Tuesday, October 7, 2008

Au Natural

I got a comment on one of my previous posts about a precip delivery who didn't get an epidural before she delivered and who had great control vs. some patients who I see come in who don't have such good control.

"Sometimes losing control is how a woman copes with birthing naturally.
While swearing and writhing all over the bed are annoying to you, it's the
patent's birth."

I agree totally with this statement. After going back to read my previous blog, I probably should have tried to make my point a little clearer and not come across so grouchy about it. I have nothing against someone going unblocked or without pain medicine during a delivery. In fact, I admire them! Totally, 100% admire them. They have something that a lot of people don't have: mental and physical strength and endurance!

The patients that I really, truly feel sorry for are the 1st time moms, especially, who come into labor not knowing anything about what it's going to be like. Or even worse, those who come in after doing all kinds of research on the Internet or listening to horror stories from friends and in turn come in scared spitless and with a complete unrealistic idea of how it's going to go. I think the one advice I can give to first time mom's is:

1) come in with an open mind. The best way to end up with a primary c/s is to be the mom who comes in saying she doesn't even want a saline lock. As hard as it can be, trust the nurses and the doctors who are taking care of you. They aren't out to get you, they aren't out to try and dash all your hopes and dreams, all we want is the best labor experience we can give you and above all else, a healthy mom and baby in the end.
2) Don't watch TLC's "Baby Story" and expect your labor to be just like that. According to them, you can get pregnant, have a baby and be home with your baby all in about 45 minutes...trust me, it doesn't really happen that way! As much as I love those kinds of shows, you have to take them with a grain of salt ;)

Back to the epidural/pain meds thing; as a labor nurse, when my patients hurt, I hurt. When I seem them crying in bed from the contractions, whether they're 1cm or 8cm, I don't want them to hurt. I wouldn't be a very good nurse if I WANTED my patients to have pain! I've seen so many mom's come in and not even really understand what an epidural is, and what they've heard about makes them totally freaked about them.

Epidurals DON'T hurt your baby, they DON'T make your baby sleepy, I have NEVER seen someone paralyzed from an epidural (and I don't think any of our anesthesiologists have either), and they DON'T stop labor. Epidurals DO enable you to be able to rest, and maybe even enjoy your labor, they DO let your body relax and not fight the pain which in turn usually makes your labor progress at a smoother rate, they DO let you (hopefully) rest and save energy for pushing out your adorable baby instead of fighting and tensing up the entire labor.

My other little "speech" for new mom's is that if you come in 7-8cm, with you BOW broken and you don't want an epidural, more power to you. You've almost made it, I will do everything in my power to help you achieve your goal. Mom's who come in for inductions, I will STILL do everything in my power to help you achieve your goal, but I will tell you up front that it's going to be a little different being induced than if your body sends you into labor 100% on it's own time schedule. Pitocin contractions are different from "regular" and once your bag of water is broken, it's a whole NEW ballgame. At least at my hospital, if you're being induced using pitocin, I can't let you in the tub, and you're on a leash known as monitor cables. That means I can't let you walk the halls either :( Trust me, this isn't my choice, I would love to let you use the tub, walk laps in the halls, because I know that stuff works! I will never, never, never tell a patient that she "has to get an epidural." It's a free country!!! But I hurt when you hurt, and when I see you crying it makes me want to cry. I will do everything I possibly can to make sure that you have the labor experience you want, but I want you to be able to ENJOY your labor if you can, not spend most of it curled up in a ball crying because you hurt so much you can hardly breathe.


  1. Hey, as a mom who has had no medication for six births...I can tell you it's okay if you ask if I want an epidural. I'm going to say "no" but you can ask. Of course, I've not ever had pit before baby is born...

    I was curled up this last time with an OP baby too, and scared out of my mind because I wasn't used to that, mine usually come out fast. I don't think you were offensive when you talked of the thrashing and how hard it is for the nurses. Mine actually told me (when I was in pain and coping the only way they'd let me as they wouldn't let me get out of the bed" not to shake my leg into the sterile plane on the bed. Since they didn't let me pee in the bathroom and would in no way let me poop there, I ended up doing that on the sterile plane when I pushed. Now, that bugged me more than asking about an epidural!

  2. You sound like your heart is in the right place -- have you ever considered doing doula training, so that you have something to offer women who want to go w/o pain meds? I've had two home births and no hospital births; as a birth junkie, I've read numerous birth stories, as well as a lot of research. Women who are well-supported emotionally as well as physically, have better and shorter labors without medications, and also have fewer interventions up to and including a C-section. While I know you cannot "labor sit" the way a doula or a midwife can, perhaps you can offer a few tips or tricks to laboring women and their birth-partners, so that they have choices for labor other than "epidural or no epidural?"


