L&D nurses: Advice please!

Kgusty30 · May 19, 2011

I am not a L+D nurse, but I spoke to one at work who was visiting her relative who happened to be assigned to me one night. She offered me some good advice. I am due in July and this baby is my 2nd. My plan for my first was to go "as far as I could with no meds", but I caved and got the epidural approx. 11 hrs into labor only 3 cm dilated.....my water did break at home before I got to the hospital, and my belief is that once I got into the hosp bed, I was hooked up to the fhr monitor and could not get out of bed (for whatever reason I don't know why or can't remember) and that really was detrimental to having a drug free delivery because I couldn't move through the pain or manage it on my own...this time, I plan on being very specific with the nurse that I would like the freedom to walk, use the shower and/or other techniques that will aid me in achieving a natural delivery (this was the advice that the L+D nurse told me). I think that the nurse is the person who you need to communicate with the most....good luck!!!!

wannaB RN · May 19, 2011

I'm not a nurse, yet but I've had three kids all natural. It's doable. If you want a natural birth, then stick that in you mind and let nothing else filtrate it. In my experience, I have never had a nurse try to change my mind. My nurses asked me regularly if I was ok and if I thought about pain meds but that's as far as that went. I had midwifes, so of course they were ok with it. I loved the fact that I had all of my kids natural. Afterwards, you feel amazing in the fact that you were strong enough to go through it, it's very rewarding.

I would just be honest with the nurse and tell her/him exactly what you want to achieve in your birth. As long as you have a supportive husband and/or friend/family member that's all you will need. Although, I'm sure it will help to have a supportive nurse but chances are you are not the only one, that the nurse has seen, requesting a natural birth.

As for a birth plan, in my humble opinion, I wouldn't do it. I think birth plans just set a women up for disappointment. How can you really plan for something that is un-plannable. What happens is a woman plans for to have this great birth, then at the very end needs a c-section (not saying this will happen to you but I've seen it happen and the women so upset because it didn't follow her birth plan)

Best wishes and Good luck!!

Elvish, BSN, DNP, RN, NP · May 19, 2011

'Tis the season for babies, it seems! This is the second or third similar thread this week. I'm 38 weeks with #2 myself so I'm with you. Very impatiently awaiting labor. :)

If you have something specific that you want for your birth (say, you want to give your baby his first bath), that's a pretty good thing to have in a birth plan. Other stuff - about Hepatitis B or circumcision, you will have to sign a consent for anyway, so unless you just want to, putting it in there might be superfluous (but it is always up to you).

Other than that, flexibility on things will go a long way. Birth plans per se are alright; it's the inflexible ones (no [insert intervention here] under any circumstances) that go on for three and four pages that tend to go badly. The best birth/postpartum experiences I've seen, the ones where everything goes right, are the ones that the mom recognizes that things might change but 'this is what I'd like if all is going well'.

You might want to talk to your doctors about some of your preferences too. I don't work at the hospital where I'll deliver, so there was a lot I didn't know about how they work. I didn't know that my primary OB would be willing to write me an order for clear liquids in labor - until I asked. I also didn't know they're okay with catching babies while mom's pushing on all fours or in other nontraditional (for a hospital, anyway) positions. Some of those things, if you can clear them with the docs ahead of time, will save you having to put them in a birth plan. And they'll help relieve some anxiety on your part, which is always a good thing.

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Make sure your labor support knows what you want so they can advocate for and encourage you. If you get a supportive nurse (I really hope you do, and most are) listen to her when she tries to help. She's seen this before and knows what she's doing.

Right now I'm reading 'Childbirth Without Fear' by Grantly Dick-Read. It was written many years ago, but so much theory is still applicable. It has helped me tremendously to remember that my body knows what to do. Yours does too, so trust it! :) Best wishes to you on your new arrival.

MandaRN94 · May 19, 2011

The hospital I worked L&D in was VERY conservative -and the OBs were very old school. It's really not the nurse you need to talk to it's your OB or midwife about your plans BEFORE you go into labor. Some OBs have standing orders -IV, cont fetal monitoring, NPO, etc... as soon as you're admitted and I remember some of our pts refusing to comply as they had their own "plan". The OBs flip out when pts refuse their orders and it can be a horrible battle/experience for all. I do not recommend birth plans in writing as we used to joke that they always jinxed the pt- they tended to end up with a crash section with every invasive monitoring out there. So my advice -talk in depth about your wishes way before you're in labor and be flexible. You may start out wanting a natural birth but there's no reason not to change that if you need pain med. There's no gold medals rewarded at the end -the goal is always a healthy mom and baby.

caskew7 · May 19, 2011

In my personal experience, I've found that every woman that I've known who desired a "natural" birth winded up getting a C-section because of complications such as the baby going into distress, excessively long labor, or no cervix dilation, etc. To each his own of course but, I don't believe that attempting to "tough" it out through the birthing process (which can be more or less painful for each and every individual) makes you any more woman than someone who opted for an epidural or pain meds.

