labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Sunday, March 16, 2008

Imagine That!

Yesterday I taught a childbirth class, something I haven’t done in a while. I was really dreading it, quite frankly, but they needed an instructor and I needed money. The class was small, which I find makes for a better session, and they were engaged in the conversation. I didn’t feel like I was lecturing, which never feels right for a childbirth class but more often than not these couples never seem very interested. And then, a father asked, “So why is it that almost everyone talks about how they ended up needing pitocin?”

Ah-ha! My segue to the soapbox.

This question came soon after a birth video in which the woman was having regular contractions every 9 minutes apart. She had a midwife, who said to the woman when she asked if they could speed up her contractions to make the labor go quicker that she was not going to mess with a process that was working fine on its own. I love that line, because it reinforces what I want to teach, not the medical dogma on how to be a good patient while in labor.

I posed the question back at the class, using the birth from the video as an example, about how each labor is different and if progress was being made do we really need anything to make it faster or better? I got an overwhelming response, and got to talk about all the reasons they’ve heard about women “needing” pitocin. I’m always amazed at the things that they hear, like a woman needed pitocin as soon as her water broke because now the baby was in grave danger of infection. Or pitocin was needed because the woman was in active labor and having contractions every 4 minutes apart with cervical change, not the 2-3 minutes that are supposed to occur during the active labor phase.

I got to tell these couples that they had a right to make decisions for themselves, and that most decisions made in labor are not emergent. For instance, when was the decision for labor augmentation made emergent? And, if this was posed to them by their provider, that they could ask for alternatives to pitocin, not to mention a few minutes to think about their options. Ultimately, the discussed turned into their rights as patients and informed consent. Even one woman said, “So if we are being told we need something, we can say no if we disagree?”

Imagine that.


Student Nurse Midwife said...

The reasons the class presents as "why" they heard women needed Pitocin are valid. I've heard almost all of the same reasons coming from OBs.

In particular, a patient who had been ruptured for an hour who was told she needed Pitocin to speed up the labor because the baby could contract an infection. No complications were present. Mom ended up with the diagnosis of failure to progress and had a C-section.

It's good to provide couples with knowledge that they *can* (and should, if not medically warranted) refuse interventions. Bravo.

Sheridan said...

Even one woman said, “So if we are being told we need something, we can say no if we disagree?”

YES! This is so important to know! If only every mom KNEW this and EMBRACED it and LIVED it. Think of the changes that could be made. :)

Christina said...

Go you! You just did all of those couples a great service by explaining patient rights. Hopefully they'll go into labor thinking more about what is needed and question some of the interventions that may be pushed on them.

I know there are necessary interventions, but so often non-necessary ones are done without presenting a full picture of what is happening.

I am a Monkey's Momma said...

Paging Dr. God. Dr. God and RN God. You are both needed in L&D to augment every laboring woman who waddles in the door and predict her birthing abilities....Dr. God & RN GOd we need you now!

If only I had known....I'd be waddling a *very* different path these days.

AtYourCervix said...

Bravo!! Great job on educating these couples on what choices they have when in labor. Imagine that: you actually have a choice!!

Every little bit of education helps. Even if it just helps ONE laboring woman.


Anonymous said...

I had a labor where the contractions never got any closer together than seven minutes apart, yet I was dilating. It was even that way when I was pushing. Thank God it was a homebirth so no one felt the "need" to make my contractions closer together. That was my easiest and most fun labor ever. I literally laughed and joked with everyone in the room until pushing time because I wasn't in much pain at all and it was about six hours start to finish. I DID keep asking "Are you SURE I'm progressing?" because I had never before had a labor like that. I hope this one I am expecting is the same. I wish I could get some kind of written guarantee from God that all my labors would be like that!

I'm glad you were teaching that birth class and taught them about informed consent. I don't think many hospital-based birth classes do that. I took a hospital-based birth class with my first and the nurse actually said "if your water doesn't break by 4 cm YOU HAVE NO CHOICE it will be broken for you". It made me so angry; I was one of those "natural" moms even as a first-time mother, and I KNEW from reading The Birth Book by Dr. Sears that ALWAYS have a choice, but no one else in the room probably knew that.

I don't even know why that nurse brought up AROM, that's usually a care provider thing; the nurses cannot break water.

mamaloo said...

