Saturday, February 7, 2009

The "Perfect" Patient

I got a comment on one of my previous blogs that I absolutely loved! A very smart woman said that her goal was to be the "perfect labor patient" and she wanted to know how to obtain that goal. So I've thought about it for a while and here are my suggestions...To preface my suggestions, remember these are my OPINIONS and don't worry, no good nurse will think less of you or take worse care of you if you aren't the "perfect" patient.

#1. Come in with an OPEN mind. It seems like the patients who come into their labor experience with a cut and dried, this-is-how-it's-going-to-happen mind set are the ones who have labors that are nothing like what they wanted. Those who come in who say "a C-section is the worst thing I could ever have happen to me" are the ones who end up in the OR and feel like a failure for not having a successful vaginal delivery. Also, I in no way believe that a C/S is any kind of "failure." It's just a different road to the same destination with different scenery and experiences to enjoy along the way!

#2. Keep in mind that as nurses (and all the docs out there too), our goal is a "healthy/happy mom and healthy/happy baby." Everything we do is working toward that goal. We aren't doing things to be mean, we aren't doing things to you to make things harder, we aren't doing things to you to ruin all your plans that you had, we really just want to make sure you and baby come out OK in the end.

#3. Try to develop a relationship with your nurse. I know that's one of my favorite parts of my job is forming that bond with my patients. When I think of what an honor it is to be a part of this amazing time in their lives it gives me shivers. The patients who come in and see me as more than the enemy who has to do all the "mean things" associated with having a baby (an IV, those painful vag exams, keeping you on those monitors) and let me into the memory that they're making, those are the patients that I remember long after I've moved them over to postpartum. Also, don't be afraid to tell your nurse what you're thinking. What you would "like" to have happen, what you are nervous about, what worked for your last labor (if you've had one) what your goals are for this labor. If you don't tell us we'll never know...

#4. The perfect patient is the one who comes in prepared, has read enough about giving birth to be informed about what to expect (but not just read all the horror stories they could find about all the horrible things that "could" happen) and are excited about delivering their baby, those are my favorite patients. Being nervous is OK and totally expected, but the patients who come in and are ready to enjoy the journey, those are my favorite!

Good luck to all the potential "prefect patients" out there! A "happy patient" is a "perfect patient!"

#5. All the nurses that I also asked for their opinion said that they remember the patients who bring food for the nurses :) Chocolate is ALWAYS a way to make friends with the nursing staff! Ha!

13 comments:

  1. The way you put quotation marks around "mean things" is really telling. When a women is in labor, intrusion can really throw her off. You haven't had kids-I've had four, and let me tell you, vag exams HURT. Not to mention sitting still for one, and being scared of another contraction hitting and not having time to prepare. And IV's-ouch. In a roundabout way, you think the perfect patient is the ones that are most submissive! You should be encouraging them to be strong.

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  2. I like what you said. I have been checking back, because I am interested in what makes a patient hard or easy. One night, I had to spend the night with preterm labor at 30 weeks. I felt soo bad for the nurses because for whatever reason, I kept throwing up all the time and they had to keep coming in and cleaning up. I felt really bad, but there wasn't anything I could do about it.

    Also..in regard to what the pp said, some women might want you to encourage them to be strong, but some may not. Vag exams, ivs, and such didn't really bother me. So I wouldn't have needed that kind of encouragement.

    I took the epidural, because, I decided that what I wanted to remember about the birth of my son was how it was memorabe for everyone. I tried to look at it as me not onkly giving birth to my son, but also my husbands, and my mom's grandson. I wanted everyone to enjoy it.

    I KNOW that not many people will agree with me...we're all different people with different goals.

    Thank you, Birthday Nurse, for interacting with me and answering my question.

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  3. Just to clarify my opinion...I don't want any of my patients to be submissive and do things just because they feel like they have to do them or we'll kick them out of the hospital. I want them to know that I'm not doing the uncomfortable things because I am trying to hurt them, make it painful or ruin their labor experience. It's part of the job of being a nurse and trying our best to reach that #1 goal of healthy mom and healthy baby. Just like as a parent you sometimes have to do things for your child's safety that they don't enjoy, you do it because you love them and want the best outcome for them in the end.

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  4. I could tell what you meant........you sound like someone I would get along with and someone who I would like to be my nurse......I would never say this, but my husband said to say that some women are just whiny pusses. (That was in regard to the first comment.) You sound like a good nurse to me.

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  5. And Jana's husband's comment shows just perfectly why I say that some men should NOT be around when their wives give birth! :-) (My brother-in-law is definitely of this type -- he should be sent out huntin' and let us wimmen-folk do the birthin'.)

    -Kathy

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  6. Don't worry...he's not allowed to help me with my comments anymore...although we did get a good laugh out of it. I do have to add that he was very supportive during my labor, and he was mainly just trying to get a laugh out of that comment.

