How much control do mom's really have during birth?

BETSRN · Feb 1, 2005

I'm learning so much from this board, thank you! I'm going into nursing school in June and I am interested in L&D. Forgive my ignorance.
I have read so many posts in here that talk about the interventions docs do during the labor. How much control do mom's and/or dad's really have during the labor?
For example:
Can mom's refuse to have an episiotomy?
Can mom's refuse to have their perinium stretched?
Can mom's refuse to give birth in the lithotomy position in stirrups?
If a mom wants to move around, will she be able to?
Do docs actually listen to mom and/or dad?
Or, should mom's who want any control just use a midwife?

First of all NO ONE has total control over their birth. Lbor happens and things happen. First, you have to understand that. Even the doctor, miswife or nurse have "control" in that sense, although I do know what you are getting at. 1) Many practitioners do NOT cut episiotomies at all any more. But some do. You an always refuse to ahve one, but you may rip anyway. The key is to ask your HCP BEFORE you choose him/her what his episiotomy rate is. If is is more than occasionally, get a new doc BEFORE you start. 2) Your perineum is going to stretch anyway. Mild massage helps. 3) Lithotomy position is the worst, except in some instances. The nurse's skill can have a lot to do with using positions that enhance nature. 4) Same as #3. The more Mom is uip and out of bed the better. But if she chooses an epidural for pain control (over natural things) then she HAS to be in the bed (but can move around in the bed and sit up,etc.). 5) You should have figured out of your doc or midwife listens to you BEFORE you are pregnant. If he or she does not, then CHANGE DOCTORS! Having a midwife does NOT ensure a natural delivery and they are just as likely NOT to listen to you as a doctor. You cannot make a global statement about midwifery over medicine.

Ms.Hobbes · Feb 1, 2005

An expectant mother and father should discuss ahead of time with their doctor what they want in labor and delivery. They should also take a prepared child birth class which will inform them of the choices they have in Labor and Delivery and what process there body will go through. As a patient you have rights and a doctors job is to explain risks and benefits of the procedures. So yes you can refuse treatment and you can request treatment during your care. The health and well being of the mother and baby will of course be weighed in on the choices of their care.

I have taught child birth classes for the last nine years and I think it is so important that people educate themselves about the choices they have, what the choices are and learn ways to cope with their labor- education, relaxtion, breathing, medication, etc. As nurses part of our job is to also serve as a patient advocate. When a woman comes into the labor room part of my admission process is to find out what at present time their birth plan is, if they have one,but also remember that as labor progresses they may change their plan as every labor is quite unique.

Sorry a little long winded :)

Mermaid4 · Feb 2, 2005

There is a patient bill of rights which applies to these moms as well as any patient. Of course, all risks must be explained and there are times when unwanted interventions are necessary. We try to accomodate patient wishes but there are always instances when patients do not realize that ultimately,the doctor ( and nurses) work for them, and barring problems, THEY are the ones in charge.

Mermaid4 · Feb 2, 2005

It always sort of amuses me when a first time couple comes in and "absolutely" refuses an episiotomy and the birth plan actually lists that they prefer to tear naturally (ouch!).....Try healing a third degree "natural" tear over a surgically precise ( in most cases) episiotomy which most times can be easily repaired. Somee of the rote birth plans we see demonstrate the lack of knowlege in the area, but we do try as best we can, to honor them. Labor is a scary time and no two are alike, but it is a myth that we labor and delivery people are out there to "get you" and foist our horrible interventions upon you. We just want to make it as positive and happy an experience for the family as we can....

palesarah · Feb 2, 2005

It always sort of amuses me when a first time couple comes in and "absolutely" refuses an episiotomy and the birth plan actually lists that they prefer to tear naturally (ouch!).....Try healing a third degree "natural" tear over a surgically precise ( in most cases) episiotomy which most times can be easily repaired. Somee of the rote birth plans we see demonstrate the lack of knowlege in the area, but we do try as best we can, to honor them. Labor is a scary time and no two are alike, but it is a myth that we labor and delivery people are out there to "get you" and foist our horrible interventions upon you. We just want to make it as positive and happy an experience for the family as we can....

actually, what amuses me is when the couple come in with a birth plan stating she'd prefer an episiotomy to tearing! I think that demostrates a lack of knowledge and education.

In most cases tears heal easier and with less pain, and are less likely to extend to a 3rd or 4th degree than an epis. The providers explain that and the fact that they will only cut an epis in case of fetal distress/emergency and the patients are good with it. We have very few episitomies and fewer yet 3rd and 4th degree tear/extensions.

Actually I wish they'd spend more

SmilingBluEyes · Feb 2, 2005

I'm learning so much from this board, thank you! I'm going into nursing school in June and I am interested in L&D. Forgive my ignorance.
I have read so many posts in here that talk about the interventions docs do during the labor. How much control do mom's and/or dad's really have during the labor?
For example:
Can mom's refuse to have an episiotomy?
Can mom's refuse to have their perinium stretched?
Can mom's refuse to give birth in the lithotomy position in stirrups?
If a mom wants to move around, will she be able to?
Do docs actually listen to mom and/or dad?
Or, should mom's who want any control just use a midwife?

