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| No. 40 | 
Jul 20, 2005, 01:01 PM
Originally Posted by FrumDoula Unless, of course, you have SmilingBlueEyes for your RN. And then you're golden.  And for the other nurses I've encountered who were either totally awesome and supportive or so professional that they wouldn't let their personal feelings color their support for the Mom. Now THOSE are super nurses!
Alison
This is one of the nicest things anyone has said of me in a long time. Thank you so much. This is a high compliment coming from you. YOu and Renee are too kind.
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Jul 20, 2005, 01:33 PM
Originally Posted by tntrn I an old-timer and think that as in much of the medical field, what's common practice is very regional.
<snipped your wonderful post>
As a labor nurse of some 29 years now, know that my most satisfying and gratifying days at work come after one of our rare no meds, or at least no epidural labors. THAT's when my labor nursing and support skills are utililized the most. Just watching monitors and adjusting IV rates doesn't cut it. Must be done, but really, how satisfying is that?
You said it brilliantly.
I never experienced labor support until I left the teaching hospitals in the midwest. The issue is, how does one teach this to nurses who can't work around nurses practicing it in hospitals that support this? If you live away from such a support network, how can you learn labor support techniques?
When I delivered in 1979 and 1981 I had a shot of "something" in my IV that helped me. There were no epidurals that I was aware of at St Paul in Dallas, TX, at that time -- of course I was a clinic patient, and clinic patients got second tier care there, I probably would not have been offered one. A nurse I work with who was a nurse at that time (I wasn't) said I probably got nisentil, which worked wonderfully, but was banned.
I agree with you on the epidurals, but I also believe if a woman wants it, she should get it. What else can we do? They can't handle it and the stress of pain inhibits labor. Many of them can't handle the pain. We can't change cultural expectations of and experiences with pain and birth when they present in L&D. Recent immigrant women from Mexico and Latin countries seem to handle labor the best, and have the shortest labors. Why? How? Why them and not other ethnic/cultural groups? One OB I work with thinks it might have to do with the fact she thinks they still have a connection with the earth where they're from.
I'd like to see more basic research on pain and discover "why" some women can ride out their labors like champs and just deliver, whereas other women are in complete agony by 1-3 cm and the pain cycle is so intense nothing will break it except for the epidural. Not much is known about pain and the body, or how the brain works, or how labor itself works ... I think these are some of those $60,000 questions in medicine that once the mechanisms are more fully understood it will be a huge breakthrough that will allow development of advanced therapeutics which we can't even begin to imagine what they would look like.
| | No. 42 |
Jul 20, 2005, 02:53 PM
Nothing, but NOTHING beats giving a natural labor-mom support. I love it. It is all-too-rare like said above. But I also enjoy my role in the labor experience of a mom using anesthesia, too. I have found ways to really become involved that transcends machines and IV's. But it's a big challenge, that is for sure. Sadly, so many want to be numb, and that is what they get.
| | No. 43 |
Jul 20, 2005, 06:15 PM
I agree, the thing that really makes my day is to have an actively laboring mom come in, say, 4-6 cms, or whatever, really into her labor, wanting to go natural. I love laboring w/my pt's. To me, this is it, this is birthing, and then the delivery... wow! Nothing beats it. Generally these women have less complications and easier births.
My background is from a large LDRP/Family Birthing Center, we were w/in the hospital, but it truly was like being apart from the hospital. We were staffed primarily w/midwives who did 90% of the deliveries. The rest were MD pt's...high risk, c/s or whatever. We did jacuzzis, squat bars, walking, etc. Totally encouraged the mom. Sure, some ended up w/epidurals....and that was OK, too. The environment was so much more into the mom and what she wanted. We really tried to make her birthing experience her own.
Now, I'm on the west coast, work in a teaching hospital, (actually getting ready to leave this facility) and, man, what a different environment! Here the residents don't "get" it....moms can labor and birth w/out an epidural!  Imagine that. The nurses are totally not into it....laboring w/the moms. It's all about the epidural. And inductions. Anesthesia is in the room the second the pt is admitted, having them sign paperwork, and often, these gals are getting epidurals at 1-2cm, not even in labor! No walking, jacuzzis, not even a squat bar, everyone delivers in stirrups w/students and resident mangling their way thru the delivery! I can hardly wait to be outta there and get back to my "natural" moms!  | | No. 44 |
Jul 20, 2005, 06:36 PM
This is why I decided to work in mother/baby at our our hospital instead of L&D. Our epidural rate is over 95%, c-section rates 35%, I very rarely see a mom who didn't get the epidural and during my rotation I was bored just staring at the monitors and adjusting IV drips.
