questions for L&D nurses from a pregnant nurse :)

LaMorenaRN · May 2, 2011

Hello. I will get right to the point

Goodies for the Nurses are always good.

Make sure your birthplan is not too intense or demanding or it WILL be passed around the nurses station and bets will be made regarding the time of your c/s

The fact that you have a CNM and doula is good.

State your wishes firmly but not threatening

Next time, stay away from a hospital with that high of a c/s rate.

adpiRN · May 2, 2011

Could you explain a little more about what's in your birth plan and what you mean by wanting a natural childbirth?

If your plan is just to not have an epidural, that shouldn't be a problem at all. Just be aware that nurses there may not have the skills to help you through natural childbirth, so you and your partner should be prepared. (but it sounds like you're fine with the hypnobirthing, midwife and doula)

If your birth plan includes things like not wanting an IV or not wanting to be on the fetal monitoring you may butt heads with nurses, but it may be possible to negotiate (like a medlock or intermittent monitoring) Postpartum pitocin is also usually standard, I've never really seen them make exceptions for that. (that decision would be made by the midwife though not the nurse)

Bribes for nurses are always well appreciated and as for the birth plan I wouldn't bring it up right away since some nurses are against them on principal, it might just be better to slip in bits of your birth plan naturally into the conversation.

Good luck!

esokitty · May 2, 2011

Not a L&d nurse (yet) but having had a nonmedicated hospital birth of an 11lb5oz baby, I can say this... make. Sure. Your support. Team is ready to react on your behalf and speak up/intervene for you. Please remember, all births are natural. The baby comes out, doesn'T it?

Best of luck! You can do this!

chiandre · May 2, 2011

l&d nurses see birth plans as a "curse" and prelude to c/s and everything else but the birth plan. you are right, l&d nurses are very "stuck in their ways" because of potential for unanticipated birth complications and of course, potential for lawsuits.

my suggestion is take the birth plan but do not make a big deal about it. let your nurses know that you have it but that you are willing to let it go if it will cause complications for you or the baby.

ask your nurse to review it and give you suggestions or any pointers. l&d nurses love that!

as for the goodies, please do not hesitate. your nurses will appreciate it.

good luck!

Elvish, BSN, DNP, RN, NP · May 2, 2011

No one I work with has a problem with reasonable birth plans, and what's in a lot of birth plans is SOP at my hospital anyway. What we have a problem with the rigidity of a few. The 'absolutely no C-section under any circumstance' sort...yeah, uh, that's going to go out the window the moment your cord prolapses. It's not so much the not wanting a c-section that bothers people (can't blame anyone for that), it's the control issues behind such a stark, absolute statement like that that are the problem.

I don't, however, think it's unreasonable to ask about things before staff start to do them. "Do you mind telling me why this is happening?" "Is this something that's absolutely necessary?" If you do that respectfully, hopefully no one will think badly of that.

I have a birth plan too (almost 36 weeks here), so please understand this comes from someone who's very much for patients asserting their rights. Mine is pretty short.

One thing I always appreciate when patients do is have stuff - like a basket of chocolate mini-bars or other kinds of goodies - set out in the room for nurses/staff who come in and can grab a goodie or two. Besides tasting good, it might be the only lunch we get. :up:

ocmama · May 2, 2011

Not an L&D nurse yet, but hope to be someday. I had 3 big babies at home naturally. I vividly remember helping a woman deliver her first baby with no pain meds (she had pit and an IV) during my L&D rotation. She was able to be up and out of bed and lean/sway on her partner while still being connected to the monitor and IV. FYI gravity is a birthing woman's friend. Labor at home as long as you feel comfortable and try to stay on your feet once you are in the hospital. I think as long as you go into the situation without a confrontational attitude you will be fine. You sound like a nice person so I doubt you will be perceived as a difficult pt. Best of luck to you and I hope you are able to birth how you want.

rkitty198, BSN, RN · May 2, 2011

I had a baby 8 months ago. I had a birthplan, but the birth had a plan of it's own. I understand wanting to plan your experience, I had this amazing plan. I had to learn to let go of my nature to control things.

I had hypertension and was placed on mag, had variable decels, ended up with an epidural, ect.

Just remember that the ultimate goal of a birthplan is a healthy baby!

I became depressed about the delivery and finally I have started to let it go. I hope you don't think I am being a Debbie downer, I just don't want anyone to feel as depressed as I was about the experience. I kept replaying the delivery in my head thinking "what could I have done to not need that epidural?" I now know I am a strong woman with a beautiful baby!

I love my son so much. I wish you and your family a wonderful experience with your soon to be baby!

