OB Nurse's View on Natural Childbirth

MomBabyUnitRN · Mar 28, 2012

I am pro -whatever the mom wants. If she wants to go natural, go for it. If she wants an epidural, go for it. I worked with a mom who wrote out a beautiful birthplan the other night. When her midwife suggested she try a whiff of pitocin to get those contractions working for her, she agreed. She knew she had to be constantly monitored after that and she was OK with it. She did wonderful. I told her she could even get up and move around as we have a telemtry monitor that will follow her anywhere. Most mom's are OK with this knowing it's their baby and their uterus we're looking after. I'll do whatever the mom wants. It's her labor and it's her birth. I've had three kiddos naturally; because there was no anesthesia available. By the time I decided that I'd like something IV, it was always too late. I had all my kids in the back woods of Montana. If I had another, I'd definitely have an epidural.

tanyaluvRN · Mar 29, 2012

I really enjoy my natural patients--but often they have not practiced any form of pain control like breathing techniques etc. Soooo they end up with an epidural after a few fentanyl doses. My advice would be to really practice some different techniques--bring some music and get a good support person. Someone who knows where the line is drawn when it comes to epidurals. Once you tell us you don't want one, we don't push it at all. Good luck.

jkat276 · Mar 30, 2012

as a Labor & Delivery nurse, and a mama who had a midwife attended natural-childbirth at a birth center, I say, If you are "low risk" go to a birth center. Find a place with providers who are going to support the type of birth you want. and/ OR, take a prenatal class, have a doula, and read and practice your techniques for coping with contraction intensity. SOOOO many who come in saying "i want to try to go natural" end up just laying in bed, holding their breath, and kind of freaking out, and their families don't really offer a lot of help. then they break down and are screaming for an epidural. Its sad. And for providers to tell women that they should not have a birth plan, that they are just "setting themselves up for dissapointment" is really disempowering for women who are trying to prepare for what will be one of the most important, life-changing experiences of their life. Yes, prepare yourself. Know that birth is unpredictable, but know what your preferences are. Know your options, gather your tools and practice some positions, breathing techniques, etc. There is very little support for women in the hospital in coping with the intensity of natural childbirth, and honestly, most nurses just are pulled in too many directions to sit with you and provide labor support. Read books! take a class! teach your partner! hire a doula! don't go in unprepared with your fingers crossed and hoping for the best. Invest in your birth, and good luck to you!

LexiRN2 · Mar 30, 2012

You prove a very good point about nurses being pulled in too many directions which leads me to my next question... What is the nurse to patient ratio on a l&d unit? I don't expect my nurse to hold my hand through labor but it would be nice to know how readily available the nurses are if I do need something.

Also, I 100% plan on having a birth plan. A lot of people think that you're setting yourself up for disappointment but if you fail to plan, then you plan to fail. You have to set your own expectations and goals and try to follow through with them as much as possible. I don't want to end up being the difficult patient of the day and I certainly don't want to be labeled as one of those nurse-patients that won't let the nurse on duty do their job.

melmarie23, MSN, RN · Mar 30, 2012

on my unit, its 1:1 for women being induced or in labor, and its 1:3 mom/baby couplets for post partum. I believe these are AWHONN staffing recommendations as well.

eden · Mar 30, 2012

Our ratio is 1:1 in active labour ( 4-5 cm with regular contractions) as reccommended by SOGC.

MomBabyUnitRN · Mar 30, 2012

on my unit, its 1:1 for women being induced or in labor, and its 1:3 mom/baby couplets for post partum. I believe these are AWHONN staffing recommendations as well.

We follow AWHONN as well.

caregiver1977 · Mar 31, 2012

As it has been said, if you want a natural childbirth, this is something that needs to be discussed with your provider BEFORE labor. Make sure you clarify what you mean by "natural" to them.

At my local hospital, where I delivered all 5 of my children, it is nearly impossible to have your definition of a natural labor. They give EVERYONE an IV and strap them to a fetal monitor. You have to FIGHT not to have pain medication. Women who don't come through the door asking for pain meds are seen as some sort of weird being.

When I had my first child I had to be induced because my pre enclampsia was compromising my baby's health. I was fine with all the interventions and basically just happy that my OB did not force me into a c-section (I told him from the beginning I wanted to avoid one if at all possible). But everytime I turned around someone was asking me if I wanted pain meds. The nurses actually looked nervous when I told them no!! There was one nurse in particular that was insisting I get an epidural. I told her that I wasn't having that much pain and that it wasn't necessary. She even sent the anesthesiologist. You can imagine the look on his face when I told him I didn't want the epidural and had told the nurse this (I hope this man hadn't been interupted from something important). This woman ended up SCREAMING at me that if I didn't get it now that I might not get one. I told her that I was 25 and old enough to deal with the consequences.

