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

Tuesday, January 27, 2009

Yet Another...

This one had steam coming out my ears....

Young woman, first time mother, in early labor. Well, more like prodromal labor because her cervix was not changing, or could have been false labor, but at this point we didn't know. She was just beside herself with her contractions so she stayed for some IV medication and sleep, and then was reevaluated several hours later. The resident did the exam and pronounced no change in the cervix. The woman was offered another dose of IV medication or to go home. She was undecided about what to do, so she was given some time with her husband to discuss what would be best.

I went back to her room to see what she wanted to do about 10 minutes later. She still wasn't sure, but needed to discuss the pro's and con's of both with me. As we talked the attending doctor came in and announced that she was going to reexamine her. I thought this was odd, and told the attending doctor that the resident just did an exam, that the cervix wasn't changed and the woman was discussing the options of more medication or going home.

The attending just said, "I'm still going to check her."

Attending does the exam, and while her hand was still in the woman's vagina announces that she is 5 centimeters and give her an amniohook so she can break her water. The woman was so happy to hear that she was 5cms that she was like, "Well, then, please break my water! Make this happen!"

So water now broken, woman happy but contracting more strongly almost immediately, the attending stands over the woman with her arms crossed and says, "So I'm told you are doing this natural?"

Before the woman can answer the attending makes a noise like, "Oh, please!" She then goes on to say, "Trust me, you won't be able to do it! You already needed IV medication when you weren't quite in labor yet. Don't go fooling yourself, really!"

I was shocked. Shocked.

And then the attending walks out.

The woman at this point was contracting quite frequently and much stronger. Before I could say anything, she said to me, "I don't want anything!"

And I said, "Of course. You can do what you want, and you can do it." A very simple statement compared to what was going on in my head.

The woman went on to labor without any medication. She was of course having a difficult time, particularly when she hit the transition phase of the labor, but went on to have the unmedicated birth she desired.

18 comments:

TracyKM said...

Wow. Perhaps that attending was part of a bet pool that that patient wouldn't go natural?
I was so impressed when I had wanted to go drug free, and then back labour had me changing my mind; I spoke with the anesthesiologist and he said he didn't think I needed an epidural that I was doing great without one! (I ended up pretty much being forced to have one, waited three hours, fully dialated and trying not to push...)
She's SO lucky to have you there!

womantowomancbe said...

Yay mama! And kudos to the supportive nurse too!

Remind me never to pick that doctor. Sounds like a real piece of work.

-Kathy

Jill said...

Ouch.

mommymichael said...

ARGH!!! ooooooo that's really annoying to say the least. what a bitch, man.


from my experience, my 3 weeks of prodromal labor were MORE uncomfortable than the actual labor and birth itself. I had contractions 2-3 minutes apart for several hours then they'd stop.. every day for 3 weeks. and the littlest thing would set it off. like a sneeze. or going pee...

maybe it was all in my head. the waiting for it to be real part, but there was just a different feeling from the prodromal labor to the actual progression made from the contractions. those felt much better. muuuuch better.

Jill said...

Shame on the attending. Maybe it strengthened her will to give birth naturally. I'm glad you were there for her. Nurses make ALL the difference.

Anonymous said...

I'm sorry. I've been following your blog for quite a while now, and I know this is going to drive you crazy, but I just don't get the whole "have to have an unmedicated birth" thing. And before I go any further, I do realize that at least one of your points is that the doctor was trying to dissuade the woman from her stated wishes.

I had our second child 16 months ago. After reading your blog and others I thought things like the birthing ball etc sounded helpful, and so I discussed with my OB delaying or foregoing an epidural. She wasn't quite as bad as your doctor, but she more or less told me I was crazy and that she has had patients who have had no pain meds for three or four births and an epidural for the last and for the life of them couldