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

Tuesday, April 29, 2008

Warning: Rant Ahead

Beware to those who don't feel like listening to me bitch and whine because that is what this post is going to be all about. And I'm pretty good at it.

Life just keeps getting busier and busier; my last few clinical days have been overwhelmingly busy with some really unusual things on top of a lot of women in labor who lack any coping skills or pain thresholds. I can feel the daggers coming via comments as I type; but bear with me. (Is it bear? That doesn't seem right.) When a woman becomes pregnant, doesn't she know she must feel a contraction or two? Hasn't she had at least several months to start preparing for birth, even if all she thinks is necessary is to watch A Baby Story? Even A Baby Story depicts painful contractions. Oh, I don't know... I just don't get it. Well, perhaps I get it a little bit- I'm sure these women know that labor usually equates pain but their fear just takes such hold of them they can't get past it. I could get into why it is so important to prepare for childbirth because fear and anxiety can worsen the pain, which then worsens the fears, and on and on. But when you don't realize that the fear makes things worse, I guess you don't really try to work past the fear or even realize that you should. I'm sure this seems insensitive to some of you, but after all the years I have worked in obstetrics it's just something I have never understood completely.

And speaking of A Baby Story, I was in the office the other day doing some new prenatal visits. A young girl (18 years old) and her boyfriend were full of questions based on what they have been watching on TV. Here are some examples of what they were worried about, thanks to A Baby Story:
"Will I end up with a c-section because I have small hips?"
"How long will my baby be in the NICU?"
"When the baby's heart stops because of an epidural, do they use forceps?"
"When will they take all the fluid from the baby to see if it's deformed?"
"When they take me to the operating room, do I have to be put to sleep?"

Thank you, A Baby Story. Thanks for your useful information and educating the women of our country on the realities of childbirth.

Another new prenatal visit reminded me that not everyone understands fertility and the normal menstrual cycle. A 22 year old, who had a 4 year old son, was surprised that she got pregnant. I asked if she was using any type of contraception and she said no. She went on to explain that her periods were only 2 days long so she thought she was infertile. I asked if her periods were regular, and yes, they were. But when she got pregnant with her son her periods were 5 days long and heavier; since then her periods changed to lighter, shorter periods and so she just assumed that it was abnormal and wouldn't need birth control because she was not able to get pregnant with such short periods. How was it possible that a baby could grow when she didn't have enough blood?



Anonymous said...

For me, at least, so much of my anxiety, fear, and subsequent failure to handle birth well came from my medical care. I always came with questions for my doctor but she never had time to answer them. She'd say she could answer three each visit and had more than that. Her rush made me feel stressed and scared which made me feel stressed about birth. And it didn't help that I was left to google my questions and read all the terrifying things on the internet. I honestly never realized how little support pregnant women get until I was pregnant.

Nine Texans and friends.... said...

Rant away.
So many women assume they will get 'their' epidural immediately upon walking into the hospital and then feel absolutely nothing from that point on. They feel no need to take childbirth ed. or read any good, accurate books, after all once they get 'their' epidural it doesn't matter, right?
Just as annoying as the women who do, do all the 'right' things and take all the 'right' classes who refuse to educate themselves about epidurals or C-sections because they *will* go all natural.
how about everyone wake up to the fact that birth is nothing if not predictable and it is best to be familiar with typical/common scenarios/occurences such as...prodromal labor, back labor, precipitous labor, side effects of epidurals, epidurals that don't 'take', epidurals that turn into spinals, pressure vs. pain...the IMMENSE amount of pressure one feels even with a 'good' epidural, labor augmentation, fetal distress....a little education goes a long way .

I wish that more hospitals and birth centers would make GOOD CBE classes more accessible and affordable and that more HCP's would encourage it.
I worked in a university hospital serving a very diverse population. Unfortunately the CBE classes were out of price range for a good portion of that population. When you are struggling to pay rent and buy food, where are you going to find $120 for CBE? I've NEVER had any care provider ask me my plans for CBE or even if I've had any. Sure by this point (about to have #8) they assume I know the ropes but what about #1 and #2 (who was a vBAC)??

A Baby Story should have some kind of disclaimer before it starts. Showing , what?, 12 minutes of what is a 4-30+ hour accurate portrayal of what labor and birth is like??

