Thursday, November 17, 2011

Tiny Humans (another L&D post)

It's that time again friends.

thanks again Pinterest.

More from the wacky world of labor and delivery. On a daily basis, we nurses and doctors escort tiny humans out of their mothers' bodies. Lets think for a second how many babies I've delivered over the course of my obstetric career. I did the math the other day (with the aid of a calculator I might add. I'm a nurse, not a pharmacist.). Just bear with me and estimate I deliver 2 babies per day - well after all that useless math, I estimated that I've been involved with somewhere around 1200 babies. Give or take one or two. Now, I don't have any babies of my own, but considering 50% of the OB-GYNs in America are males, I don't think that literally having a baby is a prerequisite to knowing how to have a baby.

And with all this in mind, there are still lots of folks who think they know my job better than I do.

And here's an update (4/12): After months of having this post up and getting all sorts of feedback, I'd just like to step back and make a few declarations of my intention. I never in any way intended for this post to be judgmental or ugly. I never intended to turn people off. I like to think that my writing is light hearted and completely intended this post to be "tongue-in-cheek" so to say. A poking fun at both natural birth AND hospital/intervention birth, if you will. Since neither alternative is right for everyone, can't we just put our differences aside and stop forcing one method over another? Read along (if you so choose) and take it with a grain of salt! Back to Birth Plans!

So today's discussion is all about those lovely ladies who like to call the shots. Literally. All the shots. I think I'll affectionately call it "Birth Plans: Good Luck with that." And before you get all offended at the jaded nurse, let me show you my side of the story.

First, we'll look at the extremists. These are the ladies who refuse IVs, lab work, monitoring, vaginal exams, anesthesia, amniotomy - basically everything. To these women, I say: Go home. Seriously, if your goal is to have a no-intervention birth, then a hospital is not the setting for that to happen. These folks belong in their tub at home with a midwife. Let me make something clear: decades of evidence-based practice has dictated a manual of policies and procedures that if burned, would provide long-lasting heat to an entire Inuit village. I don't make the rules, but I am expected to follow them. Bottom line? I am not putting my license on the line for someone who thinks they should be the exception to all the rules. Please either go home and deliver or be open to appropriate interventions.

And as a side note: the idea that we follow policy that is derived directly from evidence-based practice means that all those little things I do for my patients are not arbitrary.

Now, lets look at those ladies who have a typical birth plan. Number one most important thing to remember (those of you who are pregnant and reading this): the hospital admission isn't the place to premier your birth plan. This is something that you should develop with your delivering physician before your due date- because I'll say it time & time again- your doc writes the orders, not me! I understand there are lots of variables to a normal vaginal delivery and I do believe that people should have some control over their experience. I'm open to special considerations and requests as long as they are also approved by the delivering doctor. Apprehensive about amniotomy? Talk to your doctor. Inflexible about induction? Talk to your doctor. Adamant about anesthesia? Talk to your doctor. Mean business about monitoring? Talk to your doctor. Got the picture?

Here's a truth that's well known to labor nurses and little known to pregnant women: A chart with a birth plan often also includes c-section papers.

What often comes along with low-intervention birth plans? A lack of anesthesia. It's not my business whether or not my patients want an epidural or not. In fact, for the patients who can keep it together, delivering epidural free makes my job a lot easier. The only problem is that most ladies come in completely unprepared for labor. Having a baby is largely regarded as the most painful experience known to man, and yet women who are adamantly against using an epidural will come to the hospital with no game plan for labor. And there's nothing more frustrating than having a patient who is in absolute agony with no coping mechanism. When I do have patients that go epidural free (it still exists!!), I remain largely hands-off. Not all epidural-free deliveries are scream fests. These women know whats up and can vocalize their needs, especially those who are experienced in natural childbirth.

What's the best plan when coming to the hospital to have a baby? Be flexible. Choose a doctor who is supportive of your wishes, make an appropriate labor & delivery plan and go with it. And for goodness sakes, be flexible. There are thousands of variables that can change or go wrong during labor, many of which I have no control over. Be aware that the ultimate goal is the healthiest delivery possible for mom and baby.

And please, for the love of all things lovely, bake your nurse some cookies. It makes all that epidural-free screaming just a little more palatable.


Kendra said...

My birth plan, in bold letters started with: I understand things dont always go as we would like but this is my ideal birth plan! I still remember my nurse telling me the girl in the next room was not flexible in wavering from her birth plan and it was miserable for my nurse.
Can I also say its miserable to be in labor walking the halls and hearing ladies screaming bloody murder asking people to kill them or help them!

Erin said...

My professor for Individual and Family Development showed up his wife's birth plan. It was front and back, 10 point font, with at least 45 bullet points. I'll have to scan it and send it to you.

Alicia said...

I'm getting ready to start working on mine! The doula who did our birthing classes said to expect about 5 of your wishes to come true..if you're lucky. Narrowing it down to 5 was difficult, but it can be done. That said, no one knows how unreasonable they are going to be until they actually go through the birthing process...I'll let you know how mine goes in 2 months or around there :)

Meredith said...

That's why I'll stay home next time. :)

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