Natural Childbirth and L/D nurse-do they mix?

SmilingBluEyes · May 30, 2004

How about shadowing some L and D nurses in varying settings (e.g. larger versus small hospitals, free-standing birth centers, etc. ) to see if you would be able to do this? I think that would be a good "snapshot" of what you can expect as an L and D nurse. Also, reading the archived threads here in the OB area would possibly be helpful.

Best wishes to you!

Blackfish · May 30, 2004

How about shadowing some L and D nurses in varying settings (e.g. larger versus small hospitals, free-standing birth centers, etc. ) to see if you would be able to do this?

How does on go about that? I never knew that would be an option. I do have an acquaintance who is a CNM but is now working as a L and D nurse since the birth of her child. I should ask her. Thanks :)

Edited to add: Maybe you thought I was all ready a RN looking to start working in L&D? Can one 'shadow' a nurse if you are not all ready a nurse?

fergus51 · May 31, 2004

Many places will let you shadow without being an RN first.

Personally, I think you could do fine as an L&D nurse if you remember an important part of what you wrote (when all childbirth professionals support women in THEIR childbirth choices). I also prefer less interventions, but I know it is not what every women wants. If a woman wants an epidural at 3 cm, I can support that because I know it isn't MY opinion that matters. Also having worked in a hospital and seen the way things can go bad does make me more appreciative of having those interventions available when they are needed.

mitchsmom · May 31, 2004

I think that I will be able to support informed decisions ...thinking that I will be able to educate them somewhat and then respect whatever they go with after that???... yall can let me know if I'm dreaming here too

At least I feel like I can do that as a breastfeeding counselor now, so I hope that ability will translate over to L&D.

Blackfish · May 31, 2004

Personally, I think you could do fine as an L&D nurse if you remember an important part of what you wrote (when all childbirth professionals support women in THEIR childbirth choices)

I completely do agree with that quote! I may wish for all women that during their pregnancy they become informed and educated about the choices they may have to make during their labor and birth. But when a woman is actually in labor I would honor her choices regardless of my personal beliefs. It is not for me to say how any particular woman should give birth. I can simply offer support in whatever way she wants/needs.

I, personally, would still choose to give birth at home, without a doubt, if I was to become pregnant again and did not have any health issues that would preclude homebirth. And I would take complete responsibility for my informed choice. But, I will also be the first to say that homebirth is not for everyone :)

Thanks for you response!

Adrianna

lisamc1RN, LPN · May 31, 2004

Adrianna, thank you for asking a question that I was wondering about, also! Homebirth is for me but it is not for everyone. I think that as long as we are there for the mothers and their babies in a healthy, supportive role, then we will both do ok in L & D!

Dayray, RN · May 31, 2004

It depends allot on where you work. I've worked at 3 hospitals and each is very different. The first place I worked was kind of a middle ground. There were some interventions and some patients that birthed naturally. I was on post partum then so I'm not sure how things were presented to patients and I'm not sure how much choice/information the L&D nurses gave.

The second place I worked was very small (50 deliveries a month) this is where I got my initial training to L&D. We served a underprivileged population and most of our patients were very young 16-35. Deliveries went fast and although we sometimes used pitocin for augmentation we did few full out inductions. Patients weren't very well educated before coming to the floor. So when you talked about pain interventions most patients were hearing about them for the first time. We did not have on deck anesthesia and the anesthesiologists were not very skilled at epidural. Sometimes they would miss multiple times and they didn't do a good job of numbing up patients.

They also hated with a passion coming up from the OR to place a labor epidural. Several times I had to ask the anthologist out of the room and let them know that I would not allow them to yell or be verbally abusive to my patients and that they needed to use more local. I would dissuade my patients from having epidural because many times it seemed that the epidural placement was more traumatic then labor would have been.

So we had allot of unmediated births. This is the way I learned and had no idea that other places used so many interventions. I read all I could about labor support and got pretty good at it.

Now I work on the biggest L&D in the state. Our population is very affluent and well educated on pain management. We do allot of high risk deliveries PIH, preterm, IUGR, twins.. you name it. Inductions are common place and almost everyone has pitocin at some point and we do allot of vacuum deliveries. Our clientèle are posh 35-40 year olds and they know all about epidural. We have excellent on deck anesthesia and epidural placement is a snap. It was a shock to me when I first got there. We have a 90- 95% epidural rate and do allot of c sections. At first I didn't know what to do, I was so used to being needed for supporting labor and helping with relaxation techniques. Patients with epidural were so easy to take care of. Patients don't question interventions and they come fairly quickly. With a higher risk population interventions are more prevalent.

