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

Sunday, October 26, 2008

Knowledge is Power

On line with my previous post regarding knowledge of the birth process in the hospital, and just knowledge of normal birth in general, or even knowledge of what specific events have occurred during their own birth- I'm amazed at how little people know.

When I meet people, my profession frequently comes up in conversation. And this leads into various birth stories, doctor stories, nurse stories, midwife stories, medical problems. Just recently I met a couple who had a baby just days before. They were very excited to discuss the details of the labor and birth, and from what I gathered by what they were telling me, it became very obvious they really didn't know what was going on and why certain things were happening. They said they were threatened with a c-section because the woman's heart rate bottomed out requiring oxygen. The baby needed to be cared for by a NICU nurse in the regular nursery because they had to suck out the nose at birth.

For those who are labor nurses or midwives, or some other person working in the birth arena, know that neither of these things were the reason a c-section was "threatened" nor that a NICU nurse was needed to care for their baby.

How many people have a total misunderstanding of what occurs in birth, or specifically their own birth?

I think we (birth care providers in general) totally miss the boat on educating people on what is going on. Perhaps we assume that what we are explaining (if anything at all in some cases or places) makes perfect sense to those we are caring for when in fact they are not understanding or misunderstand the information. On the other hand, I've seen plenty of people not bothering in trying to educate themselves or be assertive in their care because "the doctor/midwife/nurse is the professional and knows what to do/what should happen/what I need..." the list goes on.

In order to change the care in the maternity care system in our country, we need to educate the public better. We need to educate people what actually happens on labor and delivery units across this country, and not by the daytime tv shows sensationalizing how disaster is lurking just a breath away and how technology and medicine saves the day. We need to educate the public on the normalcy of birth. When people begin to understand what is routine in many labor and delivery units, people would start to buck the system.

I don't know how this could be possible, frankly. It seems like such a daunting task. There is a small subset of people in this country who do support normal birth and want to educate the masses- and are trying their hardest to do it- but there are gobs more of those who like the system just the way it is and have stronger, louder, and more expensive voices when dealing with the public.

I feel like I am rambling now, so I'll try to wrap this up. Bottom line: knowledge is power. And it begins with knowing what went on in your own birth, and then people can start to understand more and more about the system we have right now. I think once it's obvious that much of what occurs during birth in many systems and how it goes against the normal and natural process of birth, things can change.

22 comments:

Sheridan said...

This is so true and important!

Education is key, but the question is, how to get the moms to want to learn and how to get normal birth information into their hands.

I do my part as a Childbirth Educator and being in charge of the Hypnobabies Yahoo Group, so I feel that I help 100's women a year (mostly from the yahoo group, I don't teach that many in my live classes)

But there are so many more to reach and teach. I can only hope that blogs like yours are helping encourage moms to learn more!

Thanks!

Doreen said...

I couldn't agree with you more. I didn't know a thing with my first birth, and I had even taken a hospital childbirth ed class! I learned more with each of my births, baby #4 was born at home. And I found myself wishing I had known so much more so much sooner. I frequently talk birth with people, and it's amazing to me how many really just aren't that interested/display the "doctor knows all" attitude. It's frustrating to those of us who have come to realize how much more there is to birthing than just getting the baby out.

womantowomancbe said...

Oh, the "I'm just following doctor's orders/ suggestions / recommendations" is so mind-boggling to me!

But I will agree that in the medical profession -- as in every other profession -- there is bound to be a tendency to cut corners in educating people about their choices and options, simply because the doctors & nurses are so familiar with everything, and probably talk "short-hand" -- which everybody else employed by the hospital understands, but the average Joe (or Jane) does not.

When I worked as a pharmacy tech, we did this all the time -- we employees could talk to each other and use short words, phrases, or even acronyms, and everybody else would understand perfectly... but the customers were confused. We had to slow down and get on their level (not in a derogatory way), and explain to them the ins and outs of their medication. But I know that most of the time, we gave them minimal information unless they were "problem people" and requested more details. They were wise to be in charge of their own health, and make sure they really understood what they were being told, but it interrupted our rhythm and slowed us down.

-Kathy

mommymichael said...

I definitely went against the flow with my births. I read and read and read and asked question after question. I don't presume to know more than any caregiver, but I will ask "am i okay? is baby okay?? then is this procedure really necessary??" I think it's a harmless question and you can learn a lot just by asking it.

My births and what I learned from each of them was definitely my catalyst to wanting to help other moms become educated. Let's face it. People do more research when buying a house then when having a baby.

MomWifeNurse said...

I completely agree. I knew everything there was to know about my pregnancy and the babies development but I really didn't think a lot about the actual birth. Something I really regretted (in different ways) in both of my pregnancies. Great post!

Real said...

I'm often amazed at how much research people will put into planning a wedding or buying a car. But when it comes to their birth of their child, they just listen to the first person whose name came up in the yellow pages.

sara said...

Absolutely.

