Hello lovely nurses. I'm confused about something going on in my OB clinicals, and since I'm not a nurse yet, I wanted input from some L&D vets. I've done a LOT of reading over the years about childbirth bc I'm still on the fence about becoming a CNM, and there has always been a common thread: that the lithotomy position is the WORST, most UNNATURAL, DANGEROUS position for childbirth and is done only for the convenience of the practitioner. Actually that might be a direct quote from Our Bodies, Ourselves. Anyway, the hospital where I'm doing my clinicals does EVERY lady partsl birth in lithotomy, with stirrups, no options, no arguments. It also has a 40% C-section rate. I understand that I might be biased, coming from Berkeley CA, where my mom had both my brother and I on all fours in an Alternative Birth Center and went home within 8 hours. But still...lithotomy? Seriously?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
And, one more thought here:
I respect your desire for women/couples to make informed and careful decisions regarding their birth experiences. But I must caution you: I do not think it is your job to inform women of the risks regarding epidural use. If they are considering using anesthesia, they should ask their OB or MDA about the potential for complications in its use. Yes, that should be reserved for their care providers, as they know their histories more intimately and it is their role to do so, legally. This is for the dr/midwife, not lay people,doulas or nurses, to do. This is simply not our role.
Yes, it's relatively RARE to have complications linked to epidural use, but they are out there.
OK, thanks, this is what I meant. It's relatively rare to have homebirth complications as well, even though it can happen. I loved my homebirths and would never exchange them for a medicated hospital birth, but if someone prefers to be numb for most of labor I can't say that's not a valid choice, for them.
I respect your desire for women/couples to make informed and careful decisions regarding their birth experiences. But I must caution you: I do not think it is your job to inform women of the risks regarding epidural use. If they are considering using anesthesia, they should ask their OB or MDA about the potential for complications in its use. Yes, that should be reserved for their care providers, as they know their histories more intimately and it is their role to do so, legally. This is for the dr/midwife, not lay people,doulas or nurses, to do. This is simply not our role.
Oh, absolutely. I'm not a birth educator and as I said, I'm not particularly militant either. I'm actually the one who is usually on the defensive anyway! I just wanted to separate the hype from the substance.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think it comes down to educating our patients more. ( really, for many intents and purposes, they are the "consumer" more than patient in today's healthcare environment) It also would be nice if everyone did not want a fast, easy, trouble-free and rather convenient labor/delivery that is absolutely painless. Where they get the idea this can be promised, I do not know. It does not come from ME. However, YES--- that is what many expect.
These are often the same folks who think they can send their newborn to the nursery for us to watch all night long, not to be disturbed, because they need their sleep---- yet we are not to dare feed the baby anything but breastmilk (so what, let the newborn starve til Mom is ready to get up??????)
These would also be the same ladies who park it in the OB dr offices, crying and carrying on and begging for an induction because at 36, 37 weeks, they simply can't take being pregnant anymore!
-----it's self-centeredness and often ignorance at play here. And yes, we do deal with it best we can.
These folks present 1 or 2 cm (really in more prodromal labor than anything else) and think they want their epidural NOW. This sort of thing certainly does not help their (or our) cause to avoid the increased risk of more interventions such as vacuum/forceps-assisted delivery or csection. It can be a vicious cycle that perpetuates itself into a spiral that starts with epidurals being done way too soon and (perhaps) too often. Ours (as nurses) always seems to be to remember: "the customer is always right"----and we have to deliver on the (assumed) promise of a comfortable and relatively complication-free delivery.
Somewhere, we should be able to meet in the middle. Most times, we can. Others, with obstinate patients and doctors, this is very difficult, if not impossible.
This is a delicate balance. Push Mother Nature too far, and she will definately do some pushing back. If there is anything I have learned in 9 years' OB nursing, it is this simple tenet. And yes, this has hit a nerve in me, so forgive my indulgence of your patience here. Venting can be a good thing sometimes. And I do love my job, 99% of the time!
Anyhow bottom line: is sub-optimal positioning used to help moms birth their babies? Yes, but they also have a role to play to avoid unncessary and unwanted interventions. And we "medical types" need to be open to educating them---but also, to listening to what they have to say.
Deb, I want to be just like you when I grow up. I'm already a sassy redhead (sort of) so I've got that going for me...
Seriously, though, I do wish more women were aware of and advocates for a positive birth experience. I'm not talking mad Bradley birthplan folks (of which my mom was one, so I can say that), and I'm not talking "I refuse to have a C/S even though my baby's in severe distress", but just knowing enough about labor and their bodies to know that they will have some pain, and that lying flat on your back is stupid. Maybe we should start giving out the relevant chapters of Our Bodies, Ourselves at the first prenatal visit. When enough women refuse to have stupid protocols enacted on them because it's easier for the doctor or exposes the hospital to less liability, we'll all be better off.
Oh, and translators. We need more of those. My clinicals are at a hospital with a majority non-English speaking population (Spanish and Russian being the most popular) and translators are scarce. We've seen some really crappy things happen because the patients and the nurses/doctors can't communicate.
Just want to warn you, not all of California is mom/baby friendly... I'm not having that experience in my clinicals, though a couple of the hospitals around here have different practices. Best of luck in finding a unit you want to work in (and wish me luck, too!).
I agree 100% with SBE. I'm in CA. Where I work, the typical patient wants her entire stay to be pain free. This is an EXPECTATION. They are beside themselves that there is ANY discomfort when ambulating post C/S. They want their epidurals upon admission. Lithotomy is pretty standard here.
I don't have much of a soap box to stand on though. I got my epidurals early with both of my deliveries, delivered in lithotomy, one MLE, one 2nd deg lac. No desire to get crunchy. I was 100% satisfied with my experience. I'm a typical patient, too :)
You have to look at your patient population. Most of the women who came to deliver at my hospital could have chosen to deliver at a more alternative birth center. Many women have no desire to consider alternative birth practices.
In my experience, women who are informed of the benefits of so-called "alternative birth practices" usually consider them favorably. I'm not talking about waterbirth or no analgesia, but different labor positions, birth balls, no IV, etc. So many women don't realize there are other options, because all they've seen and heard about is the lithotomy position.
Even if they have heard that it's not great for laboring women to lie on their backs, once they get to the hospital and the nurse helps them into lithotomy, they don't know that they can speak up.
I agree with you, ABCs aren't for every woman. But I still think we ought to follow the research when it comes to our hospitals, even if it isn't "traditional" practice.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think this responsiblity is shared between patient and medical care providers. People need to take responsibility for their outcomes, at least in part, as well.
I just wanted to separate the hype from the substance.
SmilingBluEyes
20,964 Posts
And, one more thought here:
I respect your desire for women/couples to make informed and careful decisions regarding their birth experiences. But I must caution you: I do not think it is your job to inform women of the risks regarding epidural use. If they are considering using anesthesia, they should ask their OB or MDA about the potential for complications in its use. Yes, that should be reserved for their care providers, as they know their histories more intimately and it is their role to do so, legally. This is for the dr/midwife, not lay people,doulas or nurses, to do. This is simply not our role.