I was reading a comment recently during an online discussion of birth issues and part of the comment consisted of the phrase "allowed to" as in "I might not have ended up with a c-section if only I was allowed to get up out of bed and move around." When I read the statement, that word ALLOWED sort of popped out at me like a blinking red light and I realised what's been bothering me for so long: people, particularly women, don't know that they have rights over their own bodies and that we've (big fat collect cultural "we") have created a maternity culture where women check their personal rights at the door and RNs, OBs and to less often midwives (I had me one of these) believe they have rights over me or can control which rights I can exercise.

Allowed to? Allowed to eat and drink at will. Allowed to move. Allowed to not be continuously monitored. Allowed to be IV free (when not medically indicated). Allowed to be consulted on procedures (yes, my midwife, you must ask me if you want to stretch my already progressing cervix). And on and on.

I'm working up an article for my doula website about this concept of being allowed to. I wish all women, before they stepped into a hospital (or even had their homebirth) felt the ownership of their bodies and exercised their rights to labour as they needed to and participate in their own care.

Prisca said...

my hospital pits almost everyone--they are obsessed w/ pit...

i personally hate it!

Christa said...

I had the most beautiful labor with my daughter. Contractions were four to five minutes apart, I was progressing rapidly. Then the midwife broke my water to see if the baby would drop. After an hour, my cervix went from six to four. The midwife started pitocin (didn't even ask) and the labor immediately became unbearable. I went from four to five minute contractions to one constant contraction. According to the doctor, my body was in transition, even if my cervix stopped at five. Of course I ended up with a cesarean, although not for failure to progress (my baby never dropped, even after the water broke and my uterus turned into one rock-hard contraction). I wish I had fought the pitocin. I questioned the need for it, but was basically ignored. However, I will say that, despite the last few hours of labor, the entire experience was generally pretty great. I came home with a beautiful little girl, which is all I really wanted in the first place.

anna said...

"Even one woman said, “So if we are being told we need something, we can say no if we disagree?”"

I really wish I knew what I can say "no" to. Eg, I don't want an IV, but can they insist on a hep lock? I don't want continuous or internal monitoring, but I was told that "continuous is the only option" at one hospital. I *really* don't want an episiotomy, but a ton of friends simply got cut without being asked.

We have a one-page birth plan with these three requests--but I have no idea whether the various nurses and doctors in and out of the delivery room will respect it, or take a look, smile, and ignore it.

Labor Nurse said...

Anna, you ask some very good questions. You have the right to say to anything. However, there are providers and hospitals who will say that if you do not comply with their protocols (ie, standard heplock protocol) that they will not care for you. They can't abandon you, but instead would send you elsewhere. On that note, it sounds like most of the hospitals in your area practice in a similar manner.

Unfortunately, you and your partner need to be super vigilant at these types of places, which can be very hard to do when you are in labor.

Have you talked with your provider about your wishes? I'd start this conversation with that person now, and also ask what their partners practices are, because they might be the person on call when you are in labor.

anna said...

Thanks, LN. I did talk to my ob/gyn, and she's completely fine with all my "requests," and even put them in my chart. And the hospital where I'll deliver is quite progressive: they "let" women labor as long as they need to (the other one has a three hour pushing cut-off, after which it's an automatic c-section), food and drink are encouraged, there are tub rooms, they're good with doulas, etc.

My worry is that these fairly simple and reasonable wishes of mine will all go out the window when a Dr. Windbag is the one to deliver, and he/ she couldn't care less about my wishes, because, after all, he/ she is the doctor and knows better. And I've just no idea how to protect ourselves against that kind of arrogance.

Birth plans have no legal standing, and I've even read (on another blog) that some nurses' reaction is exactly the opposite: a birth plan is something to ignore and scoff at, because it reveals the profound naivete of its authors.

Anonymous said...

Oh, I couldn't even tell you how many couples ask me questions like that in my CBE classes. I spend a whole class talking about what "normal" labor and delivery is like and then about their rights as patients. Can you tell I teach private classes ;)?

Every woman needs to know that she is the one doing the birthing and has the power!

Love, Alyson

Angi said...

And you're SURE you're NOT a DOULA????

I think a nurse here in Southern Ohio, giving such OUTRAGEOUS information as informed consent, would be drawn and quartered for such treason!

Anonymous said...

Wow, we need more educators like you. When I asked if I had a choice to refuse the I.V. at my first(only so far) birth the nurse to me "no". It makes me so mad that I was lied to. If only someone had armed me with the truth.