To me it seems that women purposefully chose to do this "all natural" process just so that they can have some sort of bragging rights, and I don't mean to offend anyone but still....I just feel like in this day and time it's unnecessary to suffer as if we were back in the fields birthing our babies.

MrsEd · May 19, 2011

The hospital I worked L&D in was VERY conservative -and the OBs were very old school. It's really not the nurse you need to talk to it's your OB or midwife about your plans BEFORE you go into labor. Some OBs have standing orders -IV, cont fetal monitoring, NPO, etc... as soon as you're admitted and I remember some of our pts refusing to comply as they had their own "plan". The OBs flip out when pts refuse their orders and it can be a horrible battle/experience for all. I do not recommend birth plans in writing as we used to joke that they always jinxed the pt- they tended to end up with a crash section with every invasive monitoring out there. So my advice -talk in depth about your wishes way before you're in labor and be flexible. You may start out wanting a natural birth but there's no reason not to change that if you need pain med. There's no gold medals rewarded at the end -the goal is always a healthy mom and baby.

I personally really appreciate it when my patients have a birth plan b/c it gives me the opportunity to sit down with them and discuss their expectations. While we have standing orders for bedrest with bathroom priveledges, continuous monitoring, and continuous IV fluids, our doctors are more than willing to allow intermittent monitoring with ambulation privileges and a heplock as long as there are no contraindications for such. I think communication is key, and you don't make your wishes known then it's easy for the nurses to carry on with what's routine.

I've had patients get to 10 cm and then beg me for their epidural, but because they were very clear with me from the beginning about their wishes and expectations I was able to be their advocate and support their desire for a drug-free delivery. I've never told a mom, "no you can't have your epidural now", but being armed with the knowledge that under no circumstance did she want an epidural regardless of what she said when she thought the pain was too unbearable, I felt confident in my ability to support mom through her delivery unmedicated knowing that it was what she truly wanted. There are some patients however that will have a code word that they let us know in advance and if they use the code we know they really want an epidural. But if you tell your nurse up front you do not want an epidural nor any other pain medication and to please not mention it again and you will let them know if you need something, most nurses will respect that.

It's also really important to surround yourself with support during labor and to be flexible. It never fails that the mom with the rigid birth plan with no flexibility inevitably ends up delivering in the OR. Best of luck to you.

zbb13 · May 19, 2011

I'm not a nurse, yet, but I have a bunch of kids. I had some of the kids naturally, and some with epidurals, and one with an induction and no epidural. You need an advocate who can really stand up for you. I once came in to L&D adamant that I didn't want an epidural. I needed to be induced due to bleeding, and although they thought I was a crazy person (the contractions are stronger with the induction), they allowed me to do this sans epidural. It all would have been a lot easier if my husband had been able to stand up for me (he is uncomfortable with medical procedures and in hospitals in general).

It was harder when the doctor came in and demanded something I didn't want. That was the toughest. I didn't want my water broken with one of my later babies (my experience was that it made my contractions slow down or stop), and he insisted. He came in at 11:30 p.m. and he was already in a mood. I didn't want to hurt the relationship with the guy who was about to deliver me, so I gave in. They broke my water, and my labor stopped. I needed pitocin. One of the nurses commented that I had been right all along, but she did this when the doctor was outside somewhere. I didn't go back to him for my next birth.

Every labor is different, so it does require flexibility on your part. I never saw the point in birth plans, I just let them know what I preferred when I arrived on the L&D floor. I said it as respectfully as possible. Most were helpful. Some became cold and critical. I wish I had taken an assertive person who knew my wishes 100% and could have stood firm with and for me.

I hope you have an easy birth, the one you are dreaming of, and a healthy baby.

anurseatlast · May 20, 2011

I have taught breastfeeding/childbirth classes for many years and I DO encourage moms to make birth plans(regardless of whether they want an epidural, water birth, ....) for several reasons:

It encourages the moms to think about what is important to them (not what their sister, mom, friend, or whoever else is telling how she "should" do it). Many first time moms don't really even know what to consider. Doing some research helps her to realize what some of her options are. (I have met many women who say, "I wish I had known that I could ask to get up and walk around. I hated being in bed, etc......")
The moms then need to discuss it with their CNM/MD so that both are clear on the expectations. It allows time for discussion and compromise if needed. It also comes in handy if the CNM/MD is not the one to catch the baby. The on-call person will know what the mom wants (Once you are past early labor, you are not usually in the mood for long discussions)
It makes it easier for the support people who don't have to stress about remembering the three things they are suppose to remember to tell the staff.
It helps the nurses to know what the mom's desires are. L&D nurses usually want to help the mom have a good birth experience. Instead of guessing what she wants, it is written down. This is especially helpful if the mom comes in late in labor.
Moms do not feel compelled to have long discussions when they really want to focus on what they are doing and coping with labor.
A well-written birth plan has a plan B for things like a C-section. This helps mom to realize that things may not go the way she wants but that she can still have a good birth experience. A friend of mine was determined to have a VBAC with baby #4 and even changed docs/hospitals. I encouraged her to include a c-section in her birth plan. At first, she didn't even want to think about it - she was determined to have a vag birth. Due to problems at 39 weeks, she had to have a c-section. In spite of that, she had her best birth experience because she had thought through and discussed with her doc what she had not liked in her previous c-sections and what would make it better for her if she had one again.

