What do you want your OB patients to get from childbirth class?

SmilingBluEyes · Mar 27, 2005

Please tell your clients :

That labor should be a NATURAL and HEALTHY process as much as possible.

That they should educate themselves as much as possible about their rights AS WELL AS responsibilities about their healthcare decision-making.

That Being "tired of being pregnant" is truly NOT a reason to encourage your doctor/ midwife to induce you. And along those lines, induction of labor, esp before the body is ready WILL raise your chance of having a csection birth significantly. The female body is usually much smarter than we are.

That their physicians and midwives DO work for them, and therefore, they are entitled to TRULY informed consent about each and every thing that does happen---that all interventions should be explained fully before being undertaken and please, never to be afraid to ask questions during those prenatal checkups! Education is powerful.

That labor/birth are *NOT* spectator sports....... PLEASE really think THOROUGHLY who you want there, and don't let it become a circus. MAKE SURE THOSE YOU CHOOSE CAN TRULY ADVOCATE FOR YOU ----sometimes you are feeling vulnerable, especially in the hospital situation.

Make sure those you choose to be ther for what is one of the most important events in your life, will serve YOUR best interests---not simply their own--- just to witness a birth....

ON that same token, Yes, It is YOUR birth, and therefore, YOUR right to decide who is there, but also, please remember, we can't have 15 people in there and have it be SAFE. Also, see That children are supervised by a responsible adult at ALL TIMES. I kid you not, I have actually had requests to "watch" young children at times. Ummm I don't think so.

PLEASE, PLEASE be assertive---ask specifically for what you need/want but also PLEASE be flexible. Unbending attitudes on the parts of medical staff, nursing OR the birthing family help no one.

Discuss with your health care provider EARLY ON your expectations and hopes for your birth experience. A Written Birth Plan is a great idea, but be SURE your doctor or midwife has SEEN IT and AGREES to its principles, or you may be disappointed sorely with your experience, when you find for one reason or another, your wishes were not met. Yes, your doctor/midwife DOES need to be "on board" for your desires/needs to be truly met.

Make sure your doctor/midwife AND the birthing unit have copies of your birth plans, if you have them.

Don't be afraid to hire a doula, especially IF you feel your support people won't be able to be there for you in the way you need. Also remember, even your support people need a break----they do get tired, hungry, emotional, too. Having a doula there can be invaluable to meet the BIRTHING FAMILY'S needs, as well as mom's.

If you can possibly do so, PLEASE DO CALL US *before* you come to the hospital for a problem, , illness, complaint or you feel you may be in labor. This enables us to have your room ready and some preliminary paperwork done and streamlines things for you and us. It will help us serve you better!

Dont' forget the breastfeeding classes. You took the time to do childbirth classes, but take a breastfeeding class, too. I realize this is often covered in childbirth classes, but not very thoroughly in my experience. If not, encourage them to take separate breastfeeding classes and ask about lactation services at the hospital where they will give birth.

BUT ABOVE ALL:

Relax and enjoy your birth experience. Most of us who are nurses, doulas, midwives and doctors DO enjoy and specifically chose labor/delivery as our passion. I can't think of another thing I would rather do.

I may think of other things later. My mind is on a roll...and my mouth is huge.

Hope this helps?

Mahnikuh · Mar 27, 2005

This is very helpful! Thank you!

daisybaby, LPN · Mar 27, 2005

What a great job you have (almost as good as mine!)-

This may sound like a no-brainer, but please remind class participants to call their OB's office before they head to the hospital. I had a patient arrive by ambulance with ZERO warning- just a frantic call from the receptionist saying "patient via ambulance coming down the hall!" Had no idea what to expect, no report, no prenatal, no MD (thus no orders), no history, etc.

When we are notified by the MD/office that a patient is coming in we are given vital information regarding the patient's history (gravid/parity, gestation, co-morbidities, allergies, etc). Having the appropriate information, paperwork, and equipment- as well as staff (neonatologists, NICU nurses, social work/crisis staff, clergy etc. ) helps us to be prepared so we can provide safe, quality care.

Of course, true emergencies might not always allow much advance warning/preparation. In this case, however, the pt was term, a fingertip/thick/high, and took the ambulance because she "thought she might have felt a (read: ONE) contraction". Energy, time, and resources were diverted for what turned out to be a non-urgent issue (not to mention her insurance co. will certainly put a big red 'reject' stamp on the transport claim as it was not medically necessary and the pt lived less than 5 miles away).

Sorry for the rant- it's been a looong day!

PS: Ditto the previous suggestions!

BETSRN · Mar 27, 2005

Hi all,
I'm new to the boards.
I'm a newly certified childbirth educator and I'm not an RN (I'd love to go to nursing school, but I'm waiting until my two children are a little older to start taking classes... another story for another time...)
I'm wondering what you, as L&D nurses (or doulas or anyone who has experience in this area!), would like your patients to learn in childbirth class. What is the most valuable information your patients need in labor, in your opinions? What are common areas of misunderstanding and what seems to shock your patients most?
Thanks for any input!

I hope that all of my clients learn to advocate for themselves as well as their baby.

BETSRN · Mar 27, 2005

Hi all,
I'm new to the boards.
I'm a newly certified childbirth educator and I'm not an RN (I'd love to go to nursing school, but I'm waiting until my two children are a little older to start taking classes... another story for another time...)
I'm wondering what you, as L&D nurses (or doulas or anyone who has experience in this area!), would like your patients to learn in childbirth class. What is the most valuable information your patients need in labor, in your opinions? What are common areas of misunderstanding and what seems to shock your patients most?
Thanks for any input!

