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.

Emergency Rooms Must Fix Themselves

A Story:
  • I went to the ER of the hospital in which I worked as ICU nurse, with a 3 day migraine so severe I couldn’t stop vomiting.  I was seven months pregnant.  My husband was a lawyer and a DA.  
  • The receptionist took me to the janitor’s closet.  So there I was, sitting on the floor with the door closed, vomiting in the slop sink.  I hauled myself up and went to the receptionist’s desk:  “I’ve been sitting on the floor of the janitor’s closet for 20 minutes, throwing-up and I don’t like that so I think I’ll throw-up here for awhile.”  And vomited all over her desk. They got me on a stretcher and into an ER bay quickly.

I know of no-one who does not have hospital horror stories.

There is a huge percentage of these stories that are absolutely unnecessary and are caused by ‘man’s inhumanity to man’ and you can become a force for change.

These postings will be published as a series of 3 books called Stay Healthy.  They will be spiral bound with a series of care plans that can be easily Xeroxed.  Here is an example of the problem and the solution. Nurses cannot effect even the smallest changes in hospitals.  They are fired for trying.  But when the first patient hands a care plan to the doctor that has ‘My baby will not be weighed on a scale without a head and foot barrier.’  checked, those scale trays will be replaced with the safe ones. Or: ‘My baby will not be placed within 25 feet of a blue bili-light.’  Bingo, they are gone.

Shaken Baby Syndrome

Shaking a baby that won’t stop crying may be an instinct of frustration. Even the saints among us have been to that point and somehow stopped themselves.

PACIFE Music to Calm stops the crying minutes after the screamer takes a breath and is quiet enough to hear it.  The mathematical character of this music along with the primal tunes Bernstein talks about quickly engage them.

Newborn drug babies, after the third day, begin a terrible and violent drug withdrawal.  The muscles in their legs undulate and cramp (we can see it and feel it), they purple cry nonstop, they shake, they have explosive diarrhea that eats their bottoms raw and they are beyond comfort.  This is the comment of one NICU nurse about a baby in drug withdrawal…

“I found a tape player and began to play the PACIFE music for him… I’d no sooner put it into the tape player than he stopped crying. It’s instantaneous. He’s looking around with a relaxed, peaceful face.”

– S. S., NICU Registered Nurse

 

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.

 

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.