There can be drawbacks to birth plans:

When they are extremely detailed ("I want to deliver with the rising sun shining on the baby's face as she is born"), it really does seem that it will be a complicated birth. Probably stats would not bear that out but if you ask a L&D nurse, she will tell you it seems to happen that way. No one wants to read a 12 page birth plan - make it short and sweet.
When moms think they will get whatever they ask for, it is a problem. Birth is unpredictable so be open to the fact that labor may (and probably will) throw you a few curves. Try to be flexible. Instead of saying, "I will never____________, " say something like, "I would prefer to avoid ___________ in an uncomplicated birth. If the need for ______ arises, I would like to have it explained if time allows." In an emergency, you have to trust your CNM/MD to do what is in the best interest of you and your baby.
If the mom does not discuss it with her care provider, it can be a disaster. It is not worth the paper it is written on if not discussed before labor. I suggest moms take 2 copies to a prenatal visit for discussion and then have the provider sign them: one goes in the chart, the other in the hospital bag just in case.

As far as having a "natural birth" goes, it helps to discuss it with women who will support you in that. Having people say things like, "Just wait until the pains hit; you'll change your mind," is not helpful. Many women find it helpful to have a couple of support people but be sure they are people you are comfortable with, who are willing to focus on YOU during labor (not talking on the phone, having a party) and who will remind you of your goals when you want to give up. Learn as much as you can about non-medical pain control (and your support people too). Having cheatsheets for support people can help when they are tired or stressed and are out of ideas. The nurses can help with ideas too. As you get to the end of your pregnancy, think positively about your ability to give birth. Women have done it since the beginning of time. Congrats on your little one!

wannaB RN · May 20, 2011

To me it seems that women purposefully chose to do this "all natural" process just so that they can have some sort of bragging rights, and I don't mean to offend anyone but still....I just feel like in this day and time it's unnecessary to suffer as if we were back in the fields birthing our babies.

Bragging rights? umm no! I do not like med's and refuse to get any kind of needle in my back/spine. I don't even take meds for a headache let alone let someone put something in my spine. I rather tough it out. I had very mild labor's (5 hrs being the longest, 3hrs being the shortest so I never experience a prolonged labor which most women do) I believe it's very rewarding for those who choose to do it, it's not for everyone. It is very painful and intense, so don't down grade a womens choose because you don't agree with it.

ocmama · May 20, 2011

I had my first while in nursing school too! :heartbeat

It hurts, but feeling everything that is happening is amazing if you just go with it. Things that I learned after delivering 3 big babies naturally:

1. Gravity is your friend so stay on your feet if possible (or sitting on a toilet is good too)

2. Tell yourself to relax and open up when you feel like clenching up

3. Having someone firmly massage your lower back/pelvis during contractions really helps (and I thought I never wanted anyone to lay a hand on me during labor)

I think attitude effects a lot so if you go into the hospital and just plan on having your baby you will do just that. Should anything unexpected come up that is why you are in a hospital. Stay strong mama and you will get through it.

As a side note I don't think that it has anything to do with "bragging rights" as someone stated earlier. It is simply a birth choice just like getting an epidural is a birth choice.

tablefor9, RN · May 20, 2011

In my personal experience, I've found that every woman that I've known who desired a "natural" birth winded up getting a C-section because of complications such as the baby going into distress, excessively long labor, or no cervix dilation, etc. To each his own of course but, I don't believe that attempting to "tough" it out through the birthing process (which can be more or less painful for each and every individual) makes you any more woman than someone who opted for an epidural or pain meds.
To me it seems that women purposefully chose to do this "all natural" process just so that they can have some sort of bragging rights, and I don't mean to offend anyone but still....I just feel like in this day and time it's unnecessary to suffer as if we were back in the fields birthing our babies.

Really? Exactly how many women would that be?

Coming across pretty condescending here. If you don't feel it's necessary to suffer, then by all means, please don't. There are good reasons not to have epidurals or IV pain meds. I'm sure you know where google scholar, EBSCOhost and CINAHL are if you want to dig out the research, please don't belittle the women that might have done that.