Feedback on my birth plan anyone? Also need baby's chart - Page 2

[MeepyCat]

Originally Posted by Tumble Bumbles 
My 'In Case of Emergency Transfer' document (because if I transfer, it will likely be due to a situation likely requiring a c-section because I wouldn't go in otherwise) has no 'please' or 'I'd prefer' or 'unless deemed necessary' in it. I kept it short and reasonable, but it's assertive. All of those statements are absolutely up for individual interpretation and do not contain a definitive consent/refusal of consent. My plan contains legal and binding statements of consent/refusal of consent to treatment that are only amendable by my husband or my signature on individual items. My husband will not be signing any admitting paperwork that voids my statements of consent/do not consent. He will only sign a consent to treat that does not conflict with our transfer plan. I'm constantly amazed at the misinformation thrown about that doctors and nurses have the right to "allow" or "not allow" a woman to exercise her legal rights in labor and delivery. It may be an uphill battle (which is why we are choosing an out-of-hospital birth), but the rights are there nonetheless..

In regards to the bolded and underlined:

You need to know that a birth plan is not a legal document.  It is neither binding upon you nor upon doctors and nurses who have not reviewed its terms prior to your hospital admission.  Even birth plans that are reviewed by health care professionals in advance are not considered legal directives. 

In the event of a transfer for emergency or c-section, it is unlikely that you or your partner will have the leisure to review admitting paperwork in the kind of detail you describe.  It is probable that hospital personnel responding to emergency will have very limited opportunity to review your paperwork.  They may not be able to read your birth plan at all.  It is also possible that the emergency you are transferring for may involve issues, conditions or considerations that you didn't imagine when making your birth plan, and consequently didn't discuss in your documentation.

In an emergency, moving your treatment forward is more important than wrangling over legalities.  It's a good idea to make some contact with the hospital in advance to find out what their policies and procedures are, and what you should expect if you have to go there.  You can also get copies of their standard admission paperwork, and discuss them with department if there are significant issues.  You need to be flexible, because you don't know for sure what you will need if an emergency arises.

[Tumble Bumbles]

Also, where did anyone get the idea that the doctors or nurses had to sign or agree with a birth plan? I mean, of course things will go smoother if one has someone 'on their side' or a caregiver who is agreeable to a birth plan but it's not necessary to have their blessing or approval to exercise one's rights in labor/birth. A woman has as many rights after she's walked into a hospital as she had before she walked in. This common idea that simply walking into a hospital is license to check one's rights at the door is a convenient myth many hospitals love to perpetuate but is in fact a myth. Women are so socialized to be nice and agreeable and not raise a fuss that simply being assertive, no matter how respectful one may be about it, is met with contempt. It's a sad state of affairs when a woman feels she needs to seek permission from an entire maternity ward staff in order to labor and birth as she wishes. Not only is it sad, it's completely untrue and unnecessary.

[Tumble Bumbles]

My husband is meeting with the lawyer he has access to through his employer to verify the legalities of it. Obviously it's not a legal document sitting in my purse without anyone having looked at it -- however, according to his advice so far (via phone) if my husband is there advocating for me (or I am advocating for myself) using the document as a guide, our verbal consent/refusal of consent is legal and binding, as well as if a copy is given to anyone in charge of our care. To my understanding, the burden is on us to make sure the staff is aware of our consent/refusal of consent, and the document serves as proof that we have fulfilled that burden.  Are you saying that myself or my husband verbally refusing consent is not legal and binding? You bet it is. To my understanding, (again this will be confirmed by the lawyer) no one can perform procedures without your express consent just because they 'disagree' with your position.

In a true life/death emergency situation, my husband will be making decisions based on my ya know, desire to live.

