"Natural" birth

amber1142 · Jul 21, 2005

Nothing, but NOTHING beats giving a natural labor-mom support. I love it. It is all-too-rare like said above. But I also enjoy my role in the labor experience of a mom using anesthesia, too. I have found ways to really become involved that transcends machines and IV's. But it's a big challenge, that is for sure. Sadly, so many want to be numb, and that is what they get.

On my first day of work at a teaching hospital I supported a 16 yo who didn't want an epidural; she had only a little stadol. She was a real trooper. It was a beautiful birth, though I was told not to expect many more like that.

SmilingBluEyes · Jul 21, 2005

I know!!! We had a 16 yo girl in caesar theatre recently, under GA who was delivered lady partslly by forceps (basically they pulled the baby out). And they called it a normal lady partsl delivery!!!!!! Good God!!!

are you SERIOUS??? :no: :eek: unbelievable.

BETSRN · Jul 21, 2005

I agree, the thing that really makes my day is to have an actively laboring mom come in, say, 4-6 cms, or whatever, really into her labor, wanting to go natural. I love laboring w/my pt's. To me, this is it, this is birthing, and then the delivery...wow! Nothing beats it. Generally these women have less complications and easier births.
My background is from a large LDRP/Family Birthing Center, we were w/in the hospital, but it truly was like being apart from the hospital. We were staffed primarily w/midwives who did 90% of the deliveries. The rest were MD pt's...high risk, c/s or whatever. We did jacuzzis, squat bars, walking, etc. Totally encouraged the mom. Sure, some ended up w/epidurals....and that was OK, too. The environment was so much more into the mom and what she wanted. We really tried to make her birthing experience her own.
Now, I'm on the west coast, work in a teaching hospital, (actually getting ready to leave this facility) and, man, what a different environment! Here the residents don't "get" it....moms can labor and birth w/out an epidural! :smackingf Imagine that. The nurses are totally not into it....laboring w/the moms. It's all about the epidural. And inductions. Anesthesia is in the room the second the pt is admitted, having them sign paperwork, and often, these gals are getting epidurals at 1-2cm, not even in labor! No walking, jacuzzis, not even a squat bar, everyone delivers in stirrups w/students and resident mangling their way thru the delivery! I can hardly wait to be outta there and get back to my "natural" moms!

I,too, am in the LDRP environment with lots of CNM's (and really nice docs as well). I am totally lucky.

I think the more natural philosophy has to be somewhat inborn in the person (doc or nurse) for them to transition into this philosophy and embrace it completely.

I'm not sure I could ever work in a teaching hospital.

michelleicu · Jul 21, 2005

How about a natural birth but had pitocin runnin thru my veins 2 hours beforehand.the nurse asked me if I wanted a epidural but I said no not knowing the extent of pain I was going thru.

RNnL&D · Jul 22, 2005

Is this routine practice.. baby in NICU after C-sec? I have never heard of this and would have thought this only applied if the infeant was in some kind of distress during labor that warranted a stat section or something of that nature. That's really ridiculous.

Not routine here. Only way baby gets stuck in NICU is if it has issues.

RNnL&D · Jul 22, 2005

For those who want that "natural" experience, more power to them. But, please, stay at home and have the baby. Why come to the hospital? And if you do, expect the full-court press to protect you and yours. Why? BECAUSE YOU'LL SUE EVERYONE if we don't.
So, once again, it comes back to hangin' all those pesky lawyers.
John Z,
CRNA

That's just sad. :crying2: Of course, in your line of work, you don't have the opportunity to witness the beauty of natural childbirth. Why should women have to give up their comfort zone (if that includes the "safety net" of a hosp. setting) just because they want to avoid the risks of epidural anesthesia and/or narcotics?

And how exactly does anesthesia "protect" a Mom and baby with a normal, low risk pregnancy? Does it not increase risks to Mom and baby?

RNnL&D · Jul 22, 2005

Yes, I think for some nurses, they react very poorly to patients who want natural childbirth. This attitude is reflected in their care. They'll bad mouth the patient at the nurses station, they won't check on her as much, they won't be as active in offering labor support ideas, etc. They'll many times try and undermine the birth plan, if there is one, by suggesting medication, by saying things like, "Hey, no one gets a reward for natural childbirth." etc. It's terribly disheartening to the patient, who has tried to be informed and could really use a strong ally in the birth room.
.........
It's incredibly easy to think it's simply the patients' fault, since they're such control freaks with their 3 page birth plan, birth ball and doula in tow. But it's usually a give and take, and the staff contributes to the failure to progress through their lack of understanding or sheer callousness. Sucks.

Excellent point.

nursey_girl · Jul 22, 2005

I would say that any birth where you actually give birth to a baby is natural...I feel like it's a woman's perogative to have her baby with pain meds on or off board. Big deal, if you need intervention... the result will be the same...A baby. Bringing a life into this world is the closest thing to nature there if you ask me...

macanes, BSN, MSN, DNP, CRNA · Jul 22, 2005

That's just it. There's nothing "natural" about being in a hospital. But, if you go to one, you should expect -- and receive -- medical care. I am NOT saying that every laboring mom should have an epidural/intrathecal. I AM saying that she should expect (1) fetal heart monitors and vital sign monitoring, (2) remaining NPO in case of an emergent c/s, (3) a c/s if her baby is showing lates or other NRFHT, (4) a spinal anesthetic for a c/s if she doesn't already have an epidural, (5) a general anesthetic for a true crash and therefore no memory at all of the birth of her baby.