  3. I found your blog thru At Your Cervix & am really enjoying it! Thanks for writing.

    I can see how in some situations your first point (the open mind part) could sometimes be very true - for example, the woman who wants to "do it naturally" but has not done any preparation (practicing coping strategies, knowing options for positions etc.), doesn't have enough support, or who doesn't have any idea what to expect other than what she's seen on "info-tainment" shows.

    But I think there are others (like myself - I had two unmedicated hospital births, the birth stories are at http://www.birthingyourbaby.com/stories.html) who will also refuse the saline lock, insist on the doppler checks vs. EFM etc.: we have an open mind - a wide open mind - that includes lot of strategies for coping without medication, using lots of movement etc. It's not that I was unwilling to have the saline lock/IV etc. under *any* circumstances - only if it was truly needed by me/baby.

    As for trusting careproviders - careproviders are humans, and like any other profession - many are trustworthy but some are not. I wouldn't automatically trust a careprovider any more than I would automatically trust any other professional (my kid's teacher or daycare provider; my lawyer; my contractor).

    Also, while I don't work in a hospital, I've read enough to suggest that some decisions about mother/baby's care are made for reasons other than the laboring mom/baby (legal, financial, under-staffing). Hospitals and careproviders have "routines", again, just like other professionals/institutions.

    I think it's partially the mom/family's job to make sure what she is hoping for is a fairly good match with the routines where she's planning to birth (home, birth center, hospital). And to communicate her wishes clearly and respectfully during her prenatal care and the birth (no one is a mind reader!). Of course, to do this, she needs to talk to people who can give her honest information so she can evaluate the match - she's not a mind reader either...

    I think it's important for careproviders to also have an open mind, trying not to lump women who do or don't want something together as always being one way or another. And to establish/earn trust by really listening to women, by treating mother/baby as individuals as much as possible.

  4. Hi, I too am a nurse. I work with birthing women assisting a licensed midwife at home births or birth center births. I love that you love what are doing. You get to take part in a miracle every time you are attend a birth. I just want to say that when we learn about nursing we learn how to be patient advocates and view our patients holistically. We know that working in a hospital makes giving the type of care we are taught to give and want to give, very difficult. You are in a position to be remembered for the rest of a woman's life as she comes into your care in labor. You can really make a difference in the family as you support her without judgement. The baby needs to be skin on skin with mama and treated gently and with respect- you have a chance to help that happen. I hope you continue to love what you are doing and that you also explore other birthing options.
    There's a great book written by a labor and delivery nurse- Hard Labor by Susan L. Diamond, RN BSN
    I highly recommend it and I'm sure you will enjoy it.I think every L&D nurse should read it.
    Helen Loucado, RN LMT CLA CIIM CLC

  5. Hey - found your blog thru 'At Your Cervix'...I'm a doula.

    It sounds like you care very much for your patients and want to help them not suffer. That is very honorable :) And I can tell that you want very much to be a good nurse.

    I've been there...seeing a mom curled up in horrible pain, and knowing that an epidural would make it all go away. But I've learned that I have to separate my own experience from hers. You say "When you hurt, I hurt." I know you are coming from a very loving place when you say that. Strange advice coming from a doula, I bet, but I'm a very emotional person and it's helped me to detach emotionaly a bit so I am able to let my client own her own birth. She knows that epidural is there, and she'll ask for it if she needs it. Which I'll admit as been hard in the past not to remind women of the option.

    You might not also get to hear days later how transformative that birth was for that woman curled up in a ball during labor, although it looked like hell from the outside. I'm lucky I get to remain in contact with the women I serve after the birth so I get to hear the stories.

    Have you read about the difference between pain vs. suffering in childbirth? Or an alternative to hospital pain charts (instead of asking pain level - for birth's normal pain it might be more appropriate to ask about how well they are coping?) Another book recommendation - Penny Simkin's "The Birth Partner" will cover the above and also arm you with LOADS of ways to help a woman who wants a natural childbirth.

  6. Have you thought about doing an elective at a birth centre, or perhaps a hospital in a different country? region?

    Some of the things that seem very normal to you would seem alien there, and vice versa. For example, if a low-risk woman in the UK asked to be cannulated 'just in case' she would be looked at like she had just arrived from Mars. Certainly, no one would be thinking that the absence of IV access was "a one way ticket to theatre".

    On induction, just wondered how much do you use prostaglandins to induce? Often this can tip a woman into labour without the need for pitocin - and then she can use the full range of other ways of coping with labour pain including labouring in water (unless contraindicated for some other reason).

    On epidurals, I think they do have their place - and you are quite right that serious side-effects are rare. However, they do also increase the rate of instrumental deliveries - especially if time for descent is not given.