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?
Ideally, when women step into the hospital shouldn't they feel assured that they're in a safe place and that the staff will only do things that are for their benefit? Isn't that what you want women to believe? Then when a woman does trust the staff and complies with the unnecessary interventions, (and don't nurses want compliant patients?) you say, oh well, shoulda educated yourself beforehand.
Even if a woman is educated and knows that the interventions are not helping her labor, she just may not have the energy to fight the system while in labor. She's coming to deliver that baby; not to start a revolution! I've heard from women whose birth plans were ignored once in the hospital; who had to spend their labor repeatedly fending off the IV's, the fetal monitors, the amniotomy, etc. What a waste of energy during labor when all your resources should be directed inward, to your own body! What if a woman is by nature not very assertive; during labor, when she's at her most vulnerable point, she's suddenly supposed to start becoming assertive?
I've seen nurses on this forum complain about patients who come in with a chip on their shoulder, who resist the nurses, who are suspicious of every needle. Maybe this is because they've had their trust abused; they came in believing that they were going to be cared for and found out that they have to check the warning label on every procedure themselves, and in many cases the benefits don't outweigh the drawbacks.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Ah yes-----Always more than one perspective you know?
See for all the "bad nurse" stories you do hear, how many "good" ones do you? Few, probably. Bad news makes for more interesting and frequent conversation. I am not saying bad things don't happen--they do---- but give us "some" credit.
See, you have places where we do try very hard to make our patients happy and respect their birth plans as much as safety, medical conditions and policies allow us. We are constrained somewhat, too, remember.
And Chaya you are right; the time in the hospital is NOT the time for a revolution. This revolution is something to be fought at another time and place, certainly. But some of the onus MUST remain with the individual consumer, you know?
Choosing one's care provide long prior to childbirth--- CAREFULLY ----is of some benefit. And there are always homebirth or midwife-run birth center possibilities for those very much-opposed to hospital policies and procedures. We nurses are HELD to these ourselves are employees. We have little wiggle room and if we violate them (policies) and a bad outcome occurs, have no leg to stand on. Therein lies a huge predicament for all concerned, if you can understand.
I have to say, the majority of nurses I work with and know try to respect our patients' requests and birth plans as much as possible, but we can't get away from what we are held to as policy. It's not as if we are going to get in writing from the patient that if a bad outcome occurs as a result of her insistance in doing something that is unsafe or violates policy, that she won't sue. And even if we could, it would never hold up in a court of law.
I do have to say, it would behoove the consumer (yes, patients are consumers)--- to investigate FIRST what the hospital environment is like BEFORE she decides to have her baby there----or chooses a dr affiliated with it. And to find out how flexible her care provider and the hospital is before she is in labor, invaluable. And it would help to know if her birth plan will hold up and be respected there or not-----she can get a clue to this often by presenting it to her health care provider early-on in pregnancy. If she feels badly (or gets negative "vibes") about it, she always has the right to seek alternative options early-on.
Yes, this takes some legwork and initiative on the part of the patient/consumer, but it's well worth it, IMO.
But some of us do show up educated, planning on a mostly natural birth experience and then find that the pain is SO MUCH MORE than we could have ever bargained for. I intended to be up and walking, I had a ball at my disposal, I had taken prepared childbirth classes and even had an open mind about not having an epidural - BUT, when I arrived at the hospital after laboring at home for several hours in severe pain, all I could do was beg for pain relief. Flat on my back? Whatever, just stop the pain. Imagine how devestating it was to learn that all my efforts at home had only earned me 2cm dilation.
I do agree that hospitals can be more mother friendly and encourage more options. In my rotation, I saw plenty of people who wanted to ambulate being told "no" simply because nurses didn't want to deal with unhooking and then rehooking the monitors, and that's clearly not supportive or helpful.
I firmly believe that the birthing experience should be what the mother wants - if that's drugs, great. If it's Bradley, great. It's far too personal and monumental in someone's life to not support choices when safe and reasonable.
And just to share a great nurse story real quick - the same nurse helped me deliver both of my babies. With my first child, she worked her butt off with me for her entire shift. I never forgot how special she was and she's the main reason I decided to go to nursing school. Imagine how wonderful it was to walk in 4 years later to deliver my daughter and have the same nurse! She even remembered us - I guess I was that bad! :uhoh21:
Ah yes-----Always more than one perspective you know?
See for all the "bad nurse" stories you do hear, how many "good" ones do you? Few, probably. Bad news makes for more interesting and frequent conversation. I am not saying bad things don't happen--they do---- but give us "some" credit.
See, you have places where we do try very hard to make our patients happy and respect their birth plans as much as safety, medical conditions and policies allow us. We are constrained somewhat, too, remember.
And Chaya you are right; the time in the hospital is NOT the time for a revolution. This revolution is something to be fought at another time and place, certainly. But some of the onus MUST remain with the individual consumer, you know?
