Could I like OB even if I'm an "all natural" kind of girl?

[lalalalexi]

So I've just graduated, and although I never have imagined myself in OB, I have been potentially offered a position in labor and delivery (and the market for new grads in my area is terrible, so I'm really considering this). I DID enjoy my labor and delivery clinicals during school but overall I object to how some OB units are run. I really don't agree with cytotecing, inducing, using pit, and using IUPCs and am not crazy about the use of narcotics or epidurals either, though I fully respect a woman's right for pain control. The nurses also informed me that some docs will "persuade" a laboring mom to do a C section for personal reasons, such as a doc wanting to get to a child's soccer game in time. I find this really appauling. I know this probably isn the norm everywhere, but I just want to know if anyone thinks that, despite my perferring low intervention births, that I still might enjoy OB and have a place there? Or do you think I'd just be unhappy and not fit in?

[iNurseUK, RN]

Sorry but this is a bit of an aside. What is the legal status of midwives in the US?

In the UK midwifery is a specialised branch of nursing with it's own training and certification and no RGN would be employed on a labour and delivery ward without midwife certification.

Is it the same in the US?

[jillyjb]

I'm Canadian trained. Interventions are pretty common here, but seem to really be the norm in the US!! I am not sure I would be so comfortable working on a floor like that either..?

[JenniferSews]

I thought I could, but I couldn't. Yes, I believe in a woman's right to choose whatever birth she wishes. Yes, I understand that interventions have their place.

Even though I understood this, I was still sickened by the entire unit. Convenience sections absolutely were the norm, as well as "That baby is too big for a lady partsl birth, we need to section" with the result of a 7#er. Over 95% of women had epidurals; it was pushed on them, and they were asked to sign the consent at the preadmission clinic. When I birthed there myself, I refused to sign the consent, and the woman actually told me, well, if you don't sign it now, you won't get one, even if you are begging for one, or need one for a c-section." I told her I was a hospital employee and I knew that was absolutely not true, and I couldn't believe she was saying that. She back-peddled and said that the anesthesia doc REALLY wanted all the women to sign the consent prior to labor. Fine, but don't threaten.

I'm sure there are some OB units that are fine. The several I experienced were not. I worked OB as a nurse, and previously I worked for several years as a doula. The cattiness is to the extreme, the disrespect for women was so sad to see, and god forbid a woman wanted something out of the ordinary. A birth plan? Ha, the nurses took turns tearing it apart and making fun of it at the desk. Want your three year old in the room? The nurses did everything in their power to prevent that. Want your husband to catch? Are you kidding me? Want to leave within 24 hours of birth? Do you want you or your baby to die, because that's what can happen. You want to birth in the tub? Why do you want to drown your baby?

It was awful. If you want to support natural birth, work at a birth center. If that isn't an option for you, check your hospital's epidural rate. If it's above 50-60%, they aren't supportive of natural birth, and have no intention of wanting to be. Do they allow midwives? Do they encourage doulas? If so, that might be the hospital for you. I'm sure there are hospitals that are not so intervention crazy, but not in my area.

I did it for six months, couldn't hack it, and transferred to the medical floor. If I'm going to be intervening, I want there to be a good reason for it, not for the convenience of staff or physician, or because no one thinks outside the box. Maybe you are up to fighting every freakin day for those moms who want a natural birth, but I wasn't. I would come home from work, so sad about the complications I witnessed from fluid overload, epidurals, pit, removing baby from mom for extended periods of time, etc. In my experience, lip service is given to evidence based practice in OB, when the reality is that convenience and "this is how we do it" reign.

Again, I'm sure there are hospitals that have wonderful OB units; but I never saw one, and I wasn't willing to job hop to keep seeking one out, nor was I willing to relocate my family in the event that I found a wonderful hospital outside of my area. Perhaps if you are much more selective than I was, and if you have the ability to relocate for a good hospital, you might have better luck.

This was my experience as well. I went into nursing school with a burning desire to do OB. After one clinical rotation I knew there was NO WAY I could do that all day. The nurses openly made fun of the patients, and spent most of the shift ignoring them while they labored, staring instead at the monitor. Even when the woman was alone and scared, the nurse stayed at the desk chatting and only offered to get the epidural ready as comfort. After giving birth with a provider I was barely on speaking terms with due to my refusal of such things as breaking my water (a full 48 hrs before ds was born, healthy as a horse and intervention free,) I knew there was no way I could build a career in OB. It hurt my soul to see women in pain and frightened (as labor is naturally frightening!) bullied and intimidated into more and more interventions until the inevitable cs resulted. Statements such as you've seen here perpetuate the myth of the only good birth is a scheduled c-sec. The research is there, but most of OB turns a blind eye.

Instead I found a second calling and a true home in sub acute rehab/LTC. Interventions are usually necessary but on occasion I get a hospice patient and have the pleasure of making someone comfortable, happy and cared for in their last days and hours. It's the kind of special, intimate time I imaged OB would be before I saw it was solely a business.

[bagladyrn, RN]

Only go for the OB position if you are truly able to separate your desires and ideas from those of the patient.

As you can see here there are many who are unable to do that.

Yes there are often unnecessary interventons, both at the behest of the doctor and the request of the patient. My job is to insure that the patient has a safe delivery and an optimal experience within the framework of what occurs during her labor. If she comes in desiring an epidural it is NOT my place to make her feel like less of a woman for that. If pitocin is ordered arguing will not change it and I want her to understand her body is not a failure because of that. A woman having a c/section is going through enough trauma and needs to hear that she has still given birth and can feel proud of what her body has done all these months to support this child. She does not need even an inkling of "well if only you'd walked more, waited longer, done this or that you wouldn't have a failed induction"

I'm a big supporter of nonintervention in birthing and let all my coworkers know that I love taking the patient who want to work that way, but will also do everything I can to help every woman celebrate HER birth experience.

Yes you may occasionally hear me "venting" to my coworkers (generally in the break room, not at the desk) because I'm only human and not every patient or situation is likeable. It's a stress reliever just like coming on the board here.

Finally realize that you are not going to come in as the newbie and institute sweeping changes. You need to "prove" yourself first and then work from there.

[flashpoint]

As long as you can support your patient no matter what choice she makes, I think you will be fine. But...I have seen a lot of OB nurses who put off patient's requests because they "think" or "hope" if they wait that the patient will get through without interventions.

When I had my second baby I had an emergency section. My daughter's heart rate dropped below 60 and she was very obviously stuck! I had one nurse that asked me why I wasn't disappointed that I was unable to have a "normal" delivery and told me that "sometimes we just fail." WOW! I felt guilty because I didn't feel disappointed or guilty or anything negative about the section. The same nurse also admonished me for not being able to drink milk!

So...please just make sure that your views aren't going to ruin the mother's experience. Good luck!

[DroogieRN]

So...please just make sure that your views aren't going to ruin the mother's experience. Good luck!

This. I have two children and used midwives both times, and I had no nursing experience then. The second pregnancy and delivery sticks out in my mind to this day, 14 years later... I was sick and vomiting every day and just begged for something for the wretched heartburn and the midwife's response was, "Are you sure you want this baby?" I had a positive Strep B and a fast first labor and she wouldn't give me prophylatic abx before my due date. My second labor was precipitous and therefore, there wasn't time to hang abx, so my son had to have seven days of IV abx and a spinal tap. She was against circumcision and made me feel like a dog for wanting it done and I had to find someone myself to do it... I could go on. And on.

If you can just support the moms and be the best nurse for them, then go for it. If you think you absolutely cannot, then don't. Just my

[babyburperrn]

Only go for the OB position if you are truly able to separate your desires and ideas from those of the patient.

As you can see here there are many who are unable to do that.

Yes there are often unnecessary interventons, both at the behest of the doctor and the request of the patient. My job is to insure that the patient has a safe delivery and an optimal experience within the framework of what occurs during her labor. If she comes in desiring an epidural it is NOT my place to make her feel like less of a woman for that. If pitocin is ordered arguing will not change it and I want her to understand her body is not a failure because of that. A woman having a c/section is going through enough trauma and needs to hear that she has still given birth and can feel proud of what her body has done all these months to support this child. She does not need even an inkling of "well if only you'd walked more, waited longer, done this or that you wouldn't have a failed induction"

I'm a big supporter of nonintervention in birthing and let all my coworkers know that I love taking the patient who want to work that way, but will also do everything I can to help every woman celebrate HER birth experience.

Yes you may occasionally hear me "venting" to my coworkers (generally in the break room, not at the desk) because I'm only human and not every patient or situation is likeable. It's a stress reliever just like coming on the board here.

Finally realize that you are not going to come in as the newbie and institute sweeping changes. You need to "prove" yourself first and then work from there.

I couldn't have said it better myself!

[HealthShepherd]

I'm somewhat surprised that most of the responses here address how the OP's views might put her at odds with the mothers' wishes. I would have thought the more likely problem would be that she'd come into conflict with the medical team and the other nurses.

[laynaER]

I think you fail to realize that it's not about you, it's about the patient. I don't think your personal beliefs should be factored into this because it's someone else's choice what they want to do with their child and their body. It's not your business to say oh I don't believe in this or that. If you can't do your job effectively without involving your own personal opinion, then don't take the job.

If you or someone else were completely against say abortion for example, I wouldn't expect you or someone else to take that job. You have a right to not do something you believe goes against your ethics, but it must not interfere with patient care.

[laynaER]

Sorry but this is a bit of an aside. What is the legal status of midwives in the US?

In the UK midwifery is a specialised branch of nursing with it's own training and certification and no RGN would be employed on a labour and delivery ward without midwife certification.

Is it the same in the US?

Nope. As an RN you can work anywhere you want. Even if you are a new grad fresh out of school. Most if not all nursing schools have an OB class with an OB clinical rotation. I know I had one. So most nurses that graduate from University have some sort of base knowledge about labor & delivery. After all, we've had to pass OB exams and know all the medications, procedures, etc. So we graduate with knowledge of labor & delivery.

[TDCHIM]

I'm somewhat surprised that most of the responses here address how the OP's views might put her at odds with the mothers' wishes. I would have thought the more likely problem would be that she'd come into conflict with the medical team and the other nurses.

It might be the most likely problem, but it isn't the most dangerous one. Being at odds with coworkers over philosophical differences in delivery interventions is a professional issue. Conveying disapproval or being unable to stop oneself from pushing patients into delaying or ceasing requests for things like pain relief because of one's beliefs is something else entirely - it's a type of intimidation or coercion when a woman is at one of the most vulnerable times in her life.

Now, please understand: I am NOT saying the OP would do the latter. I don't know her and therefore cannot truly appraise her. She may very well be able to completely compartmentalize her personal views and her duty as a nurse. Frankly, I hope she can separate those matters, because from her post she's articulate and genuinely concerned about good patient care. However, it isn't unreasonable to be concerned about the impact upon her patients if she cannot do so. Professional conflicts are primarily an issue for personnel; conflicts with patients over philosophical differences in treatment are something with a huge potential for harm or pain for those patients. So posters here are only naturally more concerned about the potential impact on the patients.

[wifemom&lpn2be]

I am still a student so I can only speak from my experiences as a pt.

I've had 3 c-sections - 1 true emergency and 2 scheduled. All I can say that as a woman, I get so much crap from other moms at the park about it "I'm so sorry you couldn't have the experience..." I have 3 healthy little girls, it doesn't matter to me how they got here!

I would just hate it if my next birth was ruined by someone INSIDE the hospital who was supposed to help me! And, I would *know*, I knew which nurses were personally offended by my lack of breast feeding!

I told everyone assigned to me that my "birth plan" was that everyone was here to have fun and goof around and tell jokes! People were coming to hang out in our room. And, after each and every c-section, I had every member of that ER tell me they never had so much fun, which in turn made the experience better for me!

If you can't put your personal opinions aside and make it special for the pt then you shouldn't take that job! There are other nurses who would LOVE to get into L&D!

I don't mean to bash the OP but L&D is an experience that you re-live and re-tell for a lifetime - it's very personal. I am sure you are a great nurse but maybe another dept would be better....