Q. Should I have an elective induction of labor?
Q. I want to make sure that my OB is there for my delivery, should I schedule an elective induction?
Q. My mother is flying in this Saturday, can I schedule an elective induction for Friday?
Q. It is my first baby and I am already dilated to 1cm. I want to schedule an elective induction.
Q. I am 38 weeks and I am contracting 4 times an hour, I would like to schedule an elective induction.
Q. My ultrasound said that my baby was already 6 pounds at 37 weeks. Should I have an elective induction at 39 weeks?
Q. I really want my baby to be born on 1/15/15. Should I be induced electively?
Q. What about an elective primary cesarean section?
Q. If I have no medical reason to have an induction, should I let my baby choose his birthday?
I do not recommend an non-medically indicated elective induction of labor or cesarean section.
Inform yourself about the risks of inducing labor early.
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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.
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“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!
Check out Perinatal Empowerment’s first YouTube video.
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