Hospital Nurses and Natural Birth

A few weeks ago, I was in the emergency room with my son, thinking he had a staph infection.  Long story short, he didn't.  But it was an eventful night, to say the least.  I heard a nurse on the phone with a doctor, panicked, as a baby boy was bleeding profusely from a circumcision-gone-wrong (I don't know what happened - he was still bleeding when we left) and was quite traumatized.  I also heard a room full of nurses talking about labor and birth.  I posted a few of the things on my BFBS Facebook page I heard (which were quite crazy if you asked me), and one of my former students-turning-Birth-Boot-Camp-Instructor, who happens to be a nurse, asked if she could write a blog post for Banned From Baby Showers about why nurses know so little about birth.  How could I refuse?  Thank you, Shazia, for helping us understand, not only the situation, but how we can improve the current state of affairs.

 
I have heard many stories from moms about a nurse being unsupportive and discouraging of natural birth. Perhaps you may have had one of these nurses attend your labor. I am a registered nurse and even I encountered a less than helpful nurse during the birth of my son at a local hospital. Nurses are often very knowledgeable and supportive of evidence-based practices in other specialties. If natural birth is evidenced to be the best option for achieving optimal outcomes for both mom and baby, why are some nurses unsupportive and even discouraging of natural birth? I hope to answer that question from a nurse’s perspective in this post.

A nurse’s knowledge base comes from their education and their experiences. To help me write this post, I polled several other nurses who work in various specialties and attended different nursing schools. I have my BSN from the University of Texas at Arlington. I went through a wonderful nursing program that consisted of 120 course hours. Birth was discussed in one 4 hour course. The course was a general women’s health course that covered pregnancy, birth, and the neonatal period. I was blessed to be taught by a Clinical Nurse Specialist who had homebirthed her own children and a Certified Nurse Midwife.

Not every nurse was so lucky during their nursing education. Some nurses that I polled stated that birth was such a small part of their nursing curriculum that they learned very little about birth. Some nurses said that birth was discussed more in depth, but comparing common maternity practices in the United States and evidence-based maternity practices were not part of the discussion. Not teaching evidence-based practices seems ridiculous to someone outside of nursing, but nursing schools in the United States are preparing nurses to work in healthcare settings in the United States. Labor and delivery nurses attend hospital births. Our hospitals do not routinely practice evidence-based maternity care. Nurses in the United States are expected to assist with planned cesarean sections, elective inductions, epidural anesthesia, and other medical interventions in birth. Unfortunately, that is what hospital birth looks like in our country. Natural birth that is intervention and medication free is rare, and most happen out of the hospital. Many labor and delivery nurses, much like obstetricians, have never observed a natural birth. In order to prepare a nurse for the patients and procedures she would encounter on a labor and delivery unit, the natural birth process is not always a priority for educational institutions.

I also polled a few nurses who work in labor and delivery. Their input was insightful. They verified that natural, intervention free birth was a rare occurrence on their labor and delivery units. They stated many moms came in to the hospital with a birth plan to have no pain medication and limit medical interventions. However, the majority had done NO preparation for their birth, other than typing out a birth plan. They said most of their coworkers view the birth plan as a joke, because most of the moms who write them end up asking for everything they wrote they did not want. One of my professors in nursing school said that you can plan all pregnancy long, but it means nothing if you don’t prepare. If you don’t take the time to prepare, you might as well forget the planning too. It’s like writing down that you are going to make an A on the test, but never actually studying for it.

When a mother is not prepared for birth, but seeks a natural birth, the demands of their nurse are drastically increased. Nursing units are often understaffed and nurses are overworked. There is a tremendous demand on a nurse when a mother is not prepared for birth, a father is not prepared to be a birth coach, and a doula isn’t present to assist mom throughout the birth process. This can create animosity towards the patients that seek a natural birth, but due to lack of preparation rely on their nurse for all of their needs during labor. Even though more women are asking for a natural birth in the hospital, many still end up with unnecessary medical intervention due to their lack of being informed and prepared. Unfortunately, this means that even labor and delivery nurses lack experience in the natural birth process, because the majority of patients are not giving birth naturally. They also doubt the ability for women to birth naturally, because they see many unsuccessful attempts. When a well-prepared and well-informed mom comes in to the hospital, they are often faced with judgment and animosity because they are categorized with the moms who aren’t prepared and informed. They assume that they will be unsuccessful also.

