What nurses need to know about birth plans

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Each day, almost 11,000 babies are born in the U.S. alone. That’s a lot of expectant mothers—and a lot of nurses, doulas and midwives helping them deliver their babies! Many mothers develop detailed birth plans as soon as they learn of their impending bundles of joy, while others have no plans whatsoever (and no plans to make any plans!) up until the big moment arrives.

Navigating the world of birth plans with your patients can be tricky—after all, it’s one of the biggest and most emotional days of the patient’s life. Here, we give you the expert tips and tricks you need to know about birth plans, how to avoid pitfalls and, most importantly, how to support the mother as she brings a beautiful baby into the world!

Why are birth plans necessary?
Some expectant mothers may arrive in your office with highly detailed plans that throw you. It’s important to understand where these mothers—and their families—are coming from.

A birth plan serves several purposes:

  • It provides communication so all parties involved—from the family to the medical team—can assist the mother in achieving the birth that she wants.
  • Having options and direction provides peace of mind so the mother feels like she’s in control of her experience.

Most importantly, as doula Maritday Rodriguez points out, “Giving birth is a natural process, but things can come up. Creating a birth plan supports the mother’s first decisions and her needs during labor and delivery.”

Next: What’s in a birth plan? →

What’s in a birth plan?
A well-thought-out birth plan will often reflect the overwhelming number of choices that mothers are faced with during this important experience. A birth plan can be a tool for nurses to help their patients feel grounded and confident about delivery day.

So what’s in a birth plan? Here are some key elements, according to Rodriguez:

  • Where will the mother deliver—birth center, hospital or at home?
  • Who will attend—doctor or midwife?
  • What type of meds—prescribed pharmaceuticals or herbal remedies?
  • Pain management—relaxation techniques, environment/ambiance or epidural?
  • Surgical intervention—caesarean or episiotomy?
  • Information on whether the mother is low- or high-risk
  • The support team—doula, Dad, significant other, family and friends, etc.
  • Creation of a baby-friendly birth environment—plans for the baby’s initial examination, immediate skin-to-skin contact and breastfeeding decisions
  • Recovery—necessary support in dealing with regular postpartum delivery issues and intervention options
  • Contingency plans—sometimes babies are sick, disabled or, even sadder, can die. Having a support team in place is imperative. A mother must know her rights to her child in health, in sickness and in death. The family must also know their rights to grieve and say goodbye.

Next: What is the nurse’s role? →

What is the nurse’s role?
As with every patient, a nurse’s role with an expecting mother is to evaluate not only her physical health, but also her emotional health. Prenatal women need to be evaluated for more than just their physical well-being.

“It’s more than blood pressure, weight checks and fetal monitoring with a Doppler,” says prenatal instructor Deena H. Blumenfeld. “Women want and need someone who will listen to their concerns. They need someone who will address their emotional needs, reassure them regarding their fears and pay attention when she says something is important to her.”

Your simplest gestures as a nurse can make a world of difference. Resist the urge to have tunnel vision—only focusing on fetal monitoring and vaginal exams—even if you’re new to the specialty. Take a deep breath and, as always, remember the patient.

Blumenfeld says the nurse’s role is just as much about hand-holding and listening. Women will look to nurses for guidance on a range of question and emotions:

How can I change position?
What massage will work?
Why can’t I eat?
I’m afraid.

Three simple things a nurse can do:

  • Be sure to watch the mother’s face to understand how she’s managing her contractions.
  • Educate her on all of her options.
  • Look her in the eye.

Next: What do mothers want? →

What do mothers want?
Blumenfeld stresses that understanding the expectant mother’s frame of mind from the moment she sets foot in the exam room can make all the difference. As her nurse, focus on providing exceptional care and making sure her experience is the best it can be, with all the knowledge and tools at your disposal.

Here’s what the mother is thinking:

I need and deserve to have everything explained to me fully.
I want my visit to be more than 10 minutes long.
I don’t want to feel rushed.
I don’t want to leave with unanswered questions or doubts.
I want to give birth in a manner that makes me feel amazing and empowered.

Communicating to the mother that your clinical expertise is aimed to make her feel supported will help you earn her trust.

Next: Avoiding the pitfalls →

Avoiding the pitfalls
You’ve prepared for years and years in nursing school to be the best nurse on the planet. The mother has come up with a birth plan to address every conceivable aspect of her pregnancy.

Enter the real world.

Here are some common pitfalls in the nurse-expectant mother relationship and tips from expert and author Kelly Whitehead on how to ride them out smoothly.

1. You forgot to ask up front about the couple’s birth plan.
D’oh! Often times a new nurse will immediately become consumed with getting what she needs, such as the initial tracings, paperwork and admission questions.

Please ask to see the birth plan or what the couple has in the plan as soon as they enter your care! Seems simple enough, but surprisingly, this easy step can be overlooked and can cause confusion and anxiety.

2. It’s another day on the job for you—not so much for the mother.
“Remember that this is the most important day/event in the lives of the parents-to-be, and not to lose sight of this,” says Whitehead. “As people working around labor, birth and new babies every day, it’s very easy for us to become desensitized to the experience.”

When the parents-to-be walk in, treat them like this is THEIR special, big day! Because it is.

3. Your nerdy nurse know-how has upset the expectant mother.
“Though as a nurse, you know and have witnessed that bad things can happen, when a normal, low-risk mom-to-be enters the hospital to give birth, she should not be unnecessarily told or reminded of this fact,” says Whitehead.

Remember, the expectant couple is already in a state of anxiety, whether it’s their first child or not. Focus on helping them stay calm and thinking positively.

4. The epidural conversation has entered the awkward zone.
“If a couple has a strong desire to have a drug-free, natural birth, please do not undercut their wishes by dangling the carrot,” says Whitehead.

Let’s face it: None of us want to see our patients in pain. However, it’s important to respect the wishes of the expectant mother. New nurses may watch their patient in labor crying, yelling and writhing in pain, and may not realize—yes, this is considered “managing well.” When the mother is entering the transition phase, the goal is to help her manage the final lap of the race, reminding her that she is almost at the finish line.

5. You’re butting heads with the doula.
Whitehead’s advice: “If the parents-to-be have chosen the support of a doula, please back them in that decision. A good doula is there to help you do your job better and more easily. Though ultimately she is there to help the parents achieve their birth plan, she does understand that things can change. On the other side, an attentive doula will also request (and challenge gently) certain areas she feels will benefit her client, such as mobility with a wireless tocodynamometer or a birth ball to help manage contractions.”

Next: It all comes back to the patient →

It all comes back to the patient
Even for nurses who have been on the other side of the birth plan, it’s easy to lose sight of the patient experience—especially on those crazy busy shifts when you barely have a moment to think. New nurses may be exposed to different opinions during clinicals from nurses on the floor.

Jeri Comstock, RN, who now works in LTC and rehab, recalls her own experiences during clinicals: “Some of the nurses liked the idea of the mother coming in prepared with the options she prefers in writing. Other nurses rolled their eyes when a birth plan was mentioned.”

Comstock, who is now the mother of five children, drew on her own experiences to form her philosophy of care in helping expectant mothers. “I discussed the validity of a birth plan with my ob-gyn. He was in support of the idea, as long as I was open to other possible outcomes. The consensus I encounter is that you can plan all you want, just don’t get your heart set on it being everything you expect. I have done it naturally, and I have done it not-so-naturally. Every experience is different; it’s empowering to know what options are open to you. It’s good to expect the unexpected.”

What’s your experience in helping patients with birth plans? Let us know in the comments section below.

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