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?
My first thought on reading the OP was that the issue would be with 'the system' and not patients. And honestly, as a nurse in the field, it is my biggest area of frustration. Most of us (I'm speaking for all the nurses I know personally) can deal with a patient whose life choices aren't ones we like or would make for ourselves. What can be much much harder is trying to stand up a system that sometimes attempts to dictate to patients based on misinformation what's best for them.
One of my favorite things about being a nurse is being a patient's advocate, but it is also one of the hardest things. It's hard to advocate for a patient that wants natural labor and birth but the doc on call wants to section so he can go to sleep/church/his family get-together. It's hard to labor a patient, it's physically hard work to be in there constantly with a laboring woman supporting her efforts all shift, only to have a doc come in and decide she's not progressing 'well enough for me' (whatever that means) so off we go to section*. So I totally get where the OP is coming from. (*Certainly, not every doc is this way. Please don't think I'm categorically doc-bashing, as I'm not. I've worked with and been a patient to some great ones and dearly wish all were like them.)
OP, if this is something you really want, I say go for it. Some places have an 'assembly-line' feel, which is unfortunate, but I'd venture to say that there are still a few places left that let moms and babies do what their bodies know how to do. If you find that a particular place doesn't sit right with you, you can either work to improve things there, or you can test the waters elsewhere.
Either way, best of luck. You certainly have a good bit to think about, and I wish you the best in your decision.
Being in your situation a couple of years ago I found that it wasn't the mothers wishes I had problems with, it was the medical staff. They mostly did zero education into the benefits/risk of AROM, monitors, etc. before labor so roughly 75% of the women weren't even given the info they needed to decide what they wanted before hand. Labor is NOT the time to have to make those decisions. Not that they were really given a choice at that point either.
The women that did come in knowing what they wanted and didn't want were treated horribly. Made fun of, picked on, and in a couple of cases things were done that they didn't want done even as they were screaming not to do it(b/c the docs were tired of waiting, not b/c babe was in trouble). That was tough. Even if they came in wanting an immediate epidural, AROM, pit, section, etc the above happened. You just couldn't win with some of the docs and nurses. Nothing that the mother chose was right and how dare they come in with any type of plan, etc.
Not that every doc or nurse was like that, but enough that it made a huge impact on care. There were some rocking nurses that really advocated for the patients and helped the moms get what they wanted and needed, but that was not the norm.
Seemed like fate when I got sick and had to go on medical leave. When I was well enough to go back to work I choose a different specialty. If there was a birthing center near me I so would go back, I really feel like it is my calling. I just had a hard time dealing with all that took place in a regular L and d dept.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think it's possible you might do well to become a childbirth educator. That way, you can be on the educational side of things, helping people to really THINK about their birth experiences and be better consumers of their health care. BUT you have to keep your personal judgments in check. I am not saying you can't have them, nor share, but be careful how you present them. In some cases, it works best to be as neutral as possible about controversial topics. I teach about many things; circumcision is an example----a very controversial topic in many places. I present the facts, medical, aesthetic and personal---- and just the facts. I work hard to keep my personal opinion from factoring in to my teaching and the class comes away not knowing how I feel one way or the other, if I succeed.
I think, from what you say here, you might be an excellent Bradley instructor. VERY much emphasis is placed on birth being a healthy, natural process and allowing loved ones to do the coaching/support in childbirth. Have you considered the positive impact you could have as an educator for new families?
So it goes with childbirth experiences, in and out of the hospital. You MUST try to remain neutrality and be the advocate, whether you agree with your patients' choices or not.
And I agree with what others said: It sounds like you will have major issues with practitioners' practices and policies, from what I gather. As long as you can keep your eye on the "big picture" and tolerate all points of view, and really be there for the families in their life-altering experience of having a baby, you will do ok. You don't have to agree with everything you see; and you can effect positive changes if you do it the right way!
I too lean more towards the 'natural' aspects of birth and had two wonderful home births. But I LOVE my job as an OB nurse. There are times that I feel like there are too many interventions. However, I think that as a pt advocate I am able to do my best to help them have the birth they are hoping for. Because of my experiences and my beliefs I tend to feel more comfortable with pt's wanting a natural birth than some of my co-workers. For some people it is hard to understand why anyone would put themselves through pain if getting an epidural is available, not too mention that in nursing school we are taught to be on top of pain control. So I think there are RN's who prefer to work with patients with epidurals. I love the challenge of getting someone through a natural as well as the bonding that happens while you provide intense support to these patients. So I think there can possibly be a niche for someone who enjoys natural birth. However, it is SO important to respect the pt's that choose otherwise, and, like a few other posts mentioned, if it seems like it would be hard to put your own opinions to the side, maybe it is not the place for you. The other big bit of info to have is what the stats are for inductions, c-sections, epidurals etc at prospective hospitals. If natural births are very few and far between it may not be the place for you.
For me, I have felt like I found my calling in the OB dept acting not only as a pt advocate but also as a natural birth advocate and a bridge for pt's that may be transferring from our local birth center (run by direct-entry midwives and CNM's) to the hospital. I hope that helps! Good luck!
