What ever happened to "mother nature"?

[im_an_honest_1]

Ok, So yes, I am a new grad and very "wet behind the ears" but I have gone through the labor process 4 times over now and I am what you could say a nontraditional nurse - starting when I am 31. Needless to say, I grew up in the Northeast, where drinking, smoking, and drugs were unheard of during pregnancy. Culture shock - in TN where I am practicing lets just say I have had more than one social work consult for +THC tests. Regardless the hospital I am working in is a small rural hospital with a great family birth unit - all LDRP rooms.

My question to all the practicing L&D nurses is - does your hospital attempt to schedule ALL the births that are expected? I would say that less than 5% of the births we deliver were spontaneous. It is routine practice where I work to schedule an induction on the woman's 39th week. Not only that, but I have witnessed 2 failed VBAC's already - why did they fail? because it got past 5 oclock in the evening and the physician wanted to go home for the night - so after letting the poor woman labor all day long - because she didn't make it to 10 cm dialated by the time the Dr. thought his day should end - she got a c-section. :angryfire It just doesn't seem fair. Nevermind the fact that at 39 weeks you are hoping that the due date is correct (I know it is verified with ultrasound but still...).

So is this a standard practice now? I am already thinking after just a couple of weeks that I will grin and bear it for the first year and then move on to a different hospital - but if this is a standard practice in L&D now, then I think I need to find a different area of nursing because it seems just wrong to me.

Thanks for any input.

[DManAZRN]

Exactly!, natural birth is so inconvenient these days...

Maybe they're medicating with THC for the morning sickness, since their HMO won't cover the meds? (Natural medicine?) hahaha, JK

I saw a true natural childbirth once, in Africa. Woman just squatted, out comes baby, not even a grimace! Oh oh, time to cook dinner. Just like nothing happened! Look ma, no bills!

Makes you want to bring back birthing chairs! No, wait too inconvenient, need to lay down in a bed so the doctor doesn't have to bend over. Amazing what gravity can do to help ladies, that's why they're up walking in circles before the birth, duh.

[ducknurse]

I think this is a problem all over! Docs dread the pts that get to 36wks and start complaining every week about awful they feel and why doesn't he do something about it:vlin:! "My sister's best friend's cousin's neighbor had a baby at 36wks and it was fine." And why should their lives be interupted for a delivery after hours when they can come in at lunch and do a section and get paid more for their time...

[seemerun]

I'm a nurse but not an L&D nurse (hopefully someday!) so my perspective is probably a little skewed but in my experience, I agree that this has been a big problem all over. However, I will say that in my neck of the woods I am starting to see the pendulum swing back the other direction. At my OB's office (all doctor led) they will do inductions but not for convenience. I got into a little discussion with my OB about evidence showing that even babies born at 38-39 weeks are showing (or at least are at increased risk for) mild deficits, and their office is really cracking down on unnecessary inductions.

I have had my MD for all 3 pregnancies and deliveries. I think he is great and would have been so disappointed not to have him there. He told me at 38 weeks that he was going to be gone for vacation my entire 39th week. Even though I was dilated to 4 and "ready to go" he flat out told me induction was not an option. He went as far as stripping my membranes but said that was as far as he would go.

In this particular office they really don't augment labor as often anymore either. They share call with another office and there are I think 8 MD's between them. Those 8 doctors rotate staying the night in the hospital so nobody is trying to get a baby out by 5 pm. Even in my relatively small circle I know of 3 people who have had successful VBAC's too - and all with different doctors.

I live in the pacific northwest and they tend to be more "progressive" so maybe that is why, or maybe I just got lucky. Either way I have been really impressed with this office.

[BabyLady, BSN, RN]

Like it or not, healthcare is a business. The longer it takes for a woman to give birth, the more it costs. This is the same more or less in all fields. Which is why we send people home while they are still sick but not critical anymore compared to the days of old where you stayed in the hospital until you were better. Acuity of patients is increasing mostly because of costs.

The physician gets paid per procedure, not hourly.

In fact, adding drugs, surgery, etc to "hurry" up a labor that wasn't supposed to start in the first place is ADDING cost when labor should start naturally on it's own....which is free.

So we really hate the fact that it's 5:00 and he wants to go home, but that is why he's making 6-figures a year and we are not....that is the job they signed up for.

