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Birth Plan Basics: FAQ about Elective Inductions of Labor

Q.  Should I have an elective induction of labor?

A. 

no3

 

 

 

 

Q.  I want to make sure that my OB is there for my delivery, should I schedule an elective induction?

A.

no1

 

Q.  My mother is flying in this Saturday, can I schedule an elective induction for Friday?

A.

no6

 

 

 

 

Q. It is my first baby and I am already dilated to 1cm.  I want to schedule an elective induction.

A.

      no2

 

 

 

Q.  I am 38 weeks and I am contracting 4 times an hour, I would like to schedule an elective induction.

A.

no5

 

 

 

 

Q. My ultrasound said that my baby was already 6 pounds at 37 weeks.  Should I have an elective induction at 39 weeks?

A.

no4

 

 

 

 

 

Q. I really want my baby to be born on 1/15/15.  Should I be induced electively?

A.

     no8

 

 

 

 

 

Q.  What about an elective primary cesarean section?

A.

no7

 

 

 

 

 

 

 

Q. If I have no medical reason to have an induction, should I let my baby choose his birthday?

A.

yes

 

 

 

 

 

 

I do not recommend an non-medically indicated elective induction of labor or cesarean section.

Inform yourself about the risks of inducing labor early.

Go the Full 40!

Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN) 

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Why the Golden Rule Doesn’t Apply in Healthcare

The Golden Rule has been preached to those in healthcare for decades.  As nurses we were taught that we should treat our patients as if they were our mother or grandfather.  I have heard doctors concluding consults with, “if it were my sister I would tell her to do X procedure.”  I know well meaning nurses whom call all their patients sweetie, because that is how they address family and they want to treat their patients like family. Empathy for our patients, care, and recommendations based on how we would like to be treated seems to be the ethical and correct behavior.  It is not the right thing to do.  To assume that we know what a person should choose or how they would like to be addressed is presumptuous at best and patriarchal at worst.

We should leave the Golden Rule concept in the past.

The Golden Rule, although a benevolent seeming concept, is fundamentally flawed.  Not everyone wants to be treated the way that someone else thinks is right.  This is concept is clearly evident in labor and delivery.  Women that choose to pursue normal means of birth, such as waiting for spontaneous rupture of membranes, are commonly labeled as difficult.  Women that decline an epidural or pain medications are often met with impatience and pressure to not suffer through the pain.  Mothers that wish to give birth vaginally, after one cesarean birth, are discouraged, badgered and bullied into submitting to a repeat surgery.  All this is done by health care providers that believe that they are treating the patient according to the Golden Rule.  Pain is bad, so healthcare providers want to take pain away from mothers.  Vaginal birth after cesarean comes with risks and they would not choose to try it.  By attempting to apply the Golden Rule in these ways, we are actually doing more harm.

We need to think about the Golden Rule in a new way.  It does not mean that we do for our patients what we would like done for ourselves or our loved ones.  We do not decide for a woman, what she should choose to do, based on what we would want our sister to choose.  A truer interpretation of the Golden Rule is respect for our patient’s wishes, requests and declinations.  Ultimately I would want my healthcare providers to respect how I want to be treated.  That is how I take care of my patients.  If they don’t want to know the details of every intervention, then I won’t tell them.  I know that education is important, but some patients do not want to hear how a urinary catheter works.  Many patients want to know every detail, and I accommodate their requests.  Personally, I prefer unmedicated labor and feel that moms miss out on something amazing when they get an epidural.  I do not treat my patients how I like to give birth.  I support them with what they prefer, whether it is an epidural, unmediated birth or somewhere in between.

I feel comfortable sharing my opinions when asked.  I give advice, but I never assume that I know what is the golden answer for each woman.

The old Golden Rule does not apply in health care.  Patient autonomy, as a priority in our nursing care, should become the new Golden Rule.  MC900439242

 

 

 

 

 

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Men Need Not Apply

 

what now

 

If we, as women, want equality in the workplace, why are we sabotaging our fellow nurses? Why do we call males in the nursing profession “male nurses”? Using this phrase insinuates that nursing is a female profession. It is true that in recent history nursing has been dominated by females. Currently about 10% of nurses are male, but that number is growing. Women have fought for status among our male physician colleagues. We wanted to be respected for our knowledge, training and experience. Our sisters, daughters and friends became medical doctors by an increasing number. Gender stereotypes in medicine have been torn to bits. We do not refer to women MDs as “female doctors”.  Yet we cling to our gender biases in the nursing field. This bias is clearly evident in the obstetrical field. In the land of labor and delivery, female nurses continue to dominantly out number male nurses. This may be more design than accident or patient preference.