Quote:

Originally Posted by MeepyCat 

Originally Posted by Tumble Bumbles 
My 'In Case of Emergency Transfer' document (because if I transfer, it will likely be due to a situation likely requiring a c-section because I wouldn't go in otherwise) has no 'please' or 'I'd prefer' or 'unless deemed necessary' in it. I kept it short and reasonable, but it's assertive. All of those statements are absolutely up for individual interpretation and do not contain a definitive consent/refusal of consent. My plan contains legal and binding statements of consent/refusal of consent to treatment that are only amendable by my husband or my signature on individual items. My husband will not be signing any admitting paperwork that voids my statements of consent/do not consent. He will only sign a consent to treat that does not conflict with our transfer plan. I'm constantly amazed at the misinformation thrown about that doctors and nurses have the right to "allow" or "not allow" a woman to exercise her legal rights in labor and delivery. It may be an uphill battle (which is why we are choosing an out-of-hospital birth), but the rights are there nonetheless..

In regards to the bolded and underlined:

You need to know that a birth plan is not a legal document.  It is neither binding upon you nor upon doctors and nurses who have not reviewed its terms prior to your hospital admission.  Even birth plans that are reviewed by health care professionals in advance are not considered legal directives. 

In the event of a transfer for emergency or c-section, it is unlikely that you or your partner will have the leisure to review admitting paperwork in the kind of detail you describe.  It is probable that hospital personnel responding to emergency will have very limited opportunity to review your paperwork.  They may not be able to read your birth plan at all.  It is also possible that the emergency you are transferring for may involve issues, conditions or considerations that you didn't imagine when making your birth plan, and consequently didn't discuss in your documentation.

In an emergency, moving your treatment forward is more important than wrangling over legalities.  It's a good idea to make some contact with the hospital in advance to find out what their policies and procedures are, and what you should expect if you have to go there.  You can also get copies of their standard admission paperwork, and discuss them with department if there are significant issues.  You need to be flexible, because you don't know for sure what you will need if an emergency arises.

[MeepyCat]

Tumble Bumble, I am by no means saying that your verbal consent or refusal to consent during care is not binding.  (Your husband's is a different issue.  If he's viewed as obstructing your care, he's not a patient and he can be removed.) 

I am not a lawyer, but I very strongly doubt that a piece of paper handed to "someone in charge of your care" in the midst of an emergency constitutes legal notice.  First - identify who, precisely, is in charge of your care.  Not always easy.  I had two emergency admissions in my last pregnancy, I received care from about a dozen doctors from three different departments, and I never met the doctor who was listed as officially in charge of my case.  Second - just because I have been handed a piece of paper doesn't mean that I have read it, and were I to go before a judge and explain that, when I was handed that piece of paper, I was evaluating a patient, obtaining vital information, and giving orders for emergency treatment, no one will expect me to be familiar with the contents of that piece of paper, or to have acted in accordance with information I was not aware of.

Most hospitals ask you to sign a blanket consent on admission.  This consent refers to "appropriate treatment for your condition," without specifying what that appropriate treatment might be.  The same consent language is generally used in all departments. 

The thing I'm trying to tell you is that, in an emergency, you don't have time.  You don't have time to review all the paperwork, you don't have time to discuss all the potential courses of care and the risks and benefits of each, you don't have time to cross out paragraphs, initial here, make a doctor initial there and get the hospital's legal counsel to sign off on the whole shebang.  Furthermore, loving husbands in the midst of a family emergency may not be as capable of this document review as they would be in calmer circumstances.

Make sure that your expectations - of the people who might care for you in an emergency, and of what you can accomplish with your birth plan - are reasonable.

[PlayaMama]

 

Occasionally, informed consent is not required. In an emergency situation where immediate treatment is needed to preserve a patient's health or life, a physician may be justified in failing to provide full and complete information to a patient. Moreover, where the risks are minor and well known to the average person, such as in drawing blood, a physician may dispense with full disclosure.

from http://law.jrank.org/pages/9110/Patients-Rights-Informed-Consent.html

i have a really hard time seeing a doctor being unable to convinve a judge that you transferred to a hospital in a dire emergency* and because of this emergency, the doctor was unable to obtain consent.

*based upon your previous definition of what would make you transfer

[AlexisT]

Okay, a lot of that stuff is extraneous.

