If you are an advocate for natural birth/homebirth with CNM

[hardworkinmama]

is L & D a difficult unit to be on as an RN? I am of the opinion that women should make informed choices about their births and that hospitals are wonderful places to give birth for sick/high risk moms & babies. But I believe that many women are great candidates for out of hospital births with little to no interventions. I've wondered if that would make L&D a bad fit for me as a RN? I appreciate anyone sharing their experiences/opinions on how my beliefs & RN role in L&D will mesh :-)

[dariah]

This topic is one that I am struggling with. Just the other day I had a pt come in at 8cm with her second baby. Once admitted, everyone gets an IV and continuous EFM. She and her husband both made comments about how bothersome the monitors are. I sympathize, but usually say something like "sorry, it comes with hospital admission." Furthermore, finding a nice, steady FHR tracing and perfectly visible and uniform contractions in a pt who is not laboring flat on her back? Not so easy. I certainly don't expect these women to lie still in bed while trying to cope with contractions, but our MDs do. I apologized to her for all the manipulation I was doing with the EFM, but explained that otherwise an MD would likely come in and insist she get in bed. She was actually very appreciative that I was willing to work with her. (And I was only willing to hold the EFM bc she was an 8cm multip....on a nullip I could not realistically do that for her whole labor.)

[lamazeteacher]

When you're working in L&D, it would be quite inappropriate to introduce the subject of home birth, as the patient is already in the hospital! The choice, if it came up at all during pregnancy, had been made. Realizing that, a nurse needs to focus on what needs the patient now has with being at the hospital. Most of them want to be reassured about their safety, and the ability of the nurses to meet any expectations of the birth plan. So go over that with them and let them know that giving birth in a bathtub hasn't occurred where they are, ONLY IF THAT WAS MENTIONED AS A PREFERENCE! If they wanted that, presumably they discussed it with their healthcare provider, and were previously informed of its non availability.

Having worked as a L&D RN at several hospitals, and a Lamaze Childbirth Educator in my own home and at hospitals for 35 years, I have seen "pendulums" regarding many concerns of expectant parents and healthcare professionals swing in all directions, back and forth.

I'm enjoying the TV series on Public TV on Sunday evenings at 8, now. Last night there was a side lying delivery that was very tastefully recreated. However according to the story the baby had spinal bifida that diverted attention from that technique, which is usually attempted in home births when a baby's head doesn't rotate to accommodate the birth. In hospital that is rarely seen, unless a midwife (NP) is present. Also underwater births aren't attempted at either place, now. The fear of aspiration and its sequellae have reduced that request (since childbirth classes explain that could happen, as well as intrauterine infection; and if the doctor entertains the question about doing that, it is usually refused. However

Once birth is planned in hospital, unless sporadic attendance or early labor prevent learning about realistic expectations, a patient might still think (or want the nurse to think she believes those options are there). However it can be addressed simply as "we haven't those facilities", when frequent contractions are occurring. Sometimes I've heard that a patient was given a derisive reply to such wishes and lectures about what they "should have done"... which isn't helpful at all. For that reason, it might not be a "good fit" if a nurse wanted to make patients feel uncomfortable about the choices the made, once they're in the hospital, in labor. The tour of the labor suite isn't the time for a discussion of that, either, as the intention of that is to provide visual and verbal reassurance and preparation for being there in labor. So any nurse who thinks working in L&D gives an opportunity for influencing patients to seek home births, that would "shine" a red light on their capability to optimally perform their duties.

[Fyreflie]

When you're working in L&D, it would be quite inappropriate to introduce the subject of home birth, as the patient is already in the hospital! The choice, if it came up at all during pregnancy, had been made. Realizing that, a nurse needs to focus on what needs the patient now has with being at the hospital. Most of them want to be reassured about their safety, and the ability of the nurses to meet any expectations of the birth plan. So go over that with them and let them know that giving birth in a bathtub hasn't occurred where they are, ONLY IF THAT WAS MENTIONED AS A PREFERENCE! If they wanted that, presumably they discussed it with their healthcare provider, and were previously informed of its non availability.