Choosing one's care provide long prior to childbirth--- CAREFULLY ----is of some benefit. And there are always homebirth or midwife-run birth center possibilities for those very much-opposed to hospital policies and procedures. We nurses are HELD to these ourselves are employees. We have little wiggle room and if we violate them (policies) and a bad outcome occurs, have no leg to stand on. Therein lies a huge predicament for all concerned, if you can understand.
I have to say, the majority of nurses I work with and know try to respect our patients' requests and birth plans as much as possible, but we can't get away from what we are held to as policy. It's not as if we are going to get in writing from the patient that if a bad outcome occurs as a result of her insistance in doing something that is unsafe or violates policy, that she won't sue. And even if we could, it would never hold up in a court of law.
I do have to say, it would behoove the consumer (yes, patients are consumers)--- to investigate FIRST what the hospital environment is like BEFORE she decides to have her baby there----or chooses a dr affiliated with it. And to find out how flexible her care provider and the hospital is before she is in labor, invaluable. And it would help to know if her birth plan will hold up and be respected there or not-----she can get a clue to this often by presenting it to her health care provider early-on in pregnancy. If she feels badly (or gets negative "vibes") about it, she always has the right to seek alternative options early-on.
Yes, this takes some legwork and initiative on the part of the patient/consumer, but it's well worth it, IMO.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Thanks, Camay.
One more thought occurs to me. If you look at a history of American Birthing Practices in the USA hospitals and compare to say, just 35-40 years ago, you would see, a revolution of sorts, has already occured.
For example: We have a come a VERY long way from the cigar/cigarette-smoking, pushy, and often aloof OB's of the 1950s-1960s, doping women out on drugs or ether (which is what happened to my mom as late as 1973!!!!) and yanking kids out with high forceps, all while the expectant dads had to wait/sweat it out in a crowded "waiting room" with other nervous dads, hearing nothing til the baby was born. Birth plans? None except get to the hospital on time and let the OB "take care of things".
Also: We have come a long way from warehousing these precious newborns in huge nurseries and allowing parents to see them only "hospital schedules". or through the windows, let alone have time to really bond or learn to breastfeed them.
And visitation policies? Ha! No one but the dad and perhaps grandparents, usually, and only for 30 min to an hour per day. Forget about siblings (unless over 14) and other loved ones. And dads certainly NEVER spent the night w/their loved ones and babies in the LDRP room, because no such accomodations even existed.....and moms often stayed in the hospital a better part of a week for lady partsl deliveries, a week spent forced to care for themselves and newborns on hospital-enforced schedules. Not exactly optimal.
KWIM? Talk to Grandma or an aunt who had a baby in a hospital back then and ask what she remembers (if anything) of the experience. My mom can't remember anything about the births (except the ether mask over her face and being put to "sleep") ---and all she does clearly remember is being scolded by a nurse for feeding her babies "off schedule".
Things can certainly improve; I won't lie. But to get a different perspective, we might want to look into the past a bit.....I think we have come a LONG LONG way. Both to the good and not so good. Litigation and insurance are not helping our cause to try and be patient and baby friendly, as much as we would like. As much as we want to please our patients, we are held to pleasing our Risk Managers just as well.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
:yelclap: :yelclap: :yelclap:
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.
Excellent points, Eliza. Sounds to me, you will do fine just being yourself. No need to be like me!
But some of us do show up educated, planning on a mostly natural birth experience and then find that the pain is SO MUCH MORE than we could have ever bargained for. I intended to be up and walking, I had a ball at my disposal, I had taken prepared childbirth classes and even had an open mind about not having an epidural - BUT, when I arrived at the hospital after laboring at home for several hours in severe pain, all I could do was beg for pain relief. Flat on my back? Whatever, just stop the pain. Imagine how devestating it was to learn that all my efforts at home had only earned me 2cm dilation.
I do agree that hospitals can be more mother friendly and encourage more options. In my rotation, I saw plenty of people who wanted to ambulate being told "no" simply because nurses didn't want to deal with unhooking and then rehooking the monitors, and that's clearly not supportive or helpful.
I firmly believe that the birthing experience should be what the mother wants - if that's drugs, great. If it's Bradley, great. It's far too personal and monumental in someone's life to not support choices when safe and reasonable.
And just to share a great nurse story real quick - the same nurse helped me deliver both of my babies. With my first child, she worked her butt off with me for her entire shift. I never forgot how special she was and she's the main reason I decided to go to nursing school. Imagine how wonderful it was to walk in 4 years later to deliver my daughter and have the same nurse! She even remembered us - I guess I was that bad! :uhoh21:
Amanda
And just think how great you will feel someday when you are able to "pay it forward" into another future nurse's life. Like passing a torch.