Ethel said...

I forget how little folks are educated sometimes. I love "A Baby Story" only becuase I want to see what the cord looks like, how big the baby is (usually small babies) and how families approach birth differently. It's not really an educational program at all. Especially since the babies are usually fed with a bottle or they edit out the nursing (that's my big bitch about the show). But yeah, COME ON!

It's interesting how much folks will talk about what they don't understand/know and use that (non)information. Wait, does that include me?

Labor Nurse said...

anonymous.... just three questions a visit, huh? That's a terrible way to treat patients. Can you imagine if this were the standard in other areas of medicine? Like oncology, for only get three questions each time you come in for your treatment. That's flabbergasting!

Nine texans- you hit the nail on the head perfectly! I agree with you completely re: educating yourself and that goes for all women regardless of their birth plans and ideas.

Sarah said...

I don't know what area anonymous is from but it was very similar for me. I once asked my doctor if I could ask a question and he said only if it is a quick one because he has other patients to see! I totally understand that doctors as well as other professions have bad days and can sometimes be short with patients but I get this feeling from him a lot. Huh, maybe I should switch?

Hilary said...

Thank you! Excellent rant.

Yes, many moms think that the prospect of an epidural means a pain free labor. A relative told me that she didn't need to take any child birthing classes because her doctor told her that she didn't deserve to feel any pain, and besides, she watched A Baby Story.

Then she told me that she would be induced, because her doc induces all of his clients. She had irregular periods and wasn't sure of her date of conception. She also had hyperemesis gravidum and was a smoker, so who knows what the normal growth and weight gain was supposed to be. When i told her she was a poor candidate for induction, and then her doctor agreed, that was the last conversation we had about her pregnancy.

My prep talk for moms who I worked with as a doula involved me telling them how long it takes to be triaged and admitted. Moms who were planning to get an epidural, I warned them about how they needed to get blood work done, be admitted, have twenty minutes on monitor, and have a big IV bag or two infused before any anesthesia is administered at all, in most cases. We are talking an hour or two of active labor.

As for the ridiculous fear filled shows, have any of you ever seen House of Babies on Discovery Health? I hope you all thought it was a little better! I was actually on that show.

FutureNP said...

When I think about the issues that we have with modern maternity care, I often wonder "how did they deal with this in my great-great-grandmother's day"? You know, back when childbirth was viewed as a normal, natural event. Well, the answer is that "back then" women would have been educated about childbirth by their families, and probably even by seeing some births before they found themselves pregnant. They would have seen the process, so they would know what to expect. I wonder how we can bring this type of experiential learning back today? I never attended a birth before my own, but "birth talk" was common around our house. Even from a young age I knew that my Mom delivered both my sister and I without any meds, refused to be shaved (back in the 70's), breastfed us, etc. It certainly contributed to my very informed but pretty laid-back attitude about my 2 births. Not that I did everything right or had the perfect experience, but I have very few complaints.

And barring better family teaching/learning, I totally agree that hospitals should be providing quality, low-cost CBE. The hospital where I delivered had free CBE - not perfect, but better than nothing. After I graduate from nursing school, I hope to be able to teach some childbirth ed wherever I end up working.

Anonymous said...

I understand that would be frustrating, but that is your field right? Breaking your arm hurts, you expect that, but I can imagine some people would express that, some louder and more annoying than others.

Now this is coming from someone who has had a natural birth, plan on doing so again. I am very much for the midwifery model as opposed to the lovely "baby story when will my baby go to the NICU way of thinking". Part of the midwifery model is not only to understand that contractions are normal and important, but to let the patient feel SAFE enough to express whatever they are feeling.

Now I am a quite laborer, but I have read many home birth/ natural birth stories where the mom in labor is very vocal about her pain moaning, and groaning. I have even heard of some midwifes coaching there patients to growl as a means of pain relief. I have read stories of women screaming how bad it hurts, but making it through. Now I don't think I could ever do that myself, but if it helps more power too you. Even if it helps until your epidural arrives, then that what helps.

I get ranting but I think the problem I have with it is the vibe I get that patients must be quite and poliet, which they really don't need to be.