I have alerady posted about advocacy, but I wanted to add something else. You can teach till you're blue in the face about labor being natural, not askig for induction, all babies are not huge, work with the pain, etc., but in the long run, your patients are going to go along with what the doc pushes anyway. It's sad but true.

I am a L&D nurse as well as a childbirth educator. I have dealt with this frustration mentioned above for years. So, along with all the stuff everyone is mentioning, you might as well educate about all the possible interventions because many of them are going to come into play, needed or not. Some hospitals are more interventive than others. Mine is NOT interventive, but I still find my patients being swayed by what the doc says/wants (not that some interventions don't become necessary).

I don't mena to throw a negitve spin on all of this but it is reality in this day and age of litigation.

If you ahve a truly motivated couple, they'll be successful whether you teach them anything or not!

Good luck and enjoy.

kmchugh · Mar 27, 2005

As an anesthesia provider, I can see perhaps more clearly certain prejudices some people in the OB department have. Often, those prejudices are based on factually incorrect information. I have seen behavior that I considered to be coercive, bullying, and downright mean. I have seen such behavior from nurses, physicians, clerks, and just about every other stripe of person who works on the floor, including anesthesia providers. These prejudices seem to go in every direction. I have seen more control freaks in the OB department, the last place they need to be, than any other department in the hospital. If I could, here is what I would tell EVERY expectant mom:

"The day you have your baby is your day. Don't be afraid to make it go your way as much as possible. If you want something, don't be deterred by someone else's prejudice about it being an 'unnecessary intervention.' By the same token, if you have decided there is something you don't want, you don't have to put up with anyone's 'gentle persuasion.' Make your own decisions, and do so based on as much information as you can find. When you decide, stand by that decision. If anyone trys to talk you out of that decision based solely on their own prejudice, kick them out, with firm instructions that they are not to return to your room. Again, this is YOUR day, you have a right to have it go your way as much as is medically possible."

And no, none of this applies only to epidurals.

Kevin McHugh, CRNA

jrring1019 · Mar 27, 2005

I think people need to know that it is going to hurt, at some point EVEN if you get an epidural. Pt's come in terrified and want an epidural before there is any pain. They need to know that they will feel SOME labor before they get an epidural. They also don't know that it HURTS to push. Also that throwing up, shakes, and a slow labor is common :uhoh3: Also, that early labor can last for days, and sleep,eat and drink as much as you can at home. Also, BATHE before coming to the hospital :chuckle

JaneyW · Mar 27, 2005

I think people need to know that it is going to hurt, at some point EVEN if you get an epidural. Pt's come in terrified and want an epidural before there is any pain. They need to know that they will feel SOME labor before they get an epidural. They also don't know that it HURTS to push. Also that throwing up, shakes, and a slow labor is common Also, that early labor can last for days, and sleep,eat and drink as much as you can at home. Also, BATHE before coming to the hospital :chuckle

Yes, please take a shower if you can. Please educate them as to WHEN to come to the hospital. I send one or two patients home almost every shift I work because they don't understand that there is no need to rush to the hospital at 2am with every one of their relatives when they have had two strong contractions in an hour and it is their first baby. They are invariably fingertip/th/hi and get sent home because their contractions go away as soon as they get there.

Be very clear about effacement. I get lots of pts who come in with 'some pain and bleeding' after an MD visit where the MD told them they were 3cms after a cursory exam. The small (one drop) amount of bleeding is from the exam and when I do my more thorough exam they are 3cms outer oss and closed inner oss and get sent home--with instructions as to the normal expected bleeding from my exam and abnormal bleeding that should bring them back in.

Last but almost most important: tell them that they need to MOVE during labor as much as possible. Even if it is only turning side to side and sitting up after the epidural. Walk as much as possible before the epidural. Help that baby move down the birth canal!

KRVRN, BSN, RN · Mar 27, 2005

I just took a childbirth ed class (I'm delivering at the hospital I work at) and I wanted to tell some of the things that the lady taught that I thought were handy to know...

First of all she reviewed the difference between braxton hicks and true labor. She told us that losing the mucus plug doesn't mean a whole lot, so don't assume labor has started! She descibed how long to wait before coming to the hospital if you are having contractions. Shaving, enemas and episiotomies are not standard.

I thought it was especially good that she pointed out that once you have an epidural, you are definitely going to receive an IV, continuous monitoring and maybe pit. You won't be up in the shower, you likely won't be walking and you might be completely stuck in the bed. She also pointed out that no, you won't have your baby placed on your chest and receive the opportunity to BF immediately if you have a CS (at least at this hospital!). So many birth plans I've heard of address these exact issues. She also took us and showed us where the NICU is and described the visiting hours and rules (being a NICU nurse there, that helps).

I liked that she was very real about how things are done and what to expect. Her bottom line was that if you want as few interventions as possible, you better not ask for an epidural, because so much comes along with it. :)

babyktchr, BSN, RN · Mar 28, 2005

If I had my wish....I would want prospective parents to know that babies don't come in a half hour, like on a Baby Story.

SmilingBluEyes · Mar 28, 2005

Boy you said it! Those shows are a real pain for us at times.