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  7. another labor nurse here:

    In regards to #1 and the having an open mind-having been the patient who really wants an unmedicated vaginal delivery, if you "have an open mind" and go with the flow, you'll end up with that epidural you dont want. you have to be strong and confident and set in what you want to keep you from wavering. Women in pain can be easily influenced. if you tell yourself that there is no other option that an unmedicated vaginal delivery, it helps you cope better. If someone keeps telling you about that magical epidural that will make you feel better and this whole labor shorter, if you aren't firm in what you want, if you have that "open mind", in your state of pain, you may be convinced to get the epidural you didn't really want and regret it later.

    and, yes, i have 4 kids and i'm a labor nurse, and still think a c/section is horrible and i'd never want one. even if i had a previa, and knew i had to have one, i'd do it, but still think it was a horrible travesty. Yes, I had that mindset when I went into labor. Yes, I had a huge baby and a big decel, i heard someone say c/s I said hell no, and had a vaginal delivery.

    being very anti-section does not mean you'll get one. Certainly doesn't make one a bad patient either.

    #2-yes, the goal is a healthy baby. yes that is the MOST important thing. but, it is not the ONLY important thing. Don't say to someone who's birth plan went way out the window and say "at least you have a healthy baby". What a slap in the face, like the mother doesn't matter. WHat she wants and what she needs is important, too. Please keep that in mind.

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  8. Jana,

    Yeah, my husband comes up with some real "winners" too! (and it worries me when I can't figure out if he's being serious or sarcastic...) :-) I can *so* picture him saying this. He was pretty supportive of me during labor (home birth), but my midwife & doula were better.

    -Kathy

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  9. I have to agree with the nurse who said a woman in pain is easily influenced, because I wanted to try for an unmedicated birth, and it didn't happen. I was induced...and when those huge whammy contractions started hitting me it was sure easy to yell, "Epidural!!" when I had nobody encouraging me to try a bit longer....I think I could have made it longer...nd it's nobody's fault they didn't encourage me. I was IN PAIN!! and the people I love didn't want me to be in pain...and I was asking for an epidural...soooooo I got one.

    I have to say, though. My labor was woooooonderful. When I got the epidural, I was a 3.....went to sleep, woke up a 10. Pushed for 45 minutes and had a baby. Wa la!!

    So not really any complaints from my end, even though next time around I am going to prepare better for another attempt at a natural birth.

    I think that nurse is right...I'm going to have to go into it as if there were no other options.

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  10. I totally love everyone's comments! It shows people acutally read my blog :) Thank you for all your input! After going back and reading them all, I feel like I should re-re-clarify (is that a word?) my "open mind" statement. I guess open mind means to me that a woman is open to whatever labor throws at them. Maybe I just have seen more "first time" mom's than mom's who have done it all before, and most of them seem to come into labor thinking it's really not going to be that big of a deal and then are horrified and petrified and don't know how to react when it turns into something they totally weren't expecting. So I guess by "open mind" I ment being open to what labor is like, what if feels like and what comes with it physically AND emotionally. Don't know if that made any sense or not...but keep the comments and opinions coming. The more sides of it I see, the more it helps me be the "perfect nurse"...

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  11. BirthdayNurse,

    I see both sides of this, and I think a lot of the time it depends on the woman, as well as her particular preparation she has done before birth.

    Some women are so locked into a "my way or the highway" kind of thinking, that when any little thing happens outside of their little preconceived notions, then it totally throws them for the loop, and all their happy little plans get thrown out the window. So in that way, yes, they do need to have an open mind, because sometimes life throws you some curve balls.

    On the other hand, you have women who have no plans whatsoever, and just do whatever the last person they spoke to says, and they take no action on their own part, and no preparation beforehand, so while they may have some nebulous idea that they'd like to avoid surgery, they don't know enough about how to make that happen, that they end up where they don't want to be. And I think that's a lot of the reason why we've got a 30% C-section rate and climbing.

    Yes, make your plans, but also recognize that sometimes life doesn't turn out the way you plan. Just watch "While You Were Sleeping". :-)

    -Kathy

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  12. Oh, and according to the Google Reader "details", you've got 107 subscribers. :-)

    -Kathy

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  13. It's always interested to read your perspectives & I appreciate that you share them!! A few things jumped out for me in this post -

    1st - the whole thing that a Cesarean birth is just a "different road" - of course on the basic level, this is true. But this different road can have a lot more risks for mom/baby/future babies and can serve to limit mom's future birth experiences. So to me, it's not like comparing apples & apples. http://www.childbirthconnection.org/article.asp?ck=10166 and http://www.childbirthconnection.org/article.asp?ck=10312

    #2 - Having an open mind & being flexible is certainly important - birth is one of those experiences that you just never know exactly what's going to happen, despite any particular preparation/planning. *However*, I don't think being "open minded" should mean that a mother has to be okay with everything, just because it might be routine in her place of birth - for example, having a routine IV or routine continuous EFM (neither is evidence-based care), if those are NOT what she wants.

    #3 - Because there are good/bad workers in any profession, I think it's important to realize that there is the occasional doctor/nurse who is putting self-interest, conveniance and/or his/her own agenda above that of his/her patient. Suggesting that ALL care providers put healthy mom/baby first ALL of the time... well, that's a stretch, for me, because those care providers are human, and humans just ain't perfect! Wish we were ;-)

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