Natural Childbirth and L/D nurse-do they mix?

christinemj · Jun 2, 2004

It pays to do your homework when researching facilities to work in. If their birth philosophy totally clashes with yours, you will be very unhappy and dissatisfied.

That completely sums it up for me. I, too, am a homebirthing mama. At the beginning of this nursing school journey, L&D was high on my list of choices, with the intent to become a CNM. As it turns out, my town is too "medical" is regards to birthing. There are NO CNMs in the city and only 2 women's health NP's. Through the years I've had the joy of attending a number of births both inside and outside of the hospital....mostly of like-minded acquaintances. However, after my clinical rotation through L&D I realized that my personal birth philosphy just wouldn't work in that particular setting. In another city, with another group of healthcare providers...I may have stayed on an L&D track. However, here, I think I would be better suited to sticking with lactation consulting and the occasional doula work.

This is one battle that just is not worth picking......

SmilingBluEyes · Jun 2, 2004

so sad how midwives are forced from practice or just plain barred by the medical establishment. but we have ourselves to blame, too, demanding HI TECH deliveries, high litigation rates and the like. It's a tough thing all around.

nekhismom · Jun 2, 2004

Here I started in L&D. The philosophy here did NOT fit with my beliefs. Too many interventions, way outdated standard orders, and a c/s rate that would embarrass anyone! I could NOT practice that way, so I transferred.

I think that whatever a woman wants in childbirth is fine, so long as it does NOT compromise mom or baby. However, women need to be educated about their options. I don't think all moms need or want epidurals. I don't see the point in getting a c/s and epidural when you're at 10 and +2 station with perfect FHT's. I don't think all women need Pit routinely in labor to augment. I definately DO NOT think enemas or shaves should be routine. Shaves are ok if c/s, otherwise, not necessary. And I DO NOT think that all women need episiotomies! That is torture!

Here, we need more options. RIght now, the birth options consist of vag. in birthing bed in lithotomy position or c/s. That's it. I would like to see more squatting, birthing balls, water births, etc. And less interventions.

I think that when I leave here, if I decide to remain a nurse, I will go to L&D. But next time I will know what to ask about and what to look for.

rpbear · Jun 4, 2004

nekhismom,

I am so sorry that you are unhappy where you are, I know you made a lot of sacrifices to move there for this job! :crying2:

CA CoCoRN, RN · Jun 6, 2004

Would a natural childbirth advocating, homebirthing mama be able to survive as a L/D nurse? I am asking in all sincerity...I have been considering going back to school to get my nursing degree to become a L/D nurse with eventual dreams to open a free-standing birth center (but who knows!).
I am just wondering if I would be able to emotionally/mentally survive the job? Would it just be too difficult to be in an environment where natural birth is not the norm? I want to be able to support birthing women and I want to be an advocate for for them. I also support the vision statement for ANACS that includes: "We foresee a time... when all childbirth professionals support women in their childbirth choices; nurses all practice evidence-based maternity nursing and actively facilitate childbearing women to have optimal births with as few interventions as possible. We envision empowered nurses who break the barriers that prevent easy adoption of less invasive childbirth choices."
Is this pie-in-the-sky dreaming? I truly want some honest opinions and I will be very grateful for them :)
Thank you!
Adrianna

Do EXACTLY as SmilingBlu said!!! View all the complications that come with childbirth and unfortunate endings...but also all the wonderful endings that come "naturally" and test your patience and endurance.

Many natural childbirth advocates see labor as this wholly natural thing that needs no intervention, blah, blah, blah (not blah in a bad way :) ) But every future mother's labor won't go the optimal road and may require intervention in some way shape or form. Also, in the real world your clientele is not always educated about the labor process and, while it is my job and duty as an L & D nurse to educate them....sometimes the time is just not there to give them all they should have learned in the anteceding 40 weeks.

Birthing centers, from my experience, serve a mainly white, holisticly inclined, higher/highly educated, upper middle to upper class patient. Those who aren't in that group but seek out birthing centers see birth as more than just "having a baby". However, many patients still it the whole event as "just having a baby" and don't take the time nor energy to invest in the experience, both before and after. For someone who's used to that background, you may be up for a bit of frustration.

I work in the "ghetto", so I'm sure I'd be shocked if I went to work at my local Cedars-Sinai or some hospital of that ilk where the pt population is more interested in their bodies and more educated. Someplace where I don't have to teach as much.

But I work where I work because I like that teaching--making an impact.