The nurses weren't that pushy all five times, but close. Read about the breathing exercises and I feel the birthing books by Shelia Kitzinger are very good if you want to learn about natual childbirth. But remember, if you do accept pain meds, you shouldn't be disappointed.

VICEDRN, BSN, RN · Mar 31, 2012

Not an ob nurse but stumbled upon the post. I am mother of two with third on the way...

the advice here is really good. I think, based upon what you want, a hospital is unlikely to provide you what you are looking for. If you can't go to a birth center, I would strongly suggest that you labor at home for as long as possible. the longer the ob folks have you in their hands, the move interventions you will get.

as for the monitor, as an ER nurse, i do continuous cardiac monitoring. Let me tell you how much fun it is to get someone on and off the monitor so they can pee or whatever. my guess is that the nursing staff would be more inclined to leave you on the monitor if only for convenience. much like in ob, we also find trouble when we look for it when we monitor patients.

the one caveat i will make is that it depends on where you live. I had one kid in MA and they were much more open to fewer interventions (and a birth plan) though i seemed to have gotten all the interventions anyway. My second was born in ATL and you forget convincing anyone in the south to intervene less (and even the provider bristled when I inquired about a birth plan).

when i inquired about protocols when i got pregnant, i was told that because i was vbac, i was told that they would require continuous monitoring so i hired a midwife and am planning a homebirth (fingers crossed that it works out).

frankly think that the whole system is set up for moms to fail. i distinctly recall no one advising me re pain management for the first one and the reality was that even 1:1 I was surprised how much time i was spent alone with my husband (who also had never been through this before).

subee, MSN, CRNA · Apr 1, 2012

I was around when women got scopolamine during labor. It was really ugly and demeaning. Then the 70's came along "Our Bodies, Ourselves" influenced women to take control of their labors and now we've cycled back to the 60's and have just abdicated control of childbirth to physicians (who have no proven track record in healthy deliveries). Their training is to "do things", not to let nature take it's course. It's a crime how unprepared women are for this totally NATURAL process experienced as long as mankind has been around. And nursing, in large measure, has also imbibed the Kool-Aid by accepting pitocin inductions, c-sections on demand, epidurals for everyone as the norm.

nurseprnRN, BSN, RN · Apr 1, 2012

this in today's npr healthwatch:

babies take longer to come out than they did in grandma's day : shots - health blog : npr

babies take longer to come out than they did in grandma's day : shots - health blog : npr

nurseprnRN, BSN, RN · Apr 1, 2012

and my daughter, who had midwifery care for her second, did so because her first labor and delivery were a fiasco. at 8cm she was "tired," so they gave her a good whopping hit of stadol so she could have a nap. really? my ob colleagues, do they really do that? when she woke up she had the baby...who was taken from her at age about 2 hours because she wouldn't nurse, too sleepy. well, d'oh. she got the stadol too.

new parents crazed with worry; crusty old bat grandmother ripped when she arrived at hospital and saw 7.5 lb normal healthy infant in nicu with umbilical artery cath, frequent heel sticks, o2 sat monitor, cardiac monitor, and a bottle of glucose in the bed. daughter specifically said breast only, but if we weren't there to enforce it, baby got glucose water. of course as soon as she woke up from her intrauterine stadol (in about 4 hours) she was fine, but they guilted her parents into keeping her in the nicu for 3 days ("you wouldn't want to be at home and find out something was really wrong with your baby, would you?" grandmother more ripped)...and discharged my daughter so she couldn't stay with the baby. grandmother now even more ripped.

baby came home and was perfectly fine. no need of all that fuss, as far as i can see. grandmother wrote cranky letter to nicu head nurse about limited visiting hours for normal baby girl all alone in one huge nicu room on pretense of infection control, when in next room long-term boarder baby has snot-nosed toddlers playing on the floor with a cast of thousands in and out all day and night. also the needle left in the baby bed, the lack of support for breastfeeding, and the crappy way they treated new dad and cranky grandmother. (no answer. guess they don't do "customer service" there.)

so no surprise when pregnancy #2 was midwifery all the way. well, except for the end. she started labor around 10:30 am, and by 10:45 they thought it would be a good idea to get the big sister over to the friend's house, as planned. husband returned from that errand at about 11:15, called midwife (one hour away) to come. daughter in armchair, making strangling noises. she said later that she was saying "the baby's coming!" but all son-in-law heard was, "aaaarrrrrgggggghhhhh!" husband caught baby at 11:35, now says he hadn't planned to be playing catch with son for a few more years. all well. baby is fine. mother is fine, father is fine, big sister is fine, and grandmother has gained new appreciation for son-in-law. :heartbeat