1) Stuff that needs to be cleared with your provider in advance: induction, frequency of monitoring. The latter may have hospital policies attached to it. "Only when necessary" is an elastic clause. Ask your HCP what their protocol is, and if you want intermittent monitoring in a hospital where continuous is standard, you need your OB/MW to sign off on it. By the time your nurse sees the birth plan, your OB/MW will have written your induction orders, so if you don't want Cytotec you need to clear that beforehand. Not all OBs permit the drape to be lowered for CS. You're going to have to ask. Also, ask how many support people are permitted in the OR: many hospitals only let you have one. It'll probably be husband OR doula, not both--and it may be down to anesthesiology, not OB. Having done it, you really don't have room for more--ORs aren't really set up for people who aren't actually involved in the surgery.

2) Stuff that's extraneous. there's no need to specify anesthesia for CS. General anesthesia is risky and they don't want to do it either. If it's not a crash, you'll have spinal or epidural. If it's a crash, it won't be up to you. The anesthesiologist and OB are going to decide what to use based on how long they have and any relevant medical factors.

At least half that plan can be snipped after a discussion of routine policy with your OB/MW. There's no need to write down "don't strap my arms down for surgery" if the hospital doesn't do it, kwim?

[momto9kidlets]

I think it is very important to remember that unless your husband is truly a medically trained person he can easily be manipulated.  I know that isn't nice, but I have seen it happen more times then you would ever imagine.  Here is an example - a doctor got frustrated with his patient because she was taking so long to birth her baby (more than 24 hours) and he had plans.  Several times he tried to convince the family that it was time to call for a cesarean and they continued to opt out and wanted to continue on with their unmedicated birth.  The doctor would leave frustrated and each time he walked out would tell them they can continue on as long as the baby is doing okay.  Finally he comes back - very frustrated and tells the dad "oh no, do you see that dip right there on the monitor?  That's not good - your baby needs help."  The dad was so worried about his baby, was tired, and he had no clue that the dip that the doctor was talking about was most likely from head compression - very normal process of birth.  Dad freaked out and convinced mom that this was a true medical emergency - they dosed her up with an epidural and the doctor forbid the nurse from checking her and an hour later they were in surgery.  The nurse later told me that they actually had to pull the baby back out of the birth canal, but dad and mom didn't know that - they thought they had a medically needed cesarean birth.  

Have you thought about perhaps at least interviewing some ob's in the event of a transfer?  Finding one that you really like and can trust would put all of this upset and frustration behind you.  I had a client do that once - she was birthing with a family practice doctor and decided she would take charge of her care and so she interviewed ob's and found one that she liked and felt she could trust.  Had her care needed to be transferred she felt she had someone she could trust and didn't have to worry.  Just a thought!!!
 

Originally Posted by Tumble Bumbles 

My husband is meeting with the lawyer he has access to through his employer to verify the legalities of it. Obviously it's not a legal document sitting in my purse without anyone having looked at it -- however, according to his advice so far (via phone) if my husband is there advocating for me (or I am advocating for myself) using the document as a guide, our verbal consent/refusal of consent is legal and binding, as well as if a copy is given to anyone in charge of our care. To my understanding, the burden is on us to make sure the staff is aware of our consent/refusal of consent, and the document serves as proof that we have fulfilled that burden.  Are you saying that myself or my husband verbally refusing consent is not legal and binding? You bet it is. To my understanding, (again this will be confirmed by the lawyer) no one can perform procedures without your express consent just because they 'disagree' with your position.

In a true life/death emergency situation, my husband will be making decisions based on my ya know, desire to live.

[LizD]

Hospital staff will not be held liable for anything they do that they feel is saving a life, whether you consent or not. This may be morally wrong and legally questionable but it's what those of us "in the biz" have seen time and again, even court-ordered cesareans. 

*I* do not hoot and laugh at birth plans, but I know just about everyone else does, and I find it abhorrent. My point was that even the "this is different!" hospitals are often the same old story, deep down. 

The whole point I see here, even in the OP, even with the general concept of the birth plan- and I helped plenty of clients write and follow them when I was a doula- is that going to the hospital with a hostile or confrontational attitude helps no one, and it certainly doesn't help you get what you want. There's a point at which you must accept that you are on someone else's turf and they have protocol and policy to follow, and in all fairness, professional licenses to protect. 