Having worked as a L&D RN at several hospitals, and a Lamaze Childbirth Educator in my own home and at hospitals for 35 years, I have seen "pendulums" regarding many concerns of expectant parents and healthcare professionals swing in all directions, back and forth.

I'm enjoying the TV series on Public TV on Sunday evenings at 8, now. Last night there was a side lying delivery that was very tastefully recreated. However according to the story the baby had spinal bifida that diverted attention from that technique, which is usually attempted in home births when a baby's head doesn't rotate to accommodate the birth. In hospital that is rarely seen, unless a midwife (NP) is present. Also underwater births aren't attempted at either place, now. The fear of aspiration and its sequellae have reduced that request (since childbirth classes explain that could happen, as well as intrauterine infection; and if the doctor entertains the question about doing that, it is usually refused. However

Once birth is planned in hospital, unless sporadic attendance or early labor prevent learning about realistic expectations, a patient might still think (or want the nurse to think she believes those options are there). However it can be addressed simply as "we haven't those facilities", when frequent contractions are occurring. Sometimes I've heard that a patient was given a derisive reply to such wishes and lectures about what they "should have done"... which isn't helpful at all. For that reason, it might not be a "good fit" if a nurse wanted to make patients feel uncomfortable about the choices the made, once they're in the hospital, in labor. The tour of the labor suite isn't the time for a discussion of that, either, as the intention of that is to provide visual and verbal reassurance and preparation for being there in labor. So any nurse who thinks working in L&D gives an opportunity for influencing patients to seek home births, that would "shine" a red light on their capability to optimally perform their duties.

I've seen tons of side lying deliveries--I think it just depends on where you are. And I didn't see the OP as wanting to influence someone's choices, but rather as being worried that because she believes in non intervention she might find traditional L&D nursing frustrating or at odds with her beliefs. I struggle with that all the time but it really impacts my care. Now I'm working rural LDRP, where patients are rarely on EFM and most don't even get an IV, and it's done nothing but cement my belief that most women, given a chance and support, can give birth beautifully with very few complications.

[klone, MSN, RN]

Yes, I didn't see any indication that the OP was going to talk to her patients about homebirth! I'm a homebirth advocate, and I have never done that.

[Marasca]

Lamazeteacher may work in an area where those choices are readily available and presented to expectant mothers. That is not the case everywhere. In my state CNMs don't attend homebirths and lay midwives do not have the ability to get a license.

When I was expecting my first child my OB recommended I use a CNM she had just hired. This midwife was to be the first CNM to practice in my city. Things were great until the big day, when we were informed that the hospital would not let her attend due to pressure from the OB/GYN community. As luck would have it, my OB was in another delivery and I was stuck with an OB who was adamantly against allowing CNMs into the hospital.

It was terrible on a level you would not believe. The nurses just seemed stunned by the whole ordeal.

Could the OP have made a difference in my situation? I don't know. It's not like the nurses approved of the actions of the OB in question. I just think I wouldn't have felt quite so alone, and that would have meant a lot to me.

[klone, MSN, RN]

Yeah, the community I used to work at, no CNMs were given hospital privileges. There were a few in the community, and they worked at the OB clinics doing prenatal and well woman care.

Same thing with CRNAs - totally shut out of the hospital. It was a very big "boys' club" there.

[hardworkinmama]

Wow, I feel so lucky to live in Dallas where we have so many birthing choices! CNMs in & out of hospital plus lay midwives & of course OBs.

No, I would never mention or suggest home birthing to moms in a hospital. That wouldn't make sense! I got a tour of the unit & it has a low risk side & a high risk side, so maybe it will be easier for me since it's kind of separate. And the low risk side is staffed with CNMs. And they gave me a contingency job offer!!! I'm going to think long & hard about the 3 year commitment they require though. That's a pretty big deal to me.

Thanks for all your input everyone!