So....then again, if you were to shadow a nurse for a few shifts in different environs, you may very well find a niche is which to fit in a hospital.

By and by....looking down the road into your future, I'd advise that, if you can stand to go to college and get the license and work in a hospital to get your experience, that you work some place where you can see it "all". That way, when you do have your birthing center going, if those emergent situations arise, you'll have that experience to call on to handle it to the extent you can and know what's likely to happen when you hand the case to the hospital.

CA CoCoRN, RN · Jun 6, 2004

lisamc1 - hehe thanks =)
mitchsmom - yea and no, it's hard to say.
Most of the time things turn out pretty well. What I can say is that, when pitocin is used too early, before the cervix is ripened or on early gestation inductions I see more fetal distress. It ends up taking allot longer to see dilation and thats more time for the baby to become tired of being squeezed. So sometimes I come in and take over a patient that has been on pitocin for 10 hours and been up to 24 mu/min. These patients are scary because the baby is usually not looking great on the monitor and there is that risk of bleeding after delivery. Sometimes they end up with C/S and I always worry about them threw out labor.
As for other problems like bleeding or failure to descend, it's hard to say most of the patients that have these problems are the older moms. I've often wondered if it's our interventions or just the patients age. The problem is that an older mom is more likely to need interventions to progress labor (at least by the standards we are used to).
I can say for sure is that we end up doing more silastic deliveries because of epidural. 1st time moms and babies get pretty tired after 2 hours of pushing and you end up having to get the baby out due to none reassuring monitor strips. Most of our docs are really good at vacuum deliveries (because they do it so much) so complications from their use are rare.
One good thing I can say is that because we have such a fast c/s response time we don't have to run back to the OR for the first sign of fetal distress. At the other places I worked patients got cut too early I think. Here we can get babies out in about 5-8 min so we can ride out some less then perfect strips.
In my opinion the worst problem this creates is difficulty for the patient that does want to have natural child birth. It depends a great deal on the doctor and their acceptance of natural child birth. I have flat out refused to check a patient that was unmediated. The doc wanted to know how much time he had. but I told him she wasn't that far along because you can tell when they don't have epidural. Also you get a few docs that want to give these patients pitocin which ties them to the bed and of course they have a really hard time because they cant move around and sadly end up getting epidural. Other docs aren't so uncaring and things go well.
I had a horrible delivery a few months back and I fear that my patient was traumatized by it. She was natural and had been ruptured for 30 hours so we ended up giving her pitocin I won't go into the whole story but it was bad. Natural child birth and Hospital interventions do not mix well. I'm sure there can be an in between but I haven't found it yet.

Do I know you?? No really, for the most part where you work sounds like where I work. Except that our patients range from 13 years to 45 (had a 45 yo. primip once). And that they are not as educated as your population. But we always have an in house on call OB and Anesth, and like you, we can ride out a strip that might get cut stat elsewhere. We don't have lots of vacuum deliveries...only when truly necessary. Except we do have one doc who old as Methuseluh who vacs EVERY MOM!! I don't call him to the room until it's almost a nurse delivery just to prevent him from vacuuming my pt.

The one thing I love about my hospital is that we get everything from Triplets to codes in O.R. I'm comfortable going just about anywhere from here. :coollook:

shay · Jun 10, 2004

One of the CNM's I work with is uber crunchy and had all HB's w/her children. A few of the nurses get freaked out with her style, but for the most part, I think yeah, it's possible to be an L&D nurse with the "if it ain't broke, don't fix it" attitude toward childbirth.

mother/babyRN, RN · Jun 12, 2004

Certainly.....Many people are under the sad misconception that just because a nurse is working in the labor and delivery department he or she just wants to throw those interventions at a person...In the hospital we have to advocate the healthiest entry into the world as possible for mom, babe and family. Sometimes, but not always, that involves a modicum of interventions, some of which include support, massage, etc...

If you advocate, as we all do, the most natural delivery as possible, you will be a great delivery nurse AS LONG AS you realize that whatever your preferences, SOME times other things have to be done or should be done to best achieve that goal and not EVERYone or not ALWAYS does it mean some sort of intervention outside the scope of "natural" delivery, is necessary....To me, these days, natural is any way they get here safely BUT I am the first to advocate for the patients personal choices as much as medically warranted....Good luck and welcome to the fold if you choose to join...If you were a Jehovahs Witness, would that mean you wouldn't condone giving blood to someone who was not?