I have personally witnessed a physician "hang out" at the nurses station and didn't want to "be bothered" with a laboring mother until the baby actually started to crown.

To me, it is the most unnatural thing in the world to have a baby crown and then everyone in the room goes "Stop!!!!" while they run to get the doctor...and THEN TELLS MOM not to push?????????

To me....as soon as that baby has descended enough, his or her butt needs to be sitting on a stool, in front of the delivery table, waiting to catch that baby.

[BabyLady, BSN, RN]

Oh..and I just love the physicians, that after two experienced nurses with probably 20+ years experience say that the labor is progressing after 4 hours on pit, the physician waltzes in....takes 25% off the nurse's effacement estimate and 5 centimeters off her dilation estimate, shakes his head and says, "Yeah, the labor isn't really progressing the way I would like and I sure don't want to put your baby at risk, looks like we are going to have to do a c-section."...with the nurses looking at each other with the "Say what????" look on their faces.

Happens every day.

[eden]

I think it depends where you are. It seems to be a much more medicalized system in the US then in Canada. Here our section rate is about 19%, which is lower then the national average and they will not schedule an induction for convenince sake but only for a medical reason. The only time I have ever seen an induction without a medical reason was when the pt's mother was in palliative care and doing very poorly.

With only one exception our docs do not go by the clock.

[bluemorningglory]

Out of curiousity but once I do get to my clinicals in nursing school, is there any way to avoid the L&D rotation? This is just so depressing.

[ducknurse]

You really do not want to skip your rotation. This is just experienced nurses sounding off to people that have the same problems and understand their frustrations. I would not trade my job on L&D for anything. I will never work anywhere else and you should never let these discussions dictate how your practice is! No matter where you work, you will run into issues, challenges, and frustrations; and will want someone to talk to. That is what we are doing and hopefully are not intending to scare you!

[bluemorningglory]

You really do not want to skip your rotation. This is just experienced nurses sounding off to people that have the same problems and understand their frustrations. I would not trade my job on L&D for anything. I will never work anywhere else and you should never let these discussions dictate how your practice is! No matter where you work, you will run into issues, challenges, and frustrations; and will want someone to talk to. That is what we are doing and hopefully are not intending to scare you!

Oh I would never skip that rotation...I am just not looking forward to it:(

[ducknurse]

I am sorry you are not looking forward to it and am even more sorry if it b/c of this discussion. You should never let these discussions color your feelings about nursing until you have experienced them yourself and can make your own judgement. The other thing to think about is: though we are expressing dislike about certain aspects of our job, if we did not LUV what we do, we have enough opportunities in nursing to make a change. There will always be something to compain about, but i LUV my job and will ALWAYS be an OB nurse!!!

[im_an_honest_1]

I would never take my job in L & D and trade it for anything. My posting is just that - I am truly shocked with how business like healthcare is now. I never in a hundred million years would have thought of myself as a "holistic" nurse, because my little brain stereotypes a holistic nurse as one that is a hippie type nurse. Now I am realizing that a holistic nurse is one that considers all aspects of healthcare, not just the medications and procedures, but the psychological, social, & medical aspects of my patient's care into account. I really want to advocate for my patients - but when it comes to healthcare and the business that it has become, drs don't want us to be patient advocates. After speaking to one of my professors and sharing my feelings (she very much has the same holistic approach to nursing) I am realizing that it is just the facility in which I am working. I need to find a place that is a better fit for me. SO I will get some experience and move on to find a better fit for me.

[mamafeliz]

I work in a University Hospital where any IOL or C/S must have a clear medical indication. It is true that a prolonged, natural labor with 1:1 nursing support is costly, but still immensely cheaper for the "system" than a C/S with recovery, subsequent VBAC or repeat C/S and associated morbidities. There is no better example of over-medicalization in our national health system than current OB practice in most areas. Profit/connvenience for physicians and hospitals cannot trump evidence based, cost-effective medicine. Our national health system cannot afford unnecessary medical and surgical procedures.

I argue that bedside nurses witnessing these excesses on OB floors could be key to national reform of OB practice in this nation. Tell your stories beyond these nursing blogs! Document and write letters! We are in an amazing time of possibility, where front line workers within health care are being solicited for ideas. The posts on Allnurses give clear evidence of the excesses in our health care system. Be part of the change.