Birthing is one of my favorite subjects. I had my first son at a hospital delivered by a CNM. I had my second son at home with a Midwife. I'm in California. I also have a great nurse story...with my first son I didn't like the first nurse who was assigned to me (she was just impersonable and rough) so we asked for another nurse. I got a wonderful caring woman who respected my wishes. I had a doula as well and I was very prepared going in. After 24 hours of prodromal labor I went in to the hospital with contractions 3 mins apart and was only at 3. 5 hours later, at 4. I consented to them breaking my water knowing full well that the pain would get worse. After using the birth ball, the toilet, the shower, walking the halls, and 8 hours of HARD labor, I gave in and had the epidural. They never hooked up the pump though, no time, because I then started saying I had to have a BM, was checked and was complete. My feet were put in stirrups but the HOB was about 45 deg and then I was helped to (almost) 90 deg for pushing. I KNEW not to be in lithotomy. Anyway, the reason why I'm telling my experience this way is because I was INFORMED. I did my research, I read the books, I took the classes and hired a doula. I made decisions knowing the consequences of them. I really believe that too many women hear horror stories from their friends and TV and make decisions based on that. They feel one twinge of pain and freak out because they keep thinking "I can't take anything worse than that so I might as well not wait until it gets that bad." When, really, they DON'T know how much they can take until they get there, KWIM?
After my first son's birth, I was empowered and went on to doula training and lactation education. I didn't like the hospital stay, being awoken every 4 hours, waking the baby when he was just fine with me, etc, so I decided to have my second son at home. What a wonderful experience that I will never forget. Now I'm in my first semester of nursing school with a goal of becoming an L&D nurse, but I have an open mind as to what will be my "calling" as a nurse. Oh, and to finish my great nurse story...I had preterm labor with my second son and was sent by my midwife to the hospital. I ran into both the CNM and the nurse that helped me out. I thanked her and she told me that she was going to school to become a CNM!! Yeah!! About a year later I ran into her again at my job at the time (a 'breastfeeding' store) and she was now a CNM and pregnant. I got to help her that time. I'll never forget her because she was so willing to work with me and help me out.
PS - Isn't it our job as nurses to educate our patients? Informed consent and all that? That's what they keep drilling into us at school. Thoughts?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
What a GREAT post eandgsma!!!!! I am so happy you chose the path that was best for you and so should others. Ty for sharing.
As far as informed consent, that is the duty of the dr/midwife, esp when it comes to benefits versus risk. That is NOT a nursing function at all, even though many think it is. We can educate and we do, but as far as helping a patient reach a decision and securing informed consent, that is the job of her primary health care provider, not her labor and delivery nurse. We just witness signatures. If the patient has doubts or is at unclear about what she is signing for, or refuses, then it becomes an issue for her doctor/midwife to take care of.
Again a lot of this sort of education should ideally take place before a patient is admitted to the hospital in active labor. And this is where I feel midwives, esp, do very well!!! From our perspective as nurses: It's hard to educate anyone and informed consent is a shaky thing, when a person is under duress or extreme pain.
Again, TY so much for sharing. Welcome to the forum.
As far as informed consent, that is the duty of the dr/midwife, esp when it comes to benefits versus risk. That is NOT a nursing function at all, even though many think it is. We can educate and we do, but as far as helping a patient reach a decision and securing informed consent, that is the job of her primary health care provider, not her labor and delivery nurse. We just witness signatures. If the patient has doubts or is at unclear about what she is signing for, or refuses, then it becomes an issue for her doctor/midwife to take care of.
Again a lot of this sort of education should ideally take place before a patient is admitted to the hospital in active labor. And this is where I feel midwives, esp, do very well!!! From our perspective as nurses: It's hard to educate anyone and informed consent is a shaky thing, when a person is under duress or extreme pain.
Ah, I see the difference now. I kind of threw in that informed consent part because of my own personal experience, not what they said in school. I should have clarified that. I do agree that it would be difficult to educate someone while in the midst of labor I guess my point is that it should be emphasized more to expectant parents the need for educating themselves on this experience. I know we can't MAKE them do anything, that's for sure.
I guess my point is that it should be emphasized more to expectant parents the need for educating themselves on this experience. I know we can't MAKE them do anything, that's for sure.
JeanettePNP, MSN, RN, NP
1 Article; 1,863 Posts
Ideally, when women step into the hospital shouldn't they feel assured that they're in a safe place and that the staff will only do things that are for their benefit? Isn't that what you want women to believe? Then when a woman does trust the staff and complies with the unnecessary interventions, (and don't nurses want compliant patients?) you say, oh well, shoulda educated yourself beforehand.
Even if a woman is educated and knows that the interventions are not helping her labor, she just may not have the energy to fight the system while in labor. She's coming to deliver that baby; not to start a revolution! I've heard from women whose birth plans were ignored once in the hospital; who had to spend their labor repeatedly fending off the IV's, the fetal monitors, the amniotomy, etc. What a waste of energy during labor when all your resources should be directed inward, to your own body! What if a woman is by nature not very assertive; during labor, when she's at her most vulnerable point, she's suddenly supposed to start becoming assertive?
I've seen nurses on this forum complain about patients who come in with a chip on their shoulder, who resist the nurses, who are suspicious of every needle. Maybe this is because they've had their trust abused; they came in believing that they were going to be cared for and found out that they have to check the warning label on every procedure themselves, and in many cases the benefits don't outweigh the drawbacks.