I was going to fetal monitoring/non-stress tests once every few days for the last week of pregnancy due to low fluids. During those sessions the nurse always had a hard time finding my baby's heartbeat because I had an anterior placenta and there was one spot on my lower-right abdomen that seemed ideal.

When I went into labor and they placed the fetal monitor they placed it on the left. I mentioned this. They disregarded it.

Sure enough, it started picking up my heartbeat when it migrated a few centimeters. So they all ran in screaming "dead baby!" and my heartbeat went through the roof.

Thankfully that clued them in, but if it hadn't I would have known to demand that they move the monitor down and to the right.

Nic said...

I am in complete agreement as well. I believe that knowing what you are facing gives you power to face it head on. Here's my thing, though: I try to educate myself about my well being. Be it pregnancy, birth, mental health, orthopedics, or anything else. I try really hard not to come across as a "know-it-all" but alot of the medical professionals I have encountered take my interest in what's going on as me being a control freak or trying to do their job for them. Neither of which is true, by the way. Maybe its the area I'm from...maybe most people around here are content to just get poked, prodded, etc without any questions or comments. Personally, I want to know what you are doing to me, why you are doing it and how necessary it really is. I've literally been scoffed at by a doctor for questioning his judgment on the severity of an injury...and guess what -- he was wrong and I was right! So, my question is this: how can we be knowledgeable without seeming like we are trying to do the professionals' jobs for them? (By the way, not trying to sound snarky or anything -- I really want to know.) :0) And, for the record, my intense interest in my well being is due to a seed planted by the midwife who cared for me during my pregnancy and the birth of my 1st daughter. Midwives are AMAZING (as is this blog)!

Joanne said...

Such an important topic! Great info on normal birth is available if people are interested in finding it . . . but how to get people interested????

I live in the South, and the joke around here is: what do you call "natural birth" in the South? getting your epidural without make-up on. The doctors who induce all their patients at 38 weeks and say "it's never too early for an epidural" are the popular doctors. Women here don't seem to mind that cesarians are (mysteriously) so common. Women don't want to go to the hospital in town that recently started transitioning to "family-centered maternity care" because they are afraid that they won't be able to send the baby to the nursery at night so they can "get their rest."

I have no idea how to broach the topic of natural birth with women without sounding like a raving lunatic or sounding like I am calling them Bad Moms because they sent their baby to the nursery or had an epidural or whatever. . . . We are just operating on completely different paradigms, and it's hard to even communicate across that gap at all.

Drofen said...

We have chosen to birth through a midwifery practice this time around, and unfortunately I'm still floored by the interventions they want for us.

The majority of the practice is with Medicaid patients, so it may actually just be a low cost option as opposed to a natural option.

Our first pregnancy was complicated by a placenta previa that resolved spontaneously at 36 weeks, and by pre-eclampsia, yet we somehow managed to escape with a natural birth.

This time we are determined that this birth will be on OUR terms, unless there is a true emergency.

It's difficult to stand fast against the current when it seems that the entire birth process in a hospital seems so contrary to the natural birth process.

Thank you for blogging about this!

Labor Nurse said...

Nic, it took me some time to think about the question you asked. I often find myself in the same predicament when it comes to my own health care. When I'm asked questions I answer them as a lay person, not as a nurse or midwife and not with any medical jargon. I often find that if I start answering questions like, 'what meds are you on?" with answers like... "I take such and such BID" then the provider becomes suspiscious.

So the one thing I can think of that would be hard for any provider to dismiss is to quote or bring journal articles, etc that support your decisions. Sign up for Medscape. Do your homework in advance. Even bring in things that you aren't sure you understand because it may be something the provider can look at and interpret for you and in turn you can make an informed decision.

joanne, you hit the nail on the head in so many ways. A big problem is that many woman don't want to educate themselves because they want the medicalized technologically based birth. And many times people think this is better because it signifies advancement in health care. Sure, these advances are in many ways a welcome need, but are not needed for everyone.

Drofen said...

Labor Nurse:

And yet even with the rise in medicalized technologically based births, the infant mortality rate has gone UP. And our ranking amongst developed nations hovers near the bottom of the list for mom's safety and baby's safety both.

It's truly unfortunate.

Drofen said...

Nic--

I've been in the same predicament as you as well. And finally I've just come down to the fact that they may not like what I have to say, and I may be labelled as the PITA patient on the unit, but my/our health is waaaaaay too important not to speak up!

My wife has a hard time with that stance sometimes, so it creates friction in our marriage too.

I've blogged about it a little bit:

http://4thstrike.blogspot.com/2008/10/31-weeks.html

mm said...

ITA... need more eduction on all fronts.

When I first became an L&D nurse, I was shocked to realize the number of women who educate themselves little to none during pregnancy (I would guesstimate that >90% of my patients really haven't done much at all in the way of educating themselves re: pregnancy & birth - and the next 9.5% probably isn't what I would consider enough). Seriously.

Most of my patients have some sort of pregnancy/labor high risk factor, usually related to lifestyle choices and/or mis/undereducation.