Still I wish every woman would educate themselves on not only labor but their bodies. I think "Taking Charge of Your Fertility" should be a required read in school, seriously! I also think that hospital classes should have a broader scope of training. If that means telling women you need to educate yourself in case you can not get an epidural, here are some resources then that would be wonderful. Above all I think there should be an attitude of labor as you wish, screaming or whining included. Contractions hurt some times, some women orgasm, for some it just hurts like hell. Do other patients who are in the hospital for other reason who are hurting like hell annoy their nurses? Probably not as much. Just because contractions are normal and not indicitive of a problem does not make them suddenly not painful for some. Not everyone will suck it up, try not to let it get to you, it is your job after all.

Liz said...

It's something that frustrates me constantly on various baby boards.

There are so many women who plan epidurals and decide they don't need childbirth classes or preparations. I find that mind boggling. You can't get it right away, and sometimes it doesn't work. Wouldn't you want to know how to cope? Don't you want to know the basic scenarios of what could happen and when certain procedures would be necessary?

One of the women in my natural birth group joined us after her surprise pregnancy. Her first birth was a nightmare of failed pain med after failed pain med. Three tries at an epidural - only one took, and it went up, paralyzing her upper body. She had not taken any kind of class and was terrified of the pain she was experiencing. Now she feel so much more relaxed and looking forward to the experience, because she feels she will be more in control. I can think of another woman who has decided not to have any more kids after her body metabolized the drugs so quickly her epi never worked. Of course, her entire birth plan consisted of Epi NOW. She was very traumatized and I can't blame her.

Likewise, as was mentioned, the women prepping for natural birth who refuse to plan for pain meds and/or surgical intervention. It's all well and good to plan for natural birth - but again, cover your contingencies! Why wouldn't you want to plan for all possibilities?

I don't understand why women give up so much control over their labors and bodies. Obviously you can't predict or control or direct labor - but you can have plans and back up plans!

As for a Baby Story - that show makes me ill, so I no longer watch.

Real said...

It just goes to show you that most women think the only reason for childbirth classes is for pain coping techniques for "going natural." They have the idea that since they are going to have an epidural, they don't need to know anything else about the process or what to expect or that it might be several hours before they can get any anesthesia.

In my experience, most childbirth educators (especially non-RNs) are natural childbirth advocates. I just haven't seen women who have had two epidural births getting excited and/or educated enough about birth to care about teaching it.

Nine Texans and friends.... said...

I can't speak for Labor nurse but I think you missed the point of her post. I am pretty sure she has no issue with women making noise in labor and birth. It's normal. There is noise (moaning, groaning, roaring, growling and even screaming-although screaming rarely helps as much as lower pitched noises) and there is out of control hysterics.
It's the women who are out of control and completely blind-sided by what they are feeling because they only prepped themselves for an immediate epidural and pain-free labor that are hard to take care of. There is a pretty big difference between women who are primal and noisy in their birthing but not fearful and a woman who is screaming out of pain and terror. The woman screaming in pain and terror is REALLY hard to take care of as she just can't/isn't able to listen to anything anyone says to try and help her and her baby. It's a scary spot for all involved; the mom, the partner, the care giver.

Anonymous said...

A baby story pisses me off to no end, teaching our girls that that's how childbirth is.. and i swear 7 times out of 10 it ends up in a c-section.

Labor Nurse said...

nine texans has it right. Its not the noise I care about. Make all the noise you want! It doesn't bother me. I would prefer a woman make the noise that makes her feel better than for her to think that she needs to be quiet and "control" the noise just to not offend anyone in the room. On the other hand, as Nine Texans points out, the woman who is screaming out of fear is difficult to care for because it's next to impossible to break that fear in the moment of such intensity. And if anyone has any tips, I'd love to hear them!!!!

Shana said...

A Baby Story is such a scary, horrifying show. There are a couple of others on Discovery Channel that is just as bad. One is called "A Baby Diary" and each show follows one woman through the end of the pregnancy, the birth, and a few weeks PP. Last week I watched on and commentator of the show said something like, "Jane decided to try for a natural birth and forgo an epidural, and she is paying for it now with the pain she is in". Later on in the PP part of the show the mom was breastfeeding her baby and the commentator said, "Jane has decided to try to breastfeed her baby, but breastfeeding is extremely difficult and most moms are not able to do it". Such helpful and encouraging commentary. Not.