Don't give me this garbage about me being biased toward epidurals. Of course I recommend them. But, I can say with absolute certainty that I have NEVER snuck up on a patient and popped in an epidural. I DO tell women in initial interview (for medical hx, know who is on the floor, etc.) that they should NOT tell me 'absolutely no to any epidural' because I cannot in good conscience or legal right come back later when she's in excruitiating pain saying, 'give me that epidural.' It's now under duress.

I'm sure you do have plenty of moms who go "natural" and have "a beautiful birth." More power to them. It doesn't always happen that way and you know it. The more common is the scared primip screaming her head off ready to die or kill someone. Get real.

So, keep the bias AGAINST anesthesia to yourself. If you want to root for the mom to go natural, you better make sure she (1) plans to get pregnant, not 'just happened, (2) goes to every prenatel class or laMaz or whatever for 'visualization of no pain', (3) was born with a naturally high pain tolerance and a tough attitude. When you can guarantee all that, then y'all can start being all high-and-mighty about so-called natural childbirth.

And, yes, if a mom is clamping down from the pain and not progressing, there is a small segment who will benefit from the relaxation provided by an epidural. Also, at the low concentrations of local anesthetic now commonly used, there is less numbness than there used to be. We expect them to feel the contraction, not the pain so much. And, we expect them to feel more at the end, through the less-well-covered sacral nerves.

Like I said, for a "normal, low risk pregnancy" mom can come to the hospital and decline an epidural. There is NO forcing them on ANYONE.

So keep your :crying2: to yourself and get real.

That's just sad. Of course, in your line of work, you don't have the opportunity to witness the beauty of natural childbirth. Why should women have to give up their comfort zone (if that includes the "safety net" of a hosp. setting) just because they want to avoid the risks of epidural anesthesia and/or narcotics?
And how exactly does anesthesia "protect" a Mom and baby with a normal, low risk pregnancy? Does it not increase risks to Mom and baby?

RNnL&D · Jul 22, 2005

I AM saying that she should expect (1) fetal heart monitors and vital sign monitoring, (2) remaining NPO in case of an emergent c/s, (3) a c/s if her baby is showing lates or other NRFHT, (4) a spinal anesthetic for a c/s if she doesn't already have an epidural, (5) a general anesthetic for a true crash and therefore no memory at all of the birth of her baby.
.......
I'm sure you do have plenty of moms who go "natural" and have "a beautiful birth." More power to them. It doesn't always happen that way and you know it. The more common is the scared primip screaming her head off ready to die or kill someone. Get real.
So, keep the bias AGAINST anesthesia to yourself. If you want to root for the mom to go natural, you better make sure she (1) plans to get pregnant, not 'just happened, (2) goes to every prenatel class or laMaz or whatever for 'visualization of no pain', (3) was born with a naturally high pain tolerance and a tough attitude. When you can guarantee all that, then y'all can start being all high-and-mighty about so-called natural childbirth.
And, yes, if a mom is clamping down from the pain and not progressing, there is a small segment who will benefit from the relaxation provided by an epidural.

Well, I don't agree with the NPO part, but maybe that is policy where you are.

It's actually not very common to see even primips "screaming their heads off ready to die or kill someone". That's your interpretation. Yes, there are some screamers, but many women handle their pain w/o screaming or threatening to kill anyone, even when they are planning for an epidural and haven't gotten one yet.

I am not biased against anesthesia. I think when a woman wants it, that is her choice and I hope that it will give her the relief she desires. I want my patients to be comfortable with their choices and if that includes an epidural, than good for them. I love our CRNA's. I think they do a great job and give our patients good relief from pain.

And I do agree, some patients who can't relax, do benefit from an epidural. I have even recommended one in these cases. :eek:

But, believe it or not, even women with unplanned pregnancies, who have never attended a prenatal class, who don't have a high pain tolerance or a tough attitude choose natural childbirth for the safety of their babes. :)

You're the one who stated women should "expect the full court press" when they birth in a hospital. Implying that women give up their right to choices if they choose hospital birth.

gypsyatheart · Jul 22, 2005

I suppose that "natural" appendectomies would be performed as they were in the old days: with six strong Bohemians holding the patient down while a barber cut without anesthetic. I guess the old trepining procedure (cutting a glabelar triangular hole in the skull with a rock to let out evil spirits) is natural, too.
For those who want that "natural" experience, more power to them. But, please, stay at home and have the baby. Why come to the hospital? And if you do, expect the full-court press to protect you and yours. Why? BECAUSE YOU'LL SUE EVERYONE if we don't.
So, once again, it comes back to hangin' all those pesky lawyers.
John Z,
CRNA

Geez, what a bad attitude you have, believe it or not, anesthesia's presence is not always required to have a baby, and yes, many, many women labor and deliver successfully w/out the use of anesthesia! In hopsitals, at that...