It starts in nursing school.

Beginning in nursing school, men are cautioned to be respectful of mother’s wishes to be cared for by women only. This warning is appropriate and justified as some cultures and religions forbid men from caring for women. Other women may have experienced sexual violence or simply prefer women only care givers. Outside of these exceptions, it should be presumed that the gender of the nurse does not matter. The hypocritical bias against men in labor and delivery is especially apparent during nursing school.  It is common for a male student to be shooed out of a patient’s room that not only has been to a male doctor, but has male residents rounding on her. The message that we are giving our fellow nurses is clear.  Male doctors are respectful and take care of patients appropriately, but a male labor nurse is, for lack of a clinical term, creepy.

I have heard the argument that men don’t understand what women need in labor, because they can’t have babies. This is a belittling and backwards notion.  If that concept is extrapolated out to other fields of nursing, then only cancer survivors can work oncology, the mentally ill can only work psych and diabetics only can teach about diabetes. There are many women that have never, and will never, have babies that are wonderful labor nurses. I have met many of these ladies and I am proud to call them friends and colleagues.

As a clinical instructor, I spoke to a patient and asked permission for a male student to take care for her during her delivery. This is not an action that I wanted to take, but what was required of me by the unit. The sweet lady agreed graciously. Her labor nurse went right in after me and sabotaged the whole plan by “clarifying” that this was a MALE nurse and he would be there for the delivery and was she SURE that she wanted a MAN in her room. When the question is posed in that way, patients may begin to feel embarrassed and feel like they should say no. Her doctor was male, which made the situation more preposterous. The student was gracious about the situation, but his learning suffered because of a nurse that felt justified in blocking him from the experience.

Is our culture biased against male nurses?

There is a cultural bias against males in OB nursing.  It begins in nursing school and is reinforced in the hospital setting. I have had multiple conversations with floor nurses, hiring managers and physicians regarding hiring males into labor and delivery. The push back is quick and strong. We don’t need men here, we don’t want men here and our patients shouldn’t have to have men in their deliveries. A survey was conducted to gauge perceptions of males in obstetrical nursing revealed that this is not what patients, nurses or men prefer (McRae, 2003). According to the study most pregnant women would accept a male OB nurse. Up to three quarters of the labor nurses surveyed had positive attitudes toward male labor nurses. Few men had worked in obstetrics, 6.8% and most said they would not want to work in OB. Male nurses did site nursing school as the reason they were not interested in OB. These results can be viewed as a tremendous positive for men who would like to pursue obstetric nursing. With very little representation in the specialty, men enjoy a favorable opinion from both mothers and current labor nurses.

Social Media weighs in on the topic.

I quick polled two of my online social groups. One is a mothers group and one is for labor nurses. The majority of the mothers reported that they would be comfortable with a male labor nurse. The ones that stated that they would  uncomfortable explained that they were exceptions. They agreed that males should be free to be OB nurses and probably would be good at the job.

Brittany Renee Dunevant summed up her feelings this way, “Women have a male doctor (OBGYN), so what is the difference? If he knows what he is doing, then he is the same as a female nurse to me.”

The labor nurse group had similar feelings. All respondents agreed that males should be OB nurses. About 46% of the nurses had worked with male OB nurses. Half of the nurses said that although there was no official ban on male nurses, it was an unspoken rule in their labor unit.

Erin L. Hollen is a perinatal nurse, certified childbirth educator and  breastfeeding counselor.  Erin discovered that she had some hidden biases that the survey brought to light. Upon reflection she observed that a male nurse may have a positive affect on fathers. Speaking of fathers Erin shares “…if they see that you can still be supportive of a woman in this situation and still be ‘masculine’ maybe they will participate more.”

Is labor and delivery a secret, girls only club?

In many hospitals the answer is yes. The new question is: How will we break down the gender bias that we are perpetuating with each new class of nursing students.

Answer: Let male nurses into OB. No questions asked.

 

McRae, M. (2003). Men in Obstetrical Nursing: Perceptions of the Role. MCN, The American Journal of Maternal/Child Nursing, 28(3), 167-173. Retrieved November 22, 2014.

