I am a CRNA who is currently 33 weeks pregnant with my first child. As of right now I am planning on delivering at a birth center near my home. However, I know the possibility may arise where I need to be transferred to the hospital, or I may get into labor and decide on my own that I'd rather deliver at the hospital. I am very determined to have a natural birth (i.e., no epidural, no IV meds)....obviously the birth center I am going to is very pro-natural birth. My concern, if I do need/decide to go to the hospital to deliver, is that the nurses there will not be very "natural birth friendly." I have been around OB long enough to get a feel for a lot of nurses attitudes towards things like natural births, birth plans, doulas, etc....and let's just say they are less than positive. I've sat in the nurses lounge and heard comments about how annoying patients are who want to have natural births, and how they "already have their paperwork ready for a c-section." This really upsets me and is one of the reasons that I don't want to go to the hospital to deliver. I want to be in an environment that is supportive of mine and my husband's wishes and I'm afraid that the hospital will not be that place.
So tell me, how do most L&D nurses really feel about natural birth? Are patients who come in requesting to go natural really treated with disdain and annoyance from the nurses? How do you feel about patients who refuse certain procedures (i.e., IV sticks, continuous EFM, etc.)? Obviously I will be putting the health of my baby first and foremost and if there is a medical necessity for any intervention I will be more than willing to have it....I just don't want a lot of unnecessary interventions attempted for the convenience of the staff. Sorry if I rambled a bit, just trying to get a feel for what to expect. Thanks in advance for any responses!!! :nuke:
I really, really don't know where these women are having babies that are not permitted to choose their birth plan and how they end up with an OB that won't follow it. That is something that should be chosen and discussed with the OB up front, and if the OB isn't "down" with the plan, then it's time to start shopping for a new one.
Where are the nurses acting as an advocate for the patient that should be telling them that they have a choice?
Hopefull, it must depend on where you are. I'm in NC and our birthing choices are very limited around here. There are very few freestanding birth centers around here, there are 2 CNMs in the entire state that attend homebirths, and CPM-attended homebirths are illegal. So, that leaves hospital births for most of us. Some medical practices have OBs that are willing to let mom birth naturally, and others do not. Even in the ones that do, what if that person is not on call and you get stuck with a rush-to-cut doctor?
I agree w/ you that it is nurses' responsibility to let pts know they have the right to refurse. However, some docs are really good at scaring pts into doing what they (the docs) want them to do, even if it's not what they want for themselves/their babies. It's a pretty complicated issue.
Hopefull, it must depend on where you are. I'm in NC and our birthing choices are very limited around here. There are very few freestanding birth centers around here, there are 2 CNMs in the entire state that attend homebirths, and CPM-attended homebirths are illegal. So, that leaves hospital births for most of us. Some medical practices have OBs that are willing to let mom birth naturally, and others do not. Even in the ones that do, what if that person is not on call and you get stuck with a rush-to-cut doctor?
I agree w/ you that it is nurses' responsibility to let pts know they have the right to refurse. However, some docs are really good at scaring pts into doing what they (the docs) want them to do, even if it's not what they want for themselves/their babies. It's a pretty complicated issue.
You're right about a lot of women not having choices. There is only one free-standing birth center in the entire state of WV....luckily it happens to be less than 5 miles from my house. There is one midwife in my area who will attend to homebirths....I'm not sure about in other parts of the state. I just know that the "norm" around here is to go to an OB, and deliver in the hospital....most women (I'd guess > 95%) will get an epidural, and the c-section rate around here is well above the national average. Natural birth is just not something women do around here very often...I think a lot of it has to do with education levels too.
Hopefull, it must depend on where you are. I'm in NC and our birthing choices are very limited around here. There are very few freestanding birth centers around here, there are 2 CNMs in the entire state that attend homebirths, and CPM-attended homebirths are illegal. So, that leaves hospital births for most of us. Some medical practices have OBs that are willing to let mom birth naturally, and others do not. Even in the ones that do, what if that person is not on call and you get stuck with a rush-to-cut doctor?
