Personal Birthing Plans

There should be only two things on a mother’s birthing plan…  anything else is self-indulgent and frivolous.  This is not a social event.  Childbirth is deadly serious and must remain professional.

BIRTHING PLAN  (2 item)

  • My baby will be born quickly.
  • The doctor must be in the hospital.  If not, the baby will be delivered anyway.

BIRTHING PLAN  (single item)

  • The doctor will be in the hospital from the time I arrive  until I deliver.

Here are the reasons:

  • Problem with a long birthing plan.  Nurses and doctors have done the things you need to have happen, hundreds of times.  They are experts and most importantly, with this level of skill much os the success is in their automatic responses.  They may look calm and friendly but each of them is a machine with hair trigger alertness to the smallest clue that something is out of the ordinary.  And they jump on it.
  • Anything distracting attention from this alertness, making sure you have fresh water next to you at all times for example, or the lights dimmed, removes focus from THE BABY.
  • A personal birthing plan, written down and presented to the hospital or it’s agents (the staff) becomes a legal document and completely changes the focus of every minute, away  from the baby and task at hand to ‘how do we keep from being sued?’  Instead of a staff of experts at your side, your birthing plan has changed them to a group of people wary and self-protective.  And that is against your best interests.  Instead of a partnership that flows perfectly, the event becomes one of possible adversaries and clumsy.    We had a mother one night who came in with a 27 item birthing plan and the R nurse said:  “You know nothing good’s going to come of this.”

Who benefits?  No one.

Who is at increased risk?  The baby.

Why  does the ideal birthing plan have only these two particular things?

  • If a doctor is on the golf course, the mother can labor on and on until he is ready.  Each contraction is the force of 2Gs on the baby’s head.  I’ve seen mothers allowed to remain in active labor for 24 hours…  720 compressions of the baby’s head with the force of 2 Gs.
  • In the 1950s and 60s, nurses were instructed by the doctor to prevent delivery by holding the mother’s legs together until he got there.  In those days if the doctor wasn’t there, you did not have to pay him.

The Doctor as God

A terrible mistake… maybe it can’t be fixed.

This idea, universal in America, is a bad foundation for building the reciprocal problem solving relationship among health care professionals essential to a good outcome.  The game changes from ‘let’s solve this problem together’ to the dysfunctional game of adults; Parent /Child.

The doctor as god assumption-stereotype is untenable for the doctor and dangerous for everyone else. The doctor is expected to make a god-like judgement immediately or he will be suspect,  he knows it and it terrifies.

How did this happen and why does it continue?  Media stereotyping, commercials, fear of lawsuit demands to: “Consult your physician first.” for normal vitamin advertisment, for exercising, even for walking agrandizes the doctor and mandates the idea of ‘my doctor’ and of dependance.

Patients are complicit also.  Looking for the ideal ‘daddy’, patients and particularly isolated, lonely and frightened elderly women visit too frequently giving too much fine, minute detailed information and leave unsatisfied and adrift.  They are assuming that the doctor is listening to each word, deeply involved in their problem and always interested in only them.  The reality is that while listening, the doctor is thinking with each new bit of information:  “How can I be sued.”

No longer is doctor synonymous with family friend.  The country doctor of my grandfather’s time, the understanding, wise and measured problem solver of my childhood may still be a med student’s dream but the time-money demands of business, insurance carrier interference, malpractice rampages and peer pressures destroy that dream.  The nurse practioner is the old country doctor of today.

A story:

  • I recently had a doctor who (after I had explained that my shake began with Polio at age 19 and that it’s essential tremor, a familial shake, my mother had it and most of my children have it…) told me that it was Parkinson’s, a completely different type of shake, and in fact antithesis to essential tremor.  She took my wrist, bent the arm, percieved a certain movement in the elbow and with a smile on her face and a nod said to me:  “Yep, you have Parkinsons.”  What happened here?  It was not about me, it became an issue of her being right, the smile was smugness on her part for discovering something that she believed made her right, but perceived by a patient to be glee at having delivered a worse-than-death-sentence diagnosis.

The Nurse as Handmaid-Tart

Read why this stereotype is so wrong and dangerous for the patient…

TV, novels, films  and much of the internet portray the nurse as secondary.  As emptier of bedpans and bringer of water.  Period.  As someone killing time until she marries a doctor (G_d forbid!).

The great majority of doctors see nurses as annoyance, as threat, as hated mother and as handmaiden.  Someone once said: “Doctors treat all nurses like old dry dog shit and they treat outspoken nurses like warm, steamy dog shit.”  She was right.

In former times, the nurse was the core of a team.  Because there was no machinery, the doctor was forced to rely on assessment and information from those closest to the patient, the nurses.  They functioned as a problem solving team and physicians were not control-avoidant, they listened and together made plans, set goals and moved on to the next step.  This system worked extremely well and it was heady.

Joys of the job.

The nurse has a goal, driven by fear of failure and the absolute fun of achieving this goal AND THE PATIENT BENEFITS.  The goal is to return every body system and function to normal.  To do this, she must know exactly what is happening physiologically with the patient, assesses every change and define and watch for the next problem.  She watches pressures, body chemistry, neuro changes, heart and lung symptoms and any improvement or degeneration of status.  In addition, she gives medical treatments, medications, personal physical care, and emotional support and kindness to the patient.