I feel that there is a particular fear/insecurity in patients when standing up for themselves with the MD's. My patients will express a certain desire with me and then COMPLETELY let the opportunity pass to talk about it with the MD when they make rounds, as if they didn't really care anyway- even though I know that's not the truth. (For example, don't want their water broken early, but will let the MD waltz in and do it without a single word).

Nurses need to educate patients more, too... except staffing is so poor in many places that we barely have the chance to do the basics much of the time, much less the "extras" that most of us would LOVE to do (and that aren't really "extras" but should be included in good care). Hospitals won't/can't staff more and it's a vicious cycle.

I love it when I get a birth plan patient, or a patient who knows enough or is curious enough, to question things, but it rarely happens (I have worked L&D for over 2 years and have probably had 2 or 3 birth plan patients). :(

On the other hand, it gives me great opportunity for education for those times that I AM able to provide it (it's not *always* so busy that I can't), and I enjoy that.

Labor Nurse said...

drofen- I wish the entire public knew about our horrible statistics when compared to other industrialized nations- particularly those who have a midwifery model of care for the majority of women. I wish they also knew that maternal mortality is going up as well.

I really just don't know what it is going to take to wake this country up.

evil cake lady said...

I totally agree. We don't know what we don't know. We have no idea how much we don't know in regards to pregnancy and childbirth. Just waking people up to that knowledge is hard!

Anonymous said...

This is a very touchy subject for me, and I appreciate you blogging about it. I didn't write a birth plan for my daughter's birth. I had gestational diabetes, and I was being induced for PIH. I knew that what I wanted, an unmedicated birth, wasn't a possibility. I accepted that I was going to have an IV. I knew I was going to have the blood pressure monitor strapped around my arm and the fetal monitors around my belly. I knew that it would be nigh onto impossible to move around. With every complication, I knew that my choices were being reduced to the point that I was determined to go with the flow to get this baby out safely.

Where the lack of information / education / understanding about my birth came in was after my daughter was born. Everything fell apart 30 minutes after her birth. I was hemorrhaging, the placenta didn't detach, and my uterus began to flip inside out. I was in so much pain and my body was going haywire from blood loss and a plummeting blood pressure that I couldn't understand what was happening. I couldn't participate in the decision-making process. I didn't understand the explanations my doctor was trying to provide. I knew that they were taking me into surgery, but I didn't know why I was going there or what they were going to do.

The lack of information continued after I was out of recovery. I knew something wasn't right. I had 8 IV's, and I was still in the labor / delivery room. When I asked what was wrong, all they told me initially was that I'd had lost a lot of blood. While this was somewhat true, it wasn't the whole story. I was at the point where I didn’t have the energy to fight for answers, and in all reality, my brain wasn’t producing the right questions to ask. When the doctor came to do rounds, he told me that the placenta came out in 20 pieces, the uterus flipped inside out, and my blood pressure plummeted from 190 / 120 to 50 / 30. However, he did not tell me that he had done a D & C after his attempt to manually remove the placenta failed. He did not tell me that the placenta not detaching was called placenta accreta. He did not tell me that my uterus flipping inside out was called a uterine inversion. He didn’t tell me that I’d lost 50 percent of my blood. He didn’t tell me what was running through the 8 IV’s that were still in my hands. Did he give me an explanation? Yes. Was it complete? No. There was no discussion of the consequences of these actions. Could I have asked? Yes. Should I have asked? Yes. Was I capable of formulating the questions? Not at that time. The trauma had taken too much of a toll on my body, and while I recognized that I wasn’t getting the full story, I wasn’t in an emotional or physical position to fight the battle to find out what had happened. I just wanted to go home. I wanted to lick my wounds in private, and pretend that it had never happened.

It wasn’t until my 6 week postpartum checkup that I found out the clinical diagnosis. At that time, I only found out because I asked if a c-section would have been a better choice than the induction. The doctor definitely wasn’t the one to initiate the conversation. Even then, it wasn’t until I was interviewing a new OB to find out what the risks were of having more children before I found out that my old OB had done a D & C.

I don’t think that my experience was all that unusual from an educational / informational standpoint. I think sometimes that the bare minimum of information is presented to the patient. Just enough information is passed on to keep them from being a pest.

Labor Nurse said...

anonymous,
thank you for sharing your (horrible) experience. Given the nature of your experience, you were certainly not in the mindset (nor your family, I presume) to be asking well thought out questions outside of "is she ok? is baby ok?" I certainly wasn't implying with my post that regardless of the immediate situation you should be asking the right questions or educating yourself in the middle of an emergency. However, your approach postpartum was right on in my opinion.

In normal, uncomplicated pregnancies and births there is plenty of time to educate and ask questions- this was the situation I was referring to in this post.

anjie said...

Amen! I have heard women say (and believe), "Ignorance is bliss." They couldn't be more wrong.

Hilary said...

Hear hear!

Jody said...

I teach and talk to my patients constantly while they're laboring with me.

Then I tell them "Knowledge is Power!!"

Jill said...

Oooh, I like your blog! I'm adding you to my blogroll. :)