What can we do about this and how can we ensure that women having a hospital birth have supportive nursing staff? We can demand evidence-based practices. We can choose doctors and hospitals that have practices in place to support the natural birth process. If we demand better care during our birth and evidence-based practices, we can work towards a society where medical staff at hospitals have seen natural birth and are experienced assisting moms who wish to avoid medical interventions and are well-prepared to do so. If we continue to blindly follow bad medical advice and fail to advocate for ourselves, hospitals will continue to utilize their policies that inhibit mothers from achieving the type of birth they want. The more we demand for better births, the more experience nurses and other hospital staff will have with natural birth.

If we can change the way women choose to birth and prepare them well, we can change the way our hospitals handle birthing women. If more moms educate themselves and prepare for an intervention free birth, we can ensure that our labor and delivery nurses gain experience with the natural birth process. If we change the norm of birth in our society, the nursing schools in our area will also have to change their way of teaching to prepare nurses who want to go into labor and delivery to effectively provide care to a birthing mom.  

~Shazia from Above & Beyond Birth blog can also be found on Facebook.

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Hospital Policies that Encourage these Outrageous C-Section Rates

Over the years, I have narrowed down the hospital policies that are the biggest problem for moms who want to have an unmedicated birth.  Short and sweet!  Here are your red flags:

1)  The use of continuous Electronic Fetal Monitoring (EFM).  I wrote about this one last week.  This chains mom to the bed.  She's not moving around, helping her baby figure his/her way out.  This policy is applied in nearly all hospital births.  It's very convenient for the nurses, but not for the mom.  Evidence indicates that it is not safer for the baby and the c-section rates rise when EFM is used.  Check with your hospital and your care provider.  If your care provider "approves" intermittent monitoring, make sure that gets written in your chart.  (Just a heads up -- while this improves your chances of not having EFM, it is not a guarantee.)

2)  If your water breaks, you are in bed for the duration of your labor.  They claim this is for your benefit, saving you from a c-section, as the umbilical cord could suddenly slip out, endangering the baby, making a c-section necessary.  The chances of this actually occurring are about .3% of all births.  How can you prevent this from occurring?  Don't let anyone break your water!  This is more likely to happen if the baby is high in the pelvis.  If your baby is low, this is not really a risk.  Also, if this is going to occur, it usually happens when the water breaks. 

A couple other things worth noting that may or may not seem obvious:  You will be on a time clock once your water breaks (find out what that means at your place of birth - usually 12-24 hours), so you really want to do things that encourage the baby to come.  Laying in bed on a monitor doesn't really do that!  Pitocin is usually started after water breaks.  Evidence just doesn't make a lot of sense with this policy.  They say that they are trying to prevent you from having a c-section, but by keeping you in bed, that is exactly where you are headed!

3)  Vaginal Exams every two hours.  The reason women are given vaginal exams are because they have epidurals and can't feel when they are ready to push.  A woman who isn't numb doesn't need to be told how dilated she is or when to push.  Failure to Progress is the 2nd most common reason women have c-sections (2nd to already having had a previous c-section).  So let's add this up:  She's in bed, on a fetal monitor, having vaginal exams every two hours.  She's not moving or using gravity. I know of a hospital midwifery group that hardly ever does vaginal exams, unless there is a medical reason to do so.  This is how it should be.  Many women will stay at a certain number of dilation for many hours and then suddenly dilate in a short amount of time.  Labor is not all about the dilation of the cervix!  Vaginal exams are directly related to the dreaded time clock. 

4)  Does your hospital employ midwives?  This is a big deal.  If there are not midwives at your hospital, only the medical model of care is practiced.  This is the only model the OBs use and the only model the nurses see.  The midwifery model of care views labor and birth as a normal process.  The medical model views childbirth as a medical emergency waiting to happen. They believe that medicine and technology improve the safety and process of birth.  

5)  Does your hospital have a no-VBAC policy?  Then they don't trust birth and they don't read the evidence.

Finally, don't ignore the red flags.   I could go on and on about policies that the majority of hospitals have that are problems for a natural birth mama.  Follow your gut.  There are great places to have your baby.  Seek them out.  Hopefully this list will be helpful on your journey.  Don't be a victim!  Like I always say, as long as your baby is still inside, you have options.  This is your birth.  Choose a birth place that respects your wishes and shows reverence towards your special day.

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