What difference does it make to you if a woman goes natural, or if she's in the hospital or not....I don't suppose you personally have ever labored or given birth, now have you? :coollook: Sometimes things just get beyond the expectation of a laboring woman, and then, yes anesthesia is required. Or, things don't progress for whatever reason and/or a myriad of other "complications".

I, honestly, am so sick of anesthesia having this attitude that they are the "be all , end all", when they truly know so little about the laboring population! What are you complaining about, anyway, isn't this your job, to provide anesthesia?? Or are you one of those who thinks OB anesthesia is beneath them? :uhoh3:

I really think you are missing the point of this thread and am so grateful when my anesthesia person so does not have the kind of attitude you do!

macanes, BSN, MSN, DNP, CRNA · Jul 22, 2005

Wrong on several points.

- I love doing OB anesthesia. I get incredible job satisfaction from it. I love my job in general, OB and otherwise.

- I do not think anesthesia is the "be all/end all." I get along great with the L&D nurses.

- I personally _do not care_ if a woman chooses not to have an epidural. As I said, more power to her. It does not affect my time, my pay, or my atttitude if a woman on the labor deck wants to "go natural." You go, girl!

- I _am_ so sick of L&D nurses who have this attitude that anesthesia is somehow unnatural, or missing the entire experience. As if a woman with an epidural somehow doesn't give birth as well or fully as those who suffer those biblical pains!

- To present an counterpoint, I _do_ disagree with unnatural use of anesthesia and surgery that has become so popular in South American hospitals, for example. There, some middle- and upper-class women think it is beneath them to deliver lady partslly -- only the peasants do that. They have their c/s whether they need one or not.

- I point out a fact: If a woman in a hospital were not monitored and cared for up to the _standard of care_ -- a legal term -- then the providers . . . including you, Ms. L&D Nurse . . . are responsible legally if something bad happens. More importantly, if I ignored my responsibility I wouldn't be able to sleep with myself at night.

- My bad attitude is reserved for those who look askance when I go in to get a medical history, consent for epidural, SAB, and/or c/s prn. "Oh, she doesn't want an epidural." I don't care. Like I said, I _cannot_ sneak up on someone and put one in while she's sleeping . . . ain't gonna happen. I get a medical history so I am aware of any unusual medical problems in case of an emergency (e.g., difficult airway, allergy, etc.). I get a consent for epidural, spinal, and general for labor or c/s as needed. If they decide later that they _do_ want an epidural, then I'm ready with a clear conscience. If we have a c/s, we don't waste time on collecting a history and doing consent paperwork. ALSO, they haven't been narc'd four ways to Sunday before I ever see and consent them! ALSO, they haven't been laboring for hours, exhausted and not hearing my words or understanding the meaning. Everything is done ahead of time and I watch happily as they labor without their epidural. Brava!

- The attitude of L&D earth mothers who want to chant and burn incense over our patients is the most irritating. Somehow, doctors and anesthesia providers really _are not_ part of their agenda. No doubt, it would be much better if a midwife did the delivery. Further, why do we need all these wires and beeping machines? PLEASE. Spare me. THAT's wear I most passionately apply my, to your mind, bad attitude. And _another_ thing: Learn how to circulate in the OR when you have to do a c/s! It's part of your job (in many places, not all, I know). If you don't like that part of your job, tough! When things have gone bad to the point of doing an emergent c/s, you better get your ducks in a row or get a new job. It can't all be chanting and breathing. Learn the science, too.

- Wow. You got me. I am male and therefore part of the problem. Good shot. I will never labor or give birth. That must mean I can't have an opinion on any female-oriented subject. I disagree, but don't have an argument that will break through your argument of the absolute.

- You're right. Anesthesia is absolutely not required to have a baby. Women have been doing it for tens of thousands of years without it. But QUIT trying to browbeat the women who do so chose into feeling like they've missed something! I'm sick of moms who berate daughters, "I didn't have an epidural! Why do you want a needle in your back?" And nurses who wear that slightly disapproving but mostly neutral expression when a mom says first thing when she rolls in, "I want my epidural." YOU get over it, lady. Give them a break! Give me a break!

Thanks for your input,

Z

Geez, what a bad attitude you have, believe it or not, anesthesia's presence is not always required to have a baby, and yes, many, many women labor and deliver successfully w/out the use of anesthesia! In hopsitals, at that...
What difference does it make to you if a woman goes natural, or if she's in the hospital or not....I don't suppose you personally have ever labored or given birth, now have you? Sometimes things just get beyond the expectation of a laboring woman, and then, yes anesthesia is required. Or, things don't progress for whatever reason and/or a myriad of other "complications".
I, honestly, am so sick of anesthesia having this attitude that they are the "be all , end all", when they truly know so little about the laboring population! What are you complaining about, anyway, isn't this your job, to provide anesthesia?? Or are you one of those who thinks OB anesthesia is beneath them?
I really think you are missing the point of this thread and am so grateful when my anesthesia person so does not have the kind of attitude you do!