That being said I would recommend finding out about your options as far as were you can work. I think you would find your self in a constant battle between your beliefs and the way care is managed in a larger hospital. Although you could also help to limit unnecessary interventions.

When it's all said and done birthing should be about choices, of course the main goals are a healthy baby and mother but everything else should be patient choice. However you have to consider where the patient is getting the information to make those choices. Educators can strongly influence patients one way or another and patients tend to go with what they perceive to be "the norm". So if you choose to work in a low intervention unit most patients will likely choose low interventions and vis versa.

Id really like to work at a place with less interventions but I love the staff where I work so it would be hard for me to leave.

mitchsmom · May 31, 2004

Dayray,

I'm just curious. Since you have worked at both sorts of places, do you see a lot more side/adverse effects as a result of all the interventions as opposed to the lower intervention place? (still trying not to choke over the epidural/pitocin,etc rates you have! although I dounderstand that a lot of pts want that...I think many of them are misguided by the docs advise/opinion on them but that's another story...) What overall differences do you see in pt and baby outcomes?

lisamc1RN, LPN · May 31, 2004

Dayray, may I just say "you rock!" :) Thank you for that very informative post!

Dayray, RN · May 31, 2004

lisamc1 - hehe thanks =)

mitchsmom - yea and no, it's hard to say.

Most of the time things turn out pretty well. What I can say is that, when pitocin is used too early, before the cervix is ripened or on early gestation inductions I see more fetal distress. It ends up taking allot longer to see dilation and thats more time for the baby to become tired of being squeezed. So sometimes I come in and take over a patient that has been on pitocin for 10 hours and been up to 24 mu/min. These patients are scary because the baby is usually not looking great on the monitor and there is that risk of bleeding after delivery. Sometimes they end up with C/S and I always worry about them threw out labor.

As for other problems like bleeding or failure to descend, it's hard to say most of the patients that have these problems are the older moms. I've often wondered if it's our interventions or just the patients age. The problem is that an older mom is more likely to need interventions to progress labor (at least by the standards we are used to).

I can say for sure is that we end up doing more silastic deliveries because of epidural. 1st time moms and babies get pretty tired after 2 hours of pushing and you end up having to get the baby out due to none reassuring monitor strips. Most of our docs are really good at vacuum deliveries (because they do it so much) so complications from their use are rare.

One good thing I can say is that because we have such a fast c/s response time we don't have to run back to the OR for the first sign of fetal distress. At the other places I worked patients got cut too early I think. Here we can get babies out in about 5-8 min so we can ride out some less then perfect strips.

In my opinion the worst problem this creates is difficulty for the patient that does want to have natural child birth. It depends a great deal on the doctor and their acceptance of natural child birth. I have flat out refused to check a patient that was unmediated. The doc wanted to know how much time he had. but I told him she wasn't that far along because you can tell when they don't have epidural. Also you get a few docs that want to give these patients pitocin which ties them to the bed and of course they have a really hard time because they cant move around and sadly end up getting epidural. Other docs aren't so uncaring and things go well.

I had a horrible delivery a few months back and I fear that my patient was traumatized by it. She was natural and had been ruptured for 30 hours so we ended up giving her pitocin I won't go into the whole story but it was bad. Natural child birth and Hospital interventions do not mix well. I'm sure there can be an in between but I haven't found it yet.

L&D_RN_OH · Jun 1, 2004

Would a natural childbirth advocating, homebirthing mama be able to survive as a L/D nurse?

Yes, depending on the facility. I delivered naturally, in a birth center, and was a doula before becoming an L&D nurse. I am huge natural childbirth advocate. It was hard for me at first, and can still be frustrating at times,when I see pts make,what I think are, uninformed decisions that set them up for more intervention. That said, I think you can only take women where they want to go in childbirth. I educate them as I can and support them in the choices they make. Working in one of the bigger hosps in this area, I see obstetric emergencies and know that intervention is sometimes a necessary evil. But, I am lucky enough to work in a facility that has a high rate of low intervention deliveries. So I get to see the cases were intervention is necessary, but still get to enjoy giving labor support to women seeking unmedicated births.

I would check out the facilities in your area, and see what type of intervention rates they have. I work in an area that has 4 hosps with L&D units. Two of them I would never work at just because of their high rates of inductions, epidurals, and csections.

It pays to do your homework when researching facilities to work in. If their birth philosophy totally clashes with yours, you will be very unhappy and dissatisfied.

Good luck on making your decision to return to school.