 

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Birth Plan Basics: What Should I Wear in the Hospital?

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I am frequently asked about the patient gowns that women are given to wear in labor.  Mothers want to know if they should and/or have to use them.

Comfort is important.

Many moms worry more about how their feet will look or shaving their legs before labor begins than what they will wear in labor.  It is good to feel comfortable in labor.  If getting a pedicure before delivery puts a mother at ease, then she should get one! The clothes a laboring woman is wears during the hours of labor and birth may have a bigger impact on her comfort than the color of her toenails.

What are you allowed to wear in the hospital?

You do have a choice!  I have labored mothers in everything from being absolutely naked. to being covered hear to toe. You are not required to wear a hospital gown.  You can wear whatever makes you feel comfortable.  There are some restrictions in the operating room.  If you are having a scheduled cesarean section or end up there after laboring, you will need to wear the hospital gown.  Hospital gowns are preferred in these situations due to infection risks and the types of monitoring equipment used in the surgery.  If you still would like to wear something else to surgery discuss your options with your nurse or doctor.

Pros and Cons of the hospital gown

Pros:

There is a fresh one waiting whenever needed.

You don’t have to worry about getting blood, poop or vomit out of it later.

Some are designed for breastfeeding or monitoring ease.

Cons:

They are made to accommodate a large variety of sizes and usually do not fit well.

Modesty can be an issue, especially while walking in the halls.

Hospital gowns can make you feel like a sick patient and less empowered.

What are my clothing options?

Occasionally I have labored a mother whom was only comfortable completely naked.  These were all patients that were laboring unmedicated. I provided modesty when she requested it with sheets. Tank tops or breastfeeding tanks are popular.  Sweat pants, shorts or yoga pants are easy to slip off for cervical checks and are comfortable for labor.  Skirts are comfortable, modest and do not need to be taken off for pushing.  There are specialty lines for labor clothes for example: http://www.prettypushers.comThe specialty clothing is designed to accommodate monitoring equipment and maximize utility and comfort.  If you do not want to pay the specialty price, there are plenty of other options.  In my most comfortable delivery I wore a breastfeeding tank and a maxi skirt with a wide, elastic waist band.  The ultrasound and toco monitors fit in the band so that I did not need to wear the monitor belts.  I moved around very comfortably and always felt modest.  When it was time to push it was easy to pull the skirt up and out of the way of the delivery.  I did not plan on wearing the skirt again, but I was happy to find that the evidence of delivery washed out easily.  I wore that skirt multiple times in my postpartum months.

Postpartum Tips

If you choose to wear the hospital gown for labor and delivery you can still wear your own clothes after delivery.  It is good idea to bring 2-3 pairs of comfortable, stretchy clothes with you for your postpartum stay and the drive home.  The hospital’s maternity underwear are disposable and great for giant pads.  Some moms prefer to bring in their own underwear or brief type panties.  Hospitals will often provide slip resistant socks for their patients.  You can bring in your own socks or slippers if you wish.  Breastfeeding moms will spend a lot of time with the baby skin to skin during the first few days.  Nursing bras are not vital for the hospital unless you feel uncomfortable without a bra.  You may want to wait to buy nursing bras until after your first week at home since your bra size will likely change.

 

The bottom line.  

Its your bottom and you can cover it however you wish!

 toilet

 

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Barefoot and NOT Pregnant

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THE BUS!!!  I jumped up and ran outside to the bus stop when I realized I was late to pick up my boys. It was a nice day and I was picturing them alone waiting for me. In my rush I didn’t slip on my shoes. I slowed down when I saw that the bus hadn’t arrived. Then something unexpected happened.  I became aware how wonderful my bare feet felt treading along the side-walk. I could feel ever pit mark and seam in the concrete. I felt the difference in temperature when I crossed from sun to shade. I arrived at the corner and let my toes wander into the grass. What ecstasy! I walked around relishing every texture. I couldn’t remember the last time I had been outside barefoot.  I felt like I had as a child.

