Good grief!!

Nurse Lochia said...

Yeah, no dopplers, no nothing. It was a nightmare. No one knew what we would get a delivery. Thankfully the kid did come around, but they wouldn't let us touch him...just skin to skin with mom. No oxygen, no stimulation, etc. The nurse at delivery documented her butt off!