She knows the status of her patient, minute to minute but she has a problem.  She can’t tell the patient’s doctor.  She can’t even tell him in private.  The best she can do is drop hints and clues… I use she for nurse and he for doctor because this defines the underlying dynamic of the exchange.  It is the same, however, with nurses and female doctors which means the dynamic is  actually about power, not gender. AND THE PATIENT SUFFERS.

And then there is the sub-text woo woo, (behind the scene and mostly invisible to the patient).  Bully managers that don’t ‘get it’, control avoidant doctors who don’t listen and administrations that have no idea what is going on in their hospital and have only one goal, money, and who make sweeping changes of doubling the nurse’s patient load to save money, (This destroys her ability to do the job correctly, a very, very expensive error.)

As for the tart!  That’s the last thing on our minds and we are generally not delicious, young, compliant and adoring subjects.  We are tired, overworked, sick of hospital politics and pissed-off.

 

What Women Want in a Man

  • A full-term baby in the big room of NICU was three days post-op from major surgery and had a long, indwelling central line of some sort.  During evening visiting hours, the surgeon from another hospital came in and told me he was going to remove the central line.   He then turned bright lights on around the crib, put the crib rail down, took the pacifier out of the baby’s mouth, turned the music off , bent down and said to this week old baby boy:  “Steven, I’m  Dr. Silen and I’m going to remove your central line.  It won’t hurt but it will feel very strange for a minute.  I will let you know when I’m finished.”   As he began to talk, the room fell silent.  He finished the procedure, talked again to the baby as promised, replaced the pacifier, turned the music back on, put the crib rail back up and dimmed the lights.  As he was leaving the unit, I ran up to him and said: “Dr. Silen, you don’t know me but you have just become my hero.  Every woman in this room fell in love with you tonight.” He looked at me in surprise and then tears came to his eyes. He bent and kissed my cheek and said that it had been a difficult day, thanked me and said that he had needed that.
  • A friend’s mother is on the way back to America, in a little sail boat, 2,000 miles from land in any direction, out of contact with anyone for 50 days and alone with her beautiful gentle, happy loving husband.  Co-ordinates in Google Earth show them as a dot completely alone in the vast ocean.  I wonder what that’s like!  It’s a second marriage and early on they bought Harleys and toured America. Then they bought a jeep and went to the top of every mountain in the American West. For the past years, they have lived on their small sailboat with long stays on island after island in the Pacific.

Women want loyalty and kindness, they want partnership, they want adventure, to be safe and they want security.  They want to build the family nest and have peace in their life.  They want interesting conversation and to laugh.

Women want the men in Nora Robert’s novels.  Women want the Dr. Silens of the world.

Doctors Are Not Fond of Nurses

There are physicians who are exceptions of course and these people are precious to the patient, to the nurse and to the profession and they are deeply loved and honored.

Hospital nurses are with the patient for long periods of intense assessments. Contrary to the American myth that casts the nurse as maid /secretary /tart, nurses are extremely skilled and if education hasn’t cultivated it, experience certainly has.  So, the nurse understands the minute picture and the big picture about the patient and she knows very well what needs to be done to fix the problem.  But she is not allowed to tell the doctor (unless she wants to destroy the rest of her professional career).   She must drop hints or give information in such a way that the doctor understands the solution and believes it was his idea.

Because of this dynamic, doctors become control-avoidant, much as the child becomes control-avoidant of the parent (or in later life, the parent of the child).

  • A STORY:  Very small preemie boys often develop large inguinal hernias because the inguinal ring is sloppy and every cough or strain pushes their bowel into the scrotum.  We had a baby, born at 25 weeks and at the point of discharge, weighing over 5  pounds, with a hernia so big the scrotum was to his ankles.  We asked the surgeon why he was not fixing it and he said he couldn’t fix it until the child was 3 years old.  I asked why and he said because the epididymus (the tiny tube that sperm goes through) was so small there was risk of cutting it.  I suggested he operate with magnifying glasses so he never spoke to me again.  One morning this surgeon was making rounds, followed by residents, interns and med students and as they entered the quiet back room where this baby was, his nurse opened the diaper and shrieked:  “Oh my God, it’s going to burst, it’s going to burst. Something has to be done about this.”  and everyone ran over to the crib to see what she was talking about.  The hernia was repaired that morning and the nurse was never seen again.

Doctors treat nurses like old dried dog shit, and they treat nurses like me like warm, steamy dog shit.

Who suffers?  The patient, the system and health care costs.  This goes on in every hospital in America and it’s very, very bad.

How to Find a Doctor

A friend, a well known actor from New York called, said he needed his hip replaced and wanted me to find him a doctor in Portland.

I went to the hospital of my choice, to the Orthopedic ward, in the middle of the night on the weekend and asked each nurse:  “If you were going to have a hip replacement, who whould you go to?”

I got one name.

Another friend, a Producer from LA called and said she was pregnant and wanted me to find her a midwife In Portland.  I said I’d find a midwife for her 4th baby but she needed an OB doc for the first.

So, I went to the hospital of my choice, to Labor and Delivery, in the middle of the night on the weekend and asked each nurse:  “If you were pregnant, who whould you go to?”

and again, I got one name.  (and midwives were part of the clinic.)

Why the middle of the night  on the weekend?  Well, those nurses would recommend someone who would be sweetly available to his patient at any time they needed him.

The Orthopedic Surgeon was Dr. Gregory Irvine.

The OB /GYN Surgeon was Dr. Susan Johnson,  now practicing GYN  medicine /surgery.