How do L&D nurses REALLY feel about natural birth?

rn/writer, RN · Nov 2, 2008

Most of the L&D nurses I know are highly supportive of "natural births" so long as mom and baby are doing well. I put "natural births" in quotes because I think it suggests that as soon as there is any kind of intervention whatsoever the birth somehow becomes unnatural and the mother "loses," and that's really unfortunate.

Sometimes patients who want everything natural come in with a high index of suspicion and an adversarial attitude toward staff. As you might expect, this can complicate matters greatly.

It does sound like you would be happiest in a birth center. Keep in mind, though, that if it becomes necessary to transfer you to a hospital, there is already something out of the ordinary, and this might necessitate measures that you consider unnatural. Midwives don't transfer patients lightly, so the fact that they are concerned would indicate a need for closer monitoring and possibily other procedures to assess and protect you and the baby.

I love to see and hear about intervention-free births. At the same time, I feel sad when women feel like they failed or like someone failed them if everything doesn't go according to plan.

I hope you have a sucessful low/no intervention birth.

hiddencatRN, BSN, RN · Nov 2, 2008

I'm not a nurse, but my DH just finished paramedic school and had to do a few clinicals in L&D. He came home being really smug and dismissive about natural childbirth, and I feel like some of that had to come from the atmosphere he was in. So my sense is that there is a lot of disdain in the healthcare community towards natural childbirth. But on this board here I've actually seen a lot of L&D nurses write very positively about letting labor progress naturally and not rushing things for the convenience of the doctor.

Have you thought about visiting the hospital you think you'd be transferred to from the birth center if you need to be?

Elvish, BSN, DNP, RN, NP · Nov 2, 2008

First, congratulations on your soon-to-be new arrival. :)

Most of the L/D nurses at my hospital think it is awesome when a woman wants to go natural and are supportive of her. We do have a few that make fun of birth plans and don't really go out of their way to help a mom wanting to labor/birth naturally. But they are not in the majority.

Your birth plan sounds very reasonable, and that is what most L/D nurses that I work with say. As long as the birth plan is reasonable, everybody's cool. Don't want your baby separated from you? Great. Want to breastfeed in the first hour? Awesome. Want skin-to-skin? Done. No pain meds or epis? No problem.

The problem comes when a family comes in with a birth plan that is inflexible - that is, "I want things this way" and not allowing for the unexpected to happen. We are all for breastfeeding in the first hour, but if baby is in respiratory distress, that trumps breastfeeding, at least until things are stabilized. The other thing that bothers some people is when families' birth plan is something they printed off the internet without researching what the pros and cons are of each decision.

Your wishes sound nothing like this. I don't know of any L/D nurse I work with that would have the slightest problem with what you are hoping for. Also, be encouraged that the grand majority of birth center births go off without a hitch w/ no need for transport to the hospital. :w00t: Best wishes to you all for a healthy pregnancy and healthy baby!

Barkow · Nov 2, 2008

Nurses at my hospital are very supportive of natural birth, so long as you've really done your research and know what to anticipate, and have a very good and prepared support system with you. Most importantly you have to be prepared to change course if the situation arises (which you seem to be) and to understand that sometimes things that might be best for your baby might not be in line with your intended birth plan. Birth is so unpredictable, and especially with birth plans it's easy to get off track very quickly if for instance your membranes rupture and labor never gets going, etc.

My hospital is very low-key regarding interventions, but at a minimum there are certain policies that L&D units have to follow, and being aware of these policies and how things are done at a certain hospital will help you know what to expect and what hospital to choose if it comes to that.

rn/writer, RN · Nov 2, 2008

I forgot to mention in my earlier post that many times it isn't the nurses that choose interventions--it's the doc(s). Each OB can have standing orders about IVs, labs, monitoring, etc. That's why it's tremendously important to scope these things out ahead of time. Docs will often work with patients who object to or are hesitant about certain parts of their standing orders, but it's far easier to discuss such matters before labor begins.

It's also a good idea to find out now if your midwife would accompany you to the hospital if a medical transfer became necessary and if she would be the one writing your orders or if she would have to hand you off entirely to a staff OB. Once again, knowing what to expect before the situation arises gives you opportunities to look at all your options.

WVUturtle514 · Nov 2, 2008

Thanks Elvish! I'm definitely not going to be inflexible....obviously, as I am in healthcare too, I know that things can and do go wrong and need to be dealt with accordingly. I guess what concerns me is that the area in which I live (southern WV), natural birth is not the "norm." Everyone usually goes to the hospital and gets epidurals or ends up on pitocin for "failure to progress"....and our c-section rate here is VERY high. When people ask me who my OB/GYN is and I tell them that I am seeing a midwife, they look at me like I have four heads. So I'm kind of the odd-man-out when it comes to birth choices. I have heard some horror stories about the nurses at the hospital that I would deliver at should I decide to go the hospital route and it makes me really nervous that I'm going to be pressured into interventions that aren't necessary or warranted. I'm very confident that I will be able to deliver at the birth center with no problems, but there is always that "what if" in the back of my mind.....

eandgsma · Nov 2, 2008

I am an L&D RN who has had both a hospital birth and a homebirth, both before I became an RN. I was very pro-natural birth, anti-intervention, etc before I really understood the reasons why these interventions were done. Now I understand the reasoning behind many of the interventions. OTOH, I also understand the reasoning behind not wanting many of the interventions. So, from that perspective and now practicing as an RN in L&D I'll tell you my personal opinion. When people come to the hospital wanting a natural birth I expect them to be VERY educated on their options and reasons WHY they want a natural birth. Too many times we have pts who think they want a natural birth with no interventions but they are not educated as to why we have certain interventions or they don't know how to cope with labor because they didn't attend classes or read a book! That drives me nuts. I think people should be open minded to certain things like IV access for an emergency. If you don't need it then good, but if there were an emergency, it'd be a lot easier to just hook a line to a saline lock vs. sticking you in an emergency. I'm all for pts ambulating, using a birth ball, trying different positions for pushing. But I do like to know how baby is tolerating labor, so please come back for 20 mins of monitoring (or whatever hosp policy is). It actually makes my job easier if my pt is ambulating in the hall. Birth plans...they do seem to "jinx" a person far more than the avg pt. I don't know why, they just do. In the end, I try to help my pts who want to go natural to get their goal and I'm proud of them either way.

It seems you are an open minded and realistic person by your comments in your post. Please keep in mind that first babies generally take longer to come out, labor is painful and exhausting. Don't beat yourself up (or let anyone else) if you just get to a point where you absolutely cannot take it anymore. It happens. It happened to me with my first baby. I wanted a natural birth, I got a SL and intermittent monitoring. I had a doula. I labored for 24 hours with a 1cm change in dilation. I finally agreed to amniotomy. I was exhausted from no sleep. I tried everything to get things moving and to tolerate the pain (birth ball, showers, walking, etc). I finally gave in to an epidural. It relaxed me enough to where I was ready to push within an hour after the epidural. So a total of 30 hours of labor, one hour of pushing and I had a 8lb 10oz baby. Now the second baby, my homebirth, it was a total of 3h45m from start to finish. Very painful but because it was quick I made it.

Well, I hope this was somewhat helpful to you. I wish you the birth you are hoping for at the birth center!! Congratulations and please let us know how it goes.

MIcrunchyRN · Nov 2, 2008

With my daughter.. I got a nurse that made natural delivery impossible...

with my 2nd my nurse was great minus a few errors in judgement. LOL she learned quickly.

With my friend who I was her support... nurse was phenomenal. No IV nothing. It really depends.

IF a transfer happens will your midwives go with you? If not do you have a doula who can help you? Because for me it was best to have soemone to help speak on my behalf about my wishes. IF You transfer you may have to let the natural birth go because usually there is something wrong where you NEED the interventions they may be doing. It just depends on WHY you transfer.

Good luck! I highly suggest contacting the hospital you may attend. Ask about their policies reguarding. Pit/Epidurals/IV's/Photography/ as well as training of nursing staff in natural births, if your able to ambulate after your membranes are gone.

GOOD LUCK! YOU can do it!

MarySunshine · Nov 2, 2008

My coworkers and I are generally really supportive of natural birth. Although, it is really hard to take care of a patient who comes through the door viewing you as the "enemy" already, like some home-birth transfer patients do.

Someone else already said this, but I just wanted to reiterate that if your midwife saw fit to transfer you, then ''medical intervention" is most likely warranted. With your background, I have no doubt you will make good decisions. You have set yourself up already to have a lovely birth. Best wishes. :)

WVUturtle514 · Nov 2, 2008

Yes, my midwife would go with me if I would need to be transferred. Also, if I opt not to deliver at the birth center and decide to go to the hospital of my own accord, my midwife has priviledges to deliver there. I guess my concern is not so much if I get transferred, because obviously if I am being transferred, there is a medical reason for it. I'm more concerned that if I would DECIDE to deliver at the hospital instead of the birth center, that I will be up against a wall with the nurses who have their "protocols". I have had a very uneventful pregnancy and I am considered very low-risk....so I don't want to be needlessly hooked up to continuous EFM and such if there is no medical reason for it. But hopefully, as long as my midwife is there, she will try to have my wishes respected as much as possible.

jhhrn68 · Nov 2, 2008

I have to agree with a previous poster - it depends more on the doctor than the nurse. You should be good with a midwife, though. We see very few natural births where I work and that is because we don't have any MD's who are supportive of natural birth. Just be sure you are well educated and you and your SO go to LaMaze classes. It is really important to be prepared! I had my second child at home with a midwife and it was an awesome experience. I wouldn't trade it for anything.