Being a birth nerd, I quickly realized my barefoot walk was similar to my unmedicated birth experience. My journey was comfortable and enjoyable. I felt the roughness of the cement, but it added to my experience. I noticed more about that walk  than any previous ones.  If I had worn shoes, I would have missed out on connecting with my environment.  Wearing shoes simply does not feel the same as being barefoot.  I feel the same about natural childbirth. Bringing a baby into this world is a miracle under any circumstances.  Natural childbirth is the barefoot version of birthing.  There is an added dimension that going natural brings to the experience.  The difference between my medicated and natural births were marked and undeniable.  I was more in tune with my body. I was at peace during the storm of contractions.  I felt euphoric and energized after my 3 natural deliveries, which was a surprise after my first two medicated births.

The conditions were perfect for my barefoot adventure. If the temperature had been different, or if there had been broken class on the sidewalk, shoes would have been necessary.  Similarly, it is not safe or prudent for every labor to be unmedicated.  When the conditions are right we have a choice.  Our society has become accustomed to a medicalized model of birth, just as we have become accustomed to wearing shoes.  We forget that there are other choices.  We absentmindedly slip on heels or tie on a pair of sneakers.  In the majority of our healthcare experiences we trust in the safety and necessity of our medical ‘shoes’.  Birth is not inherently medical in nature.  We have been conditioned to believe that the monitors, drugs and interventions are just part of giving birth.  Medical intervention is a luxury and a safety net for a natural process.  If a mother chooses to have an epidural for comfort, great!  If a mother needs to be induced due to a medical issue, we are grateful for the medical technology.  Just as I chose to walk barefoot, natural birth is a choice.  It doesn’t mean I think my birth is better than yours.  It especially does not say anything about any one else’s choices.  It doesn’t mean that I would want to have a surgery without medication, or try to heal my hypothyroid with herbs.  Sometimes its just nice to experience life in a basic way.  I experienced birth with all my senses and I loved it.

 

 

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Birth Plan Basics: Using BRAIN

image“Well, you are the expert; we will just do what you tell us.” Admittedly it is nice to be regarded as an expert, but these are dangerous words. There is something about wearing a white coat and a stethoscope that grants healthcare professionals great power over their patients. Intelligent women and men come to the hospital and abdicate their decision making power at the door.

Your perinatal team has varied knowledge, training, experience, bias, fear, and motivation. They are experts, but they are not perfect! They have seen a lot, but they haven’t seen everything. Some have not read a new research article in years, some haven’t slept in 2 days, and some had a maternal death patient with similar risk factors as yours. Sometimes they just want to go home on time and your labor is taking too long. Some of them are biased towards low intervention, others have never met a patient they didn’t want to take to the operating room.

When you are admitted to the hospital you will not know what is behind the smiling faces and monitoring machines. In most cases what you see is what you get. Doctors and nurses that are working hard to make ensure you and your baby make it safely through labor and delivery. There are many paths to that outcome. You need to be a part of the decision making.

The first step is to get educated prior to the delivery. Taking a prenatal class is an excellent way to prepare for childbirth. I personally recommend the Hypnobabies course, but there are many other programs available. Check with your local hospitals. They often offer low/no cost courses and you will be able to learn more about how labor is approached where you will be delivering. If you do not have time to attend a traditional class, there are self study options or online courses available. AWHONN, INJOY, and Evidence Based Birth are websites that have great information.

The second step is to make a birth plan. If a written birth plan is not appealing, you can still take time to discuss with your support person and your doctor/midwife your thoughts, goals and wishes for your labor and delivery. Having a mutual understanding can help make decisions during labor easier.

Third: Use your BRAIN! Every decision you make should be collaborative between you and your healthcare team. The most important person in the equation is you. Each time a decision is required, use the simple decision making tool BRAIN.

Benefits: What are the benefits of the intervention?brain

Risks: What are the risks involved? It is important to explore this and get the full list of risks. Many times healthcare providers will mention the most common or the most devastating risks. You need to be told all the risks to be able to make an informed decision.

Alternatives: Are there alternatives? Sometimes there are no alternatives, but in many situations there are alternative interventions that can be attempted. Find out your options and if you have an alternative in mind, suggest it.

Intuition: Take a minute to think and discuss with your support person. What is your gut telling you? Doctors and nurses use intuition to care for their patients too.

Nothing/not now: What if you did nothing? What if you waited an hour or three? Time can clarify most situations. In other situations doing nothing may cause a bad outcome for you or baby. How does doing nothing affect this particular situation?

Being empowered and educated will help you have the birth experience that is best for you and your baby.

Remember to use your BRAIN!