Originally Posted by Tumble Bumbles 
 Are you saying that myself or my husband verbally refusing consent is not legal and binding? You bet it is. To my understanding, (again this will be confirmed by the lawyer) no one can perform procedures without your express consent just because they 'disagree' with your position.

[2lilsweetfoxes]

The biggest part of my birth plan was the following lines:

Explain all procedures before performing, to include: risk of the procedure, benefit of the procedure, if there is an alternative and the risk/benefit of the alternative, and the risk if we decline or delay performing the procedure in question.

and I also made it clear that I knew there were times and circumstances the birth plan should not be followed.  Basically, I was letting them know I wasn't stupid, but that I would take into consideration what they said without allowing myself to be bullied. 

FWIW, my birth plan was followed pretty closely--except the baby came so fast that they didn't have time to get the mirror out.  And I chose to push in the lying-on-the-back position.  It just felt right--maybe it slowed it down a bit.  Oh, well.  And the part about eating and drinking--forget it.  But, I wasn't really hungry as I'd just had supper an hour before the baby was born (ate then went to the hospital--baby born not long after we got there).  After the baby was born, my popsicle got ninja'd by my son and I had to share my Pepsi with my daughter.  My poor midwife had just put her dinner in the microwave, thinking I had several hours to go, when we called her back to deliver the baby--they hadn't even finished prepping me.  I told my husband the next baby, we'll make sure we have an emergency homebirth kit. He said that at first contraction we were heading to the hospital--oh and we are done having babies.  Oh, she still got to eat her meal hot.

[Tumble Bumbles]

Thanks for clarifying Meepycat. Of course, in an emergency situation my consent would be to do what preserves life, either of me or the baby.  The only reason I specified "my husband or myself" was more in the event that I was not able to (for whatever reason) advocate for myself. I also wanted to specify that I was indeed married since I've retained my maiden name and if they saw the 'father' had a different last name may assume he didn't have spousal rights to make decisions concerning my care (again in the event I was not, for whatever reason, able to communicate).

One thing I did want to mention to is that I believe every woman should read the Patient's Rights and Responsibilities Act (it may be named the same or similar) for their specific state. In our state, the Patient's Rights are written very much in the patient's favor and we have a lot of rights that I tailored my transfer document around (using similar terminology). I also printed a copy of the Patient's Rights for our reference. More important than my plan actually being followed to the very letter is that everyone knows we have educated ourselves extensively on what our rights are and are not afraid or intimidated to use them (if necessary) which we feel cuts down on a lot of potential pressure from staff.

Believe me, I wouldn't walk into the hospital with an adversarial mindset. I would be praying for a caring, agreeable staff willing to help and accommodate our wishes but in the event that they don't, we will be prepared.

[Thparkly]

I am pretty much overwhelmed by the thread at this point. I can't tell who is talking to me or to somebody else. 

I have already decided where I am giving birth and do not need to second guess my choice at this stage. I will present my birth plan because every single doula and childbirth educator I have spoken with has recommended it. I have heard many varied stories from people about how the hospital staff has treated their birth plan; and for the most part the vast majority of it has been positive and without scorn.  Most medical professionals I know deal with people understanding that they are not doctors and have misguided notions in some areas.

I do not expect a birth plan to be a legally binding document.  It is a guide for my support 'team' and hospital staff; one I will refine with my midwife when I finally get to Michigan, but by that time I will be 34 weeks pregnant.

Please if anybody is replying to me, address your post with my name, Thparkly:-)

[lovebeingamomma]

I didn't read any of the posts, I just noticed how very long the birth plan was.  I have A LOT of specifics for my birth plan as well, but I KNOW nurses will not read it all, or remember it all, so I made it very short.  So my only suggestion is take out the things that aren't necessary, for example "let mom and dad give baby bath".  You don't need that, because regardless of it being there, the nurse will STILL ask you, because she'll forget or not have read that, so that's an easy thing in the moment you can answer, "no thanks, we're going to do it ourselves".  There are probably a number of other things that don't *need* to be there because you won't forget when they ask you.  Good luck :)