You need to research the practices at the hospital you were offered the position at. I work in a hospital that low risk women can get away without even having to get a S.L. if they request it. Episiotomies are almost unheard of. We have low induction rates; many of our women deliver after 40 weeks. We do VBACS, water births, and our C/S rate is well below the national average. Several of our clinics do parallel care with HB licensed midwife groups. I trust birth but know you have to always be prepared for "just in-case", which is seen a lot more as you add on interventions.
Just down the road it is a different story. No water births, no VBACS (despite the fact that they are the only hospital in the area that has an actual surgical suit right on the unit) and the highest C/S rate in the county...try to get away without at least a S.L.? you'll be laughed at. It is not as bad as other area's and you still can have a natural birth if you are low risk, but I am a little spoiled where I work.
Most nurses that speak negatively have never been to a home birth, have only seen the product of a home birth gone bad come in their doors, and have only experienced hospital births with interventions that are usually the cause of those "oh sh*t moments"
I'm too against so many things going on in L&D and postpartum that I know I wouldn't be able to take such a position. But if you think you can without banging your head against a wall after every shift, then I say take what you can get. :)
Is anyone working in L&D to gain experience before going back to school for their CNM or CPM?
As a HBAC mom myself i know i would have a tough time working in a traditional OB floor, but birth really is my passion and i am just wondering how many nurses out there are just sucking it up and dealing with all the unecessary inductions, c-sections, lack of informed consent, to gain experience so they can continue on working in a more natural birth environment?
Specializes in Nurse Leader specializing in Labor & Delivery.
Is anyone working in L&D to gain experience before going back to school for their CNM or CPM? QUOTE]
I'm not working L&D in order to gain experience, but I am going back to school for my CNM. There are several programs for which L&D experience is NOT a prerequisite.
Is anyone working in L&D to gain experience before going back to school for their CNM or CPM? QUOTE]
I'm not working L&D in order to gain experience, but I am going back to school for my CNM. There are several programs for which L&D experience is NOT a prerequisite.
Where would these programs be? I graduated in Dec. after changing careers to become a CNM. I precepted in L&D and don't know I could work in the very unfriendly natural birth environment that is Las Vegas. Luckily I had a baby in March so have had some time off to think about what my next step will be.
My first thought on reading the OP was that the issue would be with 'the system' and not patients. And honestly, as a nurse in the field, it is my biggest area of frustration. Most of us (I'm speaking for all the nurses I know personally) can deal with a patient whose life choices aren't ones we like or would make for ourselves. What can be much much harder is trying to stand up a system that sometimes attempts to dictate to patients based on misinformation what's best for them.
One of my favorite things about being a nurse is being a patient's advocate, but it is also one of the hardest things. It's hard to advocate for a patient that wants natural labor and birth but the doc on call wants to section so he can go to sleep/church/his family get-together. It's hard to labor a patient, it's physically hard work to be in there constantly with a laboring woman supporting her efforts all shift, only to have a doc come in and decide she's not progressing 'well enough for me' (whatever that means) so off we go to section*. So I totally get where the OP is coming from. (*Certainly, not every doc is this way. Please don't think I'm categorically doc-bashing, as I'm not. I've worked with and been a patient to some great ones and dearly wish all were like them.)
OP, if this is something you really want, I say go for it. Some places have an 'assembly-line' feel, which is unfortunate, but I'd venture to say that there are still a few places left that let moms and babies do what their bodies know how to do. If you find that a particular place doesn't sit right with you, you can either work to improve things there, or you can test the waters elsewhere.
Either way, best of luck. You certainly have a good bit to think about, and I wish you the best in your decision.
Your post makes me think of this paraphrased quote: "You're either part of the problem or you're part of the solution." I say, bring on your "all natural kind of girl" attitude and help solve the problem! Go change things, one delivery at a time.
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Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
My first thought on reading the OP was that the issue would be with 'the system' and not patients. And honestly, as a nurse in the field, it is my biggest area of frustration. Most of us (I'm speaking for all the nurses I know personally) can deal with a patient whose life choices aren't ones we like or would make for ourselves. What can be much much harder is trying to stand up a system that sometimes attempts to dictate to patients based on misinformation what's best for them.
One of my favorite things about being a nurse is being a patient's advocate, but it is also one of the hardest things. It's hard to advocate for a patient that wants natural labor and birth but the doc on call wants to section so he can go to sleep/church/his family get-together. It's hard to labor a patient, it's physically hard work to be in there constantly with a laboring woman supporting her efforts all shift, only to have a doc come in and decide she's not progressing 'well enough for me' (whatever that means) so off we go to section*. So I totally get where the OP is coming from. (*Certainly, not every doc is this way. Please don't think I'm categorically doc-bashing, as I'm not. I've worked with and been a patient to some great ones and dearly wish all were like them.)
OP, if this is something you really want, I say go for it. Some places have an 'assembly-line' feel, which is unfortunate, but I'd venture to say that there are still a few places left that let moms and babies do what their bodies know how to do. If you find that a particular place doesn't sit right with you, you can either work to improve things there, or you can test the waters elsewhere.
Either way, best of luck. You certainly have a good bit to think about, and I wish you the best in your decision.