The following are true stories -- believe it or not!
A patient has been stuck at a certain dilation for some time without change. The doctors have discussed a possible c-section with the patient and she and her husband are very disappointed due to the fact that she has tried everything to accomplish a natural labor and vaginal birth. After giving the patient and her husband time alone, the nurse enters the room to find the husband with his face between his wife's legs shouting, "Come out baby! Come out!"
A man was supporting his wife who had been laboring for many hours and was distressed at the length of time it was taking for the baby to arrive. The nurse enters the room to find the husband holding his wife shaking her up and down like a bottle of ketchup hoping to expedite the process.
A woman had hired a doula to help her through her labor whose advise and help she requested when contractions weren't strong enough to dilate her cervix. Doulas usually have many good suggestions of natural means of helping labor along. The nurse entered the room to find the doula in bed with the patient, spooning her, performing nipple stimulation from behind her while the husband read a book at the bedside. (Maybe not the most appropriate choice for a hospital setting.)
Friday, January 30, 2009
Trust or Mistrust: The Controversial Birth Plan
If you are planning on coming to the hospital with a strict birth plan, or maybe even planning a home birth, here is a story that you should consider before you do:
A woman came into our unit with her husband one night in early labor. As we showed her to her room it became apparent that she intended to take control of her labor from the beginning. Declining the gown that we offered her, she opened one of her many bags and began to change into her own gown that she had selected just for the occasion. She introduced her two hired doulas (labor coaches) while her husband presented us with a typed, multi-paged birth plan that she had prepared based on her research during her pregnancy of natural childbirth. In it, like many other patients that we see, she spelled out her wishes for how her labor would be managed:
“I decline having a routine IV access placed.”
“I wish to have minimal monitoring of my baby. No continuous monitoring please.”
“I wish to have a natural birth. Please do not offer me pain medications unless I ask for them.”
“I do not want to have a C-Section unless absolutely necessary, and would like the opportunity to discuss it with my husband first.”
“No vacuum or forceps.”
“I would like minimal staff entering my room during my labor.”
“I would like to keep cervical exams to a minimum.”
The birth plan continued like this for several pages containing requests most of which we would accommodate anyway…without her requests for them. This was similar to the many birth plans that are presented to us on a regular basis by our patients and that we work hard to respect and follow. But the thing that stuck out about this birth plan was the fact that at the end-- it was notarized.
Was this supposed to make it more official? Was it supposed to threaten us in some way? Threatened is how we felt. Is that the best way to begin a therapeutic relationship?
Luckily, her labor progressed in a normal way and we were able to keep to her birth plan without any mishaps. We monitored her only as often as we were required to by hospital policy. She was able to do what she and her two doulas wished – birthing ball, tub, massage – common labor comforts. (As if labor was at all comfortable…)
Throughout her care, she confided to her nurse that she really didn’t want to birth in a hospital setting. She wanted a home birth. But she decided to come to the hospital only to have doctors more available if needed, and only if they agreed to keep from intervening in her natural labor process.
But in labor, things can go wrong so shockingly fast.
With the patient annoyed, the nurse placed the monitor on to check the baby only to find the fetal heart rate to be very low – 50 beats per minute. The nurse called for help as the heart rate continued to fall. The baby would soon be dead if we didn’t act now. We quickly took her back to the OR for an emergency C-Section and had the baby out within 7 minutes. But by the time we were able to help the baby there was no heart beat. We were unable to resuscitate in time and the baby will have permanent brain damage if it lives at all. Had we been able to monitor, we would have been able to intervene sooner, and that mother would have had a beautiful healthy bouncing baby boy in her arms.
What would have been more important: her ideal labor experience? Or a healthy baby and mother? Patients spend so much time researching in order to be able to tell us what they do and do not want in labor, but is that where their top priorities should be? Let us keep you and your baby safe. After all, you have the ultimate task of raising your child. It will be the way you raise your child that will determine what kind of parent you are…certainly not the way you gave birth.
A woman came into our unit with her husband one night in early labor. As we showed her to her room it became apparent that she intended to take control of her labor from the beginning. Declining the gown that we offered her, she opened one of her many bags and began to change into her own gown that she had selected just for the occasion. She introduced her two hired doulas (labor coaches) while her husband presented us with a typed, multi-paged birth plan that she had prepared based on her research during her pregnancy of natural childbirth. In it, like many other patients that we see, she spelled out her wishes for how her labor would be managed:
“I decline having a routine IV access placed.”
“I wish to have minimal monitoring of my baby. No continuous monitoring please.”
“I wish to have a natural birth. Please do not offer me pain medications unless I ask for them.”
“I do not want to have a C-Section unless absolutely necessary, and would like the opportunity to discuss it with my husband first.”
“No vacuum or forceps.”
“I would like minimal staff entering my room during my labor.”
“I would like to keep cervical exams to a minimum.”
The birth plan continued like this for several pages containing requests most of which we would accommodate anyway…without her requests for them. This was similar to the many birth plans that are presented to us on a regular basis by our patients and that we work hard to respect and follow. But the thing that stuck out about this birth plan was the fact that at the end-- it was notarized.
Was this supposed to make it more official? Was it supposed to threaten us in some way? Threatened is how we felt. Is that the best way to begin a therapeutic relationship?
Luckily, her labor progressed in a normal way and we were able to keep to her birth plan without any mishaps. We monitored her only as often as we were required to by hospital policy. She was able to do what she and her two doulas wished – birthing ball, tub, massage – common labor comforts. (As if labor was at all comfortable…)
Throughout her care, she confided to her nurse that she really didn’t want to birth in a hospital setting. She wanted a home birth. But she decided to come to the hospital only to have doctors more available if needed, and only if they agreed to keep from intervening in her natural labor process.
But in labor, things can go wrong so shockingly fast.
With the patient annoyed, the nurse placed the monitor on to check the baby only to find the fetal heart rate to be very low – 50 beats per minute. The nurse called for help as the heart rate continued to fall. The baby would soon be dead if we didn’t act now. We quickly took her back to the OR for an emergency C-Section and had the baby out within 7 minutes. But by the time we were able to help the baby there was no heart beat. We were unable to resuscitate in time and the baby will have permanent brain damage if it lives at all. Had we been able to monitor, we would have been able to intervene sooner, and that mother would have had a beautiful healthy bouncing baby boy in her arms.
What would have been more important: her ideal labor experience? Or a healthy baby and mother? Patients spend so much time researching in order to be able to tell us what they do and do not want in labor, but is that where their top priorities should be? Let us keep you and your baby safe. After all, you have the ultimate task of raising your child. It will be the way you raise your child that will determine what kind of parent you are…certainly not the way you gave birth.
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