As an RN, I am torn in half by this question. Choice? Where is it a
free choice and where is it a forced choice? Do you really have
options when you birth in a hospital? It is difficult to give the
woman complete freedom of choice when you have hospital policies and
norms to go by. There are numerous people we have to report to,
including the pregnant family. There are the doctors, administration,
supervisors, etc.--anyone and everyone with a piece of paper stating
how to care for that patient.
I have seen how protocol turns in favor of and against anyone
interfering with it. One example: a pregnant woman with gestational
diabetes was complaining about her extended stay (due to monitoring)
in the labor and delivery department. She wanted the fetal monitor
removed to rest during the night. The staff, having orders for
continuous monitoring, oriented her against doing this. She did so
anyway, and didn't want anyone to touch her. Thank God (for her RN)
this was reported in her record, because when the morning shift
arrived and her OB went to place the fetal monitor to auscultate a
FHR, there was none. The fetus had died sometime during the night.
There's no way to tell if this unfortunate situation is going to
happen unless there is continuous fetal monitoring. Preventive
measures could have been implemented. So what happened as a result?
Stronger policy. Everyone keeps the monitors on at all times. Where
is a woman's freedom to choose? She has none. A laboring patient is
not permitted to freely move around the delivery room due to fetal
monitoring. Even if they're in latent phase, 95% of the patients must
use the bedpan to urinate and aren't allowed to ambulate to the
My response to this? As an RN yes, I agree with this. I am expected
to run the floor without preventable complications. I am completely
responsible for anything that happens on my shift. I have to follow
hospital policies and department norms. Choices? FREE CHOICES? Nope.
You make choices only within the options that are presented, which
are fairly limited. But, then again, you arrived at a *hospital*
seeking the aid of someone or some entity that has to be governed by
rules in order to provide safe and efficient care for *everyone* who
arrives. This includes the patient who needed no medical
"interference" because everything is "normal," the patient who
arrives "normal" and becomes complicated, and the complicated
patient. The rules are for *everyone*.
As a patient and a mother, I have seen the other side of this. I have
been "confined" to a bed and I have had the experience, not by
hospital choice, but because not knowing that I was in labor (because
of distractions at home) I arrived fully dilated. So I got to
ambulate, shower, and urinate freely, among other things. It's pure
bliss. I can't say my previous experience was "bad," because I didn't
know any better. I didn't know what I could and couldn't do as a
laboring patient. I didn't know that I was being stripped of some
basic rights just for having stepped into the hospital.
Do we want freedom and choices? Yes. We want to feel like we're
delivering as naturally as possible even though we arrived at your
institution for *guidance and assistance*. Sometimes the only reason
we arrive at the hospital is because it's expected of us. We need to
have a prenatal record or we're considered negligent. We are required
to find an institution to deliver in or we're held responsible for
complications that could just as easily have occurred anywhere we
chose to deliver. Where does the violation of our choices begin?
Medical plans and doctors. Medical plans won't cover some deliveries
if not performed under some situations. Doctors won't cover your
pregnancy if you arrive after a certain number of weeks/months. So we
need to have a complete change in perspective and views if we're to
allow pregnant women and their families free choice as to when, where
and how to deliver.
Reprinted from Midwifery Today E-News (Vol 2 Issue 22 June 2, 2000)
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