Happy mothers day! Give that little one a million kisses when they arrive!

amyj23 · May 2, 2011

As an L&D nurse the best advice I can give you is to call your MW before you go into the hospital. She knows who the NCB friendly nurses are and can call the unit and request your nurse prior to your arrival. The MW I work with does this with me and a handful of other nurses.

My advice about the birth plan is keep it simple. If you state that you want NCB, bradley, or hypno birth the nurses know what that means....you don't have to go into to much detail.

Stick with the things you truly have an option over. For example: circ or not to circ, eye meds/vit K or not, baby to chest at delivery or clean up first, mirror at delivery or not. And understand that hospitals do have policies like IV access and such...talk with your MW about these things.

The WORST birth plans that ALWAYS end up with a CS are the ones that focus on negative issues like "refusing this and that" and have phrases like "under no circumstances." The nurses reading this have seen the greatest, easiest, no intervention deliveries ever. And they have seen the worst outcomes anyone can imagine. When patients use words like "refuse and under no circumstances" it sets a very negative tone because it sounds condescending and doesn't take into account complications that are always a possibility no matter how minute.

Yes some nurses are more NCB friendly than others but over all any L&D nurse wants you to have the birth you want.

BabyLady, BSN, RN · May 2, 2011

Hello! I am a med/surg nurse who is 34 weeks pregnant with my first child and will be delivering at a hospital close to my home (not the hospital that I work at - my hospital doesn't have an L&D). I have taken a Hypnobirthing class and am hoping for a natural childbirth. A CNM will be delivering my baby and I also have a Doula to help me. The hospital I am delivering at has a level III NICU and has a good reputation for difficult deliveries. It has a c-section rate of 41%. It also has a reputation for being less than cooperative with natural birthing mamas and for having older, "stuck in their ways" nurses who can be downright rude (for example, after a coworker of mine gave birth and was birthing the placenta, a nurse went to hook up Pit and my coworker asked to not have it. The nurse replied that "well, then I guess you will bleed to death" and stomped off)
The question I would have asked your co-workers is this: How long had it been since she had given birth? The widow for this is not endless....30 to 45 minutes, after that, it requires an intervention sooner than later....also, if a nurse had said that to me, trust me, a member of hospital administration would have been at the bedside by morning.
This is why I am posting. I am looking for advice to help me have the birth that I want while not alienating/******* off the nursing staff. I know things happen and am well aware that my birth plan may not go as planned. I also have elevated BP (not pre-eclampsia, it is a pre-existing condition) so I know that inducing me/other interventions may be a reality. I have talked at length with my midwife about that. But I really really really want to make an effort to have a natural childbirth and would love the support of the nursing staff in my quest.
Since you have a Midwife AND a Doula...here is an option: The CNM writes the orders...not the nurses. The CNM needs to have a good enough rapport with the nurses in order for them to respect her birthing practices and those of her clients. Your CNM needs to make that clear to the staff and report them accordingly...as a patient, you do not have to put up with their attitudes.
Any advice for how to make this happen besides just being nice and polite about it? Should I bring a basket of goodies for the nurses, or is that blatant bribing lol. I have a birth plan that I will bring - do nurses even read them? Do they help? I guess I just really want to know from L&D nurses what you need from me and what I can do as a patient to facilitate the process.
I really appreciate the advice. I have been stressing about this a lot. Thank you.

Good luck!

Hushi05 · May 2, 2011

I work with an excellent group of wonderful (and kind) nurses, so my jaw just drops when I hear stories like this. What I would say is that you need to clarify your wishes with your *provider*; nurses follow hospital protocol (like running pit after delivery), but it's not up to them to decide whether or not you should have it. When you refuse things like IVs or monitoring, you put the nurses in a bad position *unless you have decided that in advance with your provider* and the provider has written it into the orders.

I work at a University hospital where we do high risk deliveries of all kinds, but every one of our nurses will help a woman have a natural delivery if she wants it, has agreed with her provider, and if it is appropriate according to her individual circumstances.

Written birth plans are useful for you to use for a discussion with your provider; they are meaningless when waved in front of a nurses's face when you present in labor.

tablefor9, RN · May 3, 2011

1. Be nice. Since it sounds like you are, you're halfway there.

2. Talk to your CNM about your preferences, like intermittent monitoring, saline lock, diet, out of bed, pit IM or not at all, etc. She should write your orders accordingly.

3. Discuss this with the nurses, in a non-defensive manner, and remember, there are mean people and control freaks in every realm of human experience. You don't have to let them drive the train at your delivery. Even the most medically minded L&D RNs I've worked with would honor a birthplan and cheer when things went well.

Good luck to you, happy mother's day!