The Plan

The Plan

The Plan should be filled out with the principles of case 1 and case , this gives you an idea of what I’m looking for. They begin with the assessment and continue with the doula actions implemented. Keep in mind, that during labor you are continuing to assess and re-evaluate the goals. Below is a list of the forms that I would like you to use to complete your birth plan. A less formal birth plan can also be typed up and given to the hospital personnel (optional).

· Assessment Data – gathered from your client interview.  This should also include a paragraph that discusses what you talked about with the care provider at the prenatal interview.

· Needs Identification

· Goals – based off your clients’ goals and your needs identification. Prioritize these according to Maslow’s Hierarchy of Needs.

· Doula Actions – This will happen before and during birth.

· Self-Evaluation – How did your actions affect your client? Where they are helpful? Not helpful? If they were not helpful, go back to the beginning of the process and start a new plan.

 

Debriefing After Birth

Message to Medical Personnel:

Building bridges within the medical team. We also feel like doulas are a part of that team and should be treated as such. With that in mind, our students are asked to fill out a debriefing form to help them communicate better with the other members of the medical team as well as help them understand how they can improve. We appreciate your willingness to cooperate.

· As a nurse/doula team, what did you do right?

· What could have been improved?

· For your client, what went right?

· What could have been improved?

·

Case 1

This case contains a hypothetical woman that has come to the hospital with specific medical complaints. As a doula, you will be providing care that is non-medical in nature. This case study shows how the roles of different birth professionals differ, as well as how they complement each other. It also shows how doulas can use critical thinking skills during the birth.

http://obgynmorningrounds.com/blog6/rounds/hospitalized-patients/chorioamnionitis/

Case 2

This case study is presented to show how a woman utilizes the different modes of thinking in order to make decisions before and during birth. It also shows how a doula helps to facilitate this decision making process.

Goals

· To understand how to apply knowledge of the different modes of thinking.

· To provide an example of the role the doula works with the mother to make decisions.

· To provide an example of how birth plans can be fluid and workable when unexpected situations arise..

 

Reading assignments:

None for this case study.

Assessment

When I first met with this client, she knew exactly what she wanted help with and how she wanted her birth to go. Most of this came from how her previous birth had gone. For her births she held the belief that medication should only be used when needed. She felt like her body was able to do what it needed to do. On the other hand, pregnancies were hard for her. While she did not feel like pitocin was what she should do, she choose to use castor oil with her first birth. It was a long labor after that.

She would have liked to labor more without the iv, but because she was gbs+, her midwife said that antibiotics were necessary. This made her feel like it was important to go in early enough to get that done. She had originally wanted to see if she could go without an epidural, but after 24 hours of labor, she was very tired. At this point she decided to get an epidural, which she was grateful for because she at least felt like she could sleep.

During her first labor, her mother had come to help, but this client felt like she was not helpful at all and wanted to make sure that her mom was not with her during birth for her next labor. She also had her baby taken away for a long period of time with her first baby and wanted to make sure that it did not happen with her second unless medically necessary. At this point in time, she as planning on getting an epidural with her second, but wanted to be able to move around as much as possible until she got the epidural.

I gave her information on intermittent monitoring. We also discussed waiting to have to cord cut until it stopped pulsating. She liked both of these ideas and decided to discuss them with her care provider. Not only did these ideas fit in with her own ideas of the roles of medication, but they made sense to her that these would provide the kind of care that she wanted. We also discussed roles her mother could play that would allow her to feel like she could help, but not be in the way. My client decided that the best thing to do would be to ask her mother to babysit her son. That way she could help, but not be there for the birth, which made my client nervous. Comfort measures were not discussed much, as my client felt like she didn’t need that.

Needs Identification, Prioritization and Doula Actions

After the first meeting, a care/birth plan was made that included my clients preferences and desires. These are the needs originally identified.

Client goals:

1. Keep her baby with her immediately afterward.

2. Keep her mom out of the birth room.

 

Physiologic Needs

Changes in bowel movements related to castor oil use. Doula Action: Bring depends or use hospital pads so that she does not have to worry about any accidents.

 

Safety needs

Opportunity for enhanced communication related to making decisions in conjunction with healthcare providers. Doula actions: Discuss the need to talk with their care providers about movement during labor, but also make sure everything is okay with the baby.

Social Needs

Opportunity for enhanced communication. Doula Actions: Have client discuss what she wants her mother to do with her. Discuss having her watch the other child while mother is in labor.

Esteem Needs

Desire for control related to decisions regarding infant care after he is born and movement during labor. Doula Actions: Educate client on delayed cord clamping and other newborn procedures related to care of infant afterward. Educate client on the use of intermittent fetal monitoring to allow more movement. Encourage communication with care provider to discuss these options and perhaps schedule a time that you, as the doula, can meet her provider to discuss these options also.

Opportunity for enhanced empowerment. Doula Actions: Discuss options and choices available concerning the ability to make decisions in their labor and birth.

Because her first labor had been so slow, she was expecting this one to be the same. She decided to take castor oil again because it worked well with her first one, but she thought she would have another long labor before she went into the hospital. It turns out, that the Castor oil proved to be very effective, and she was laboring hard and strong within a few hours. She was not anticipating this, and was glad that she had a doula there to help her work through her labor unprepared. At this point, there was a change in birth plan due to necessity. The hospital was 45min away and she had not been prepared to deal without an epidural.

Once she got to the hospital, she asked for the epidural and was able to receive one fairly quickly. When the baby was born, she was able to have him with her immediately afterward.

Decision Made	Problem Solving Technique Used
She choose not to be induced with pitocin	Critical thinking, intuition, scientific thinking
Used Castor oil	Critical thinking
Went in early when she was gbs+	Critical thinking, scientific thinking
Choose to use the epidural	Critical thinking, trial and error
Choose to keep her mother out of the birth room	Trial and error
Choose to have her baby with her after	Trial and error, critical thinking, intuition, scientific thinking
Planning on epidural with second birth	Trial and error, critical thinking
Choose to have intermittent monitoring	Critical thinking, scientific thinking
Choose to take castor oil the second time	Trial and error