Moms/families do have a measure of control! but----Ya know what, it's give and take in any situation. Moms always have the ultimate say in their care planning. They can refuse any intervention, and we must adhere to it. Sometimes, in extreme cases, an AMA form must be done to accomodate their wishes.

But I also caution them to remain open-minded as things can change on a dime. And many first- time parents have NO clue how the best laid plans can change while raising kids. Often, birth is the first of many lessons that teach them that.

I respect they want to control their situation, and that the hospital environment is very intimidating. It's not home and they are not comfortable at times. I do my very best to make the entire birthing family comfortable from the moment they step in the door, such as showing them around our unit, where they can get refreshements, public phones, etc. Help them get settled in the room comfortably, and set them at ease. Gaining trust with them is paramount.

Fortunately, the doctors do discuss their birth plans with them in advance, and make NO absolute promises, but don't dismiss them, either. Some things are negotiable, others not. If they want a total home birth experience, they are usually told the best place to go is a midwife run birth center. But most are happy with the care they receive with us. They are prepared and know what to expect, and we respect all their wishes, as much as possible. Meeting them in the middle is helpful!

Hope this helps. :)

BY THE WAY: none of the above things you mentioned as issues are a problem where I work. Moms can move about in labor, as long as they and their babies are fine. Moms can refuse episiotomies; these are NOT done routinely anyhow, by our doctors. They can refuse manipulation of any sort of their perineums. And barring epidural anesthesia, they can birth in any number of positions of their choosing. No reason why NOT, unless baby is in trouble! Does this help?

WhatToDo · Feb 2, 2005

Thank you fro your responses. I certainly understand that doctors and/or nurses often know what is best for mom and baby, especially in distress, and sometimes plans must change at the last second.

I hope I can work somewhere liek SmilingBlueEyes. I've seen and read to many horror stories about mom's not getting a lot of choice. I'm sure mostof you are aware of the classic debates about how much medical intervention is necessary during birth, i.e. midwives v. doctors.

Some of you brought up legal consent issues with this. My question is, do you think people actually understand what they are consenting too? Most of the time those consent forms are written in legalease or highly technical langauge that most people do not understand.

Zhlake · Feb 2, 2005

It always sort of amuses me when a first time couple comes in and "absolutely" refuses an episiotomy and the birth plan actually lists that they prefer to tear naturally (ouch!)

20 years of research has demonstrated that tearing naturally reduces perineal trauma, pain, discomfort, sexual dysfuntion and urinary/stool incontince postpartum.

I "absolutely" refused an episiotomy unless it was needed for fetal distress.

asher315 · Feb 2, 2005

Where I work now, the docs have the control. Maybe it's because some of our pts aren't educated about everything, mostly it's the docs tell them or don't tell them until after it's done. For example, we do alot of inductions of labor, the pt comes in and says "Im having my baby today" doesn't know squat. An IV is started, then pit, then the doc showes up and checks the pt AND ruptures membranes. We are comitted then, ripe cervix or not. The pt can't get up to help with pain or labor. If I told you our c/section rate you would be outraged.

The nurses do as much as possible to be pt's advocate but you can only do so much. I don't do L&d anymore, I'm the baby nurse. The peds are professional, very good and nurse friendly. :)

Mermaid4 · Feb 3, 2005

I really thing there is too much "education" going on for laboring moms....In any other area of medicine, people are allowed to voice their choices without some well intentioned medical person thinking they are either uninformed or uneducated. There are many more rectal fistulas with tears and I have to say I prefer intact perineums and no episiotomies, but as a person who has been personally through just about every OB experience one person can have, if I say I want an episiotomy because of what I have been through and seen over two decades of nursing, it does not mean I am either uninformed or uneducated. It simply means I know what I want, and to assume otherwise is a great dis service to most patients that present to labor and delivery. We can spout statistics until we are blue in the face but rarely are research poles unbiased in some fashion. If you agree with something you can find a report to back yourself up, but out in the trenches, that is not always the case. We have a follow up clinic so we see those patients post severe tears vs episiotomies and the healthier healing is by far, the episiotomy crowd. That may have to do with hygiene and many other factors, but in my experience and despite the research quoted here, episiotomis win ( and we probably do only 15 a year in a population of 700 or so births in that time so I am not advocating them at all). If you have ever seen or ever had a rectal fistual and seen the pain and suffering involved, you just might jump back to the real world and not the statistics. I am for natural as delivery as possible and in the case of first or second degree tears which do or don't require repair, that is one thing, but the more severe, or tears "naturally" down to the rectum, are another thing.

Mermaid4 · Feb 3, 2005

We have a lovely natural labor and delivery environment with hot tubs, massages, non interventive therapy as long as mom and baby are ok and I love it. But there are unfortunately those times when we have to do things none of us wish we had to.....