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Old 02-01-2013, 08:14 AM   #31
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Re: Birth Plan for Hospital

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Originally Posted by z2akids View Post
The hospital's first priority with any patient is safety. These are things that are evidenced based to keep patients safe. The problem is that the people who are more likely to refuse an IV and insist on eating are also likely to be the same people who don't want to be monitored, want to avoid exams, etc. All in all, those patients are the ones who - if something goes wrong - are less likely to be caught early due to the cascade of choices that are made.

I suppose if you really wanted to look at it, these policies are not completely enforceable. No hospital has the staffing for 24/7 continuous care of every patient who might need emergency surgery. If you want to sneak food, then you will have opportunities to do so. The hospital however will make your status NPO, which means that food services is not going to bring you a tray. In an emergency, you cannot uneat the food in your stomach. And, because your digestive system slows during labor/delivery, anything you eat is going to sit around longer to be aspirated in an emergency. Honestly, my first two labors were both close to 24 hours and I don't think I ever once thought about food. My body was far too busy doing something else (and my digestive tract was slow) to be worried about food.

The difference with paramedics is that those people who are bleeding out in the ambulance are already dead without extreme circumstances. If they get in a line, great. If they don't, they don't. Anyone in that situation who makes it to the hospital alive and survives is a life saved that would otherwise have been list. Those paramedics are good, but sometimes they cannot get a normal IV started. When they can't, they can put in an interosseous line. An IO line goes into the bone. It is quick, efficient, nearly certain access and definitely used in emergencies and not routinely. No one is sitting in the ambulance trying over and over to stick a patient who is bleeding out. A try or two and they move on to IO or other options.

However, in the hospital, if a mom in labor begins to hemorrhage, and they cannot get a line in, it is 2 lives lost that should have been saved. Absolutely an IO line can be put in in the hospital. But, there is increased risk of infection. Removal is very painful. But, if you refuse IV access during labor, it may be the only quick means of knocking you out for an emercency C-section or other lifesaving treatment. No one plans to be the person will need emergency access. If we could plan that, then we could avoid putting IVs in the majority of hospital patients.
Agree wholeheartedly, especially with the bolded (and especially as someone who has to put in IVs emergently.)

That said, I have never actually written a birth plan, but I have made a big effort to communicate with the staff about what I would like with each of my births.

For example, with my last kiddo, I let the nurse know early on that I didn't want him to leave the room for routine stuff. She was fine with that. Unfortunately, little guy ended up in the NICU shortly after birth (and I'm so grateful to this same nurse for picking up on some abnormalities and getting him there fast.) Because I had a natural (unmedicated) delivery, my recovery time was pretty short and she moved heaven and earth to get me over to the NICU to see him quickly. Same nurse was also an awesome labor coach - she told me how much she enjoyed helping moms through natural labor - and she had some great suggestions that made things a lot more comfortable.

Don't underestimate the hospital staff, all of the L&D nurses I know love their job and want to help people have a great experience.

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Old 02-01-2013, 08:25 AM   #32
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Re: Birth Plan for Hospital

And, just a further comment on IVs. Some nurses are really good. I personally can barely hit the broad side of a barn. So, if you were my patient and things were going south, I'd try, but I'd also be paging my charge or other nurse who is good. They'd get there as fast as possible, but it is a delay. And, if they cannot get access, you're looking at waiting on the response team. Even at my large urban hospital, that means 2 people per shift who cover all of the emergencies in a 800+ bed hospital with 3 towers of 7-12 floors each, etc. Additional delay while mom and baby's lives could be hanging in the balance.

An IV should not limit your movement. They aren't generally uncomfortable. They aren't put in because nurses are Pit happy. Honestly, hanging meds, answering beeping IV pumps, etc. is a pain. It's a lot more work than leaving an IV hepwelled.
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Old 02-01-2013, 10:57 AM   #33
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Re: Birth Plan for Hospital

Thanks for the explanations, they make good sense. Fortunately, not an issue here since the only reason I'll ever be in the hospital versus home/birth center is if I risk out, in which case I'd be more than happy to follow policy
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