I agree w/ you that it is nurses' responsibility to let pts know they have the right to refurse. However, some docs are really good at scaring pts into doing what they (the docs) want them to do, even if it's not what they want for themselves/their babies. It's a pretty complicated issue.
I can understand how alot of this could happen with a first-time mother...but not so much with a multipara that "knows the deal".
What I saw this summer in L&D was doctors expecting labor to progress significantly in ridiculously short-periods of time...like 2 hours, etc. Even with the lack-of-education issue...anyone who has even watched a few health programs knows that labor can take a very long time...I certainly wouldn't want to keep pushing Mom if she just wanted it over with...I would probably remind her of her goals and let her know when that window of an epi was closing so she can be as comfortable as possible.
One thing that I noticed was that these women also don't question the doctors, which is something I always did even before I got into nursing school...I figure if they couldn't explain it...then maybe I should re-think it.
This is where I trust the nurses more...I did get to see some women that were allowed to labor several hours and it just flat out never progressed and even with pit, didn't even budge...I can understand those b/c you certainly don't want to sit there and wait until there is a major problem before you get around to a c-section. If a nurse tells a patient that her dilation and/or effacing isn't moving...I trust that nurse. It's a subjective call anyway and certainly more accurate, in my mind, than a OB that walks in and does a single lady partsl check vs several.
We don't do OB at my hospital, so unfortunately I do not work at the hospital where we would be going.
If your CNM has privileges at that hospital, she probably has a "feel" for who will be supportive of your goals - utilize her expertise! Nothing wrong with calling the unit and arranging for a private (not the group walkthrough you get in childbirth classes) tour of the unit. You can kind of "chat up" any nurses who are available as well - be a familiar face when you arrive. I enjoy when I can meet a patient and say "Oh yes, I remember you - I met you last month".
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Ok here is how I feel in a nutshell, as an L/D nurse and childbirth educator. CHOICE should be allowed-----educated and prepared choice. But we are nursing a DYAD, not a single unit. So sometimes, baby's needs trump those desires for all-natural birthing. I feel much better when I get a birth plan that tells me their wishes succinctly and clearly, but I always ask for flexibility and promise the same. I LOVE participating/being allowed the priveledge of attending all births, natural, or "otherwise" ....but I agree with prmenrs, the more unbending the plan is, the more likely trouble will follow. It's been my experience.
Besides, PARENTING is the journey, not just the birth.
I wish you the best. Try to find a birth place that fits you and please, oh, please remain flexible, not only in birthing, but in parenting your child. It will save a lot of heartache for you and all around. You don't have much time. I hope it all works out and you and your baby emerge from a happy birth experience in good health.
1. Do whatever it takes to keep me and my baby safe.
2. Feed me afterward.
Not saying you should give the medical staff carte blanche to perform all kinds of unwanted interventions, but I just loved the simplicity of this one.
Ok, I am not an L&D nurse, but this topic caught my eye. I have two kids of my own, and this is my experience. First, I think it is great that you have done your research. With my first, I wanted to go natural, but didn't really understand what that meant. I didn't research anything, and I gave birth at a university teaching hospital. Bad idea. They already have a plan in motion for every laboring mother, and do not take into account that every woman, and every situation, is different. My water broke, and I rushed right to the hospital. I was told since I had ROM, that I had less than 12 hours to deliver or they would have to do a C-section. (Not true). I was also told since I was only 1cm dilated when I came in, that I was not progressing and needed pitocin (not true, and that stuff is EVIL). I went quickly from feeling fine and in control, contractions were tolerable, to being in unbearable pain. I would have contraction on top of contraction, with no rest between them, and I couldn't breathe. I literally started to hyperventilate. My nurse had been pushing an epidural since I walked in, being quite rude about it, telling me I "couldn't handle the pain without one" and I was "being stupid." I ended up requesting a new nurse because she was not being supportive or helping me in any way, she made me feel worse. My second nurse was amazing. I did end up asking for IV drugs because I felt overwhelmed. Not sure what it was, and frankly the rest of my birth was a blur. I felt disconnected from my body, completey out of control and ended up falling asleep (so I am told). I couldn't focus on pushing, and my daughter got stuck. The top of her head was out, and I was just too tired to push anymore. After 3 hours and no progress, they told me I would need a c-section...that woke me up, and I pushed her right out. She wasn't breathing. Not really sure why, but I have read stories about both pitocin and IV pain meds having this effect. She spent a week in the NICU and it was the worst week of my life.