Melissa Originally Posted by tntrn I an old-timer and think that as in much of the medical field, what's common practice is very regional. For example, I used to work in a high-risk hospital, doing 300 births a month, and we NEVER, I repeat, NEVER did epidurals. Our patients were very well prepared to go natural and many felt guilty if they took a little Nisentil (told you I was an old-timer.) Moved up the coast and on my first day at there, watched (in horror) as a saddle block was put in on a crowning multip. Came home and told my DH I had to find another line of work.
After 16 years here, I find that epidurals are the expected, to the point, that some patients are brainwashed into thinking they will "need" one. I respect their choice to have one, but I have to say that I don't honestly believe they are being given a full disclosure of what the choices are.
We are still lucky to have 1 to 1 care on our labor patients, but once that epidural goes in, there not a lot of nursing support to be done anymore. The patient is either sleeping soundly, or partying with the room full of visitors. I groove on the gal who comes in at 7 or 8 cms. or the one who goes without by choice.
I agree with whoever said that some nurses are uncomfortable with the naturally laboring patient, but I believe that is mostly because they haven't had the experience to get comfortable with it. Interesting, because one of those young things told me that us "old broads" weren't comfortable with interventive births. I think she had it only partly right: we're uncomfortable with it because we know it could be different and safe and satisfying without all of that. And because we've been there, done that and don't necessarily think that it's better the way it is now.
As a labor nurse of some 29 years now, know that my most satisfying and gratifying days at work come after one of our rare no meds, or at least no epidural labors. THAT's when my labor nursing and support skills are utililized the most. Just watching monitors and adjusting IV rates doesn't cut it. Must be done, but really, how satisfying is that? | | No. 45 |
Jul 20, 2005, 06:38 PM
All of my labor nursing experience has been on the west coast. And the place where we did 300 a month and no epidurals was a teaching hospital. I'm farther north now, in a smaller facility, NICU (32 weeks and over) and the order of the day is epidurals. That's what I mean by medicine being regional.
That being said, I have seen cases where an epidural was the only thing thing that enabled someone to deliver vaginally. But at the non-epidural hospital, our pcs rate was about 12%. So go figure. And probably the "induction before ready" theme is probably more the cause for our high c/s rates now than the epidurals.
It seems to me that women aren't being given the encouragement to labor without anesthesia...at least not in this area. I think that is sad. Many think they can't do it because they haven't been told that they can; indeed some come in saying "my doctor told me I'd need an epidural." That tends to p*ss me off! They don't get it in their prenatal visits, they're not getting it prenatal classes and they're mostly not getting it during their hosptal stay. Of course, by then it's usually too late to make any difference....unless she's 8 or 9 cms on arrival.
| | No. 46 |
Jul 21, 2005, 05:27 AM
I suppose that "natural" appendectomies would be performed as they were in the old days: with six strong Bohemians holding the patient down while a barber cut without anesthetic. I guess the old trepining procedure (cutting a glabelar triangular hole in the skull with a rock to let out evil spirits) is natural, too.
For those who want that "natural" experience, more power to them. But, please, stay at home and have the baby. Why come to the hospital? And if you do, expect the full-court press to protect you and yours. Why? BECAUSE YOU'LL SUE EVERYONE if we don't.
So, once again, it comes back to hangin' all those pesky lawyers.
John Z,
CRNA Originally Posted by HeartsOpenWide It seems like there are so many different meanings to different people for "Natural Birth"
What do you consider "Natural Birth"? When a patient comes into your hospital wanting the most "Natural Birth" possible, what can she expect? | | No. 47 |
Jul 21, 2005, 05:55 AM
Originally Posted by fergus51 I've noticed a lot of women think natural just means vaginal.
I know!!! We had a 16 yo girl in caesar theatre recently, under GA who was delivered vaginally by forceps (basically they pulled the baby out). And they called it a normal vaginal delivery!!!!!! Good God!!!
| | No. 48 |
Jul 21, 2005, 06:18 AM
Originally Posted by SmilingBluEyes Nothing, but NOTHING beats giving a natural labor-mom support. I love it. It is all-too-rare like said above. But I also enjoy my role in the labor experience of a mom using anesthesia, too. I have found ways to really become involved that transcends machines and IV's. But it's a big challenge, that is for sure. Sadly, so many want to be numb, and that is what they get.
On my first day of work at a teaching hospital I supported a 16 yo who didn't want an epidural; she had only a little stadol. She was a real trooper. It was a beautiful birth, though I was told not to expect many more like that.
| | No. 49 |
Jul 21, 2005, 07:55 AM
Originally Posted by oneillk1 I know!!! We had a 16 yo girl in caesar theatre recently, under GA who was delivered vaginally by forceps (basically they pulled the baby out). And they called it a normal vaginal delivery!!!!!! Good God!!!
are you SERIOUS???   unbelievable.
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