Second pregnancy...I did my research. Knew what I wanted, and what I didn't, and I had reasons for everything I choose. I had a very supportive doctor....now one dr in the practice was a real pain...I saw her once when my dr was on vacation, and the woman pretty much told me since I had "problems" getting my daughter out, that I was a petite woman, and that my son was measuring big, that I needed to schedule a c-section and not even try laboring. I pretty much told her to shove it and that I was not scheduling a c-section without a trial of labor. That is an easy way out for dr's that don't want to wait around for a women to give birth, it is risky and selfish in my opinion (not all c-sections, just scheduled ones without a medical reason). Anyway, I gave birth at a new, smaller facility near where I live. Nurses were amazingly supportive of natural birth. My water broke for the second time after a night of contractions. I waited a while to go in, I was not given pitocin, was able to walk around and switch positions, and in just a few hours gave birth to my son with 3 pushes, no drugs or interventions. He was two lbs bigger, I might add, and a much easier birth. My first birth was a horrible experience, but my second one was wonderful. Just research birth options, and you will have a better chance having the birth you want. If you have to go into a hospital, know what they do and why they do it....and if it is really necessary. I wish you luck on having a great birth experience, and on having a beautiful, healthy baby, no matter how s/he comes into this world.
We always have anesthesia to speak with patients on admission. When my patients tell me they want medicine free deliveries, I support them. However, I also requests they leave their options open (some CRNA's wont' come back if they say no upfront). Having had 3 children (by accident) without medication I can see both sides. It depends on the person, their knowledge, their coping skills and their labor.
"I'm one of those who volunteer to take these kind of patients as I really enjoy using all the alternative techniques I've learned over the years. The only ones I find really difficult are those who come in stating they want to "go natural", but have done NO preparation - no classes, reading, or talking with their provider (usually they just say "Oh I've been watching A Baby Story"). These are the ones who are totally panicked when reality sets in."
I feel the same way. I love to help patients go natural, but the women who are not prepared-I just don't get... I can only do so much to help comfort wise or to help with focusing etc, but if you haven't prepared by practicing etc it just may not happen...
1. Do whatever it takes to keep me and my baby safe.
2. Feed me afterward.
Not saying you should give the medical staff carte blanche to perform all kinds of unwanted interventions, but I just loved the simplicity of this one.
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.
some CRNA's wont' come back if they say no upfront
Wow, I'm surprised they get away with that!! That would NOT fly at my hospital; if someone wants pain relief (at any time) they get it. I thought that was a big guideline by one of the powers that be (JAHCO or ???).
I just think that's cruel, I support natural childbirth but also I think patients have every right to change their mind.
I dare say most of my patients are the variety described in other replies, that say "natural" but have no idea what they are getting into and haven't really prepared, so they end up changing their mind, and I don't think they should be punished for that.
I could also see how that could really undermine natural child birth, b/c I would think a lot of moms are going to be so scared they will just say 'yes' rather than give it a try and then not be able to get something if they decide they want it later (I know I would have!).
Elvish, BSN, DNP, RN, NP
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Hopefull, it must depend on where you are. I'm in NC and our birthing choices are very limited around here. There are very few freestanding birth centers around here, there are 2 CNMs in the entire state that attend homebirths, and CPM-attended homebirths are illegal. So, that leaves hospital births for most of us. Some medical practices have OBs that are willing to let mom birth naturally, and others do not. Even in the ones that do, what if that person is not on call and you get stuck with a rush-to-cut doctor?
I agree w/ you that it is nurses' responsibility to let pts know they have the right to refurse. However, some docs are really good at scaring pts into doing what they (the docs) want them to do, even if it's not what they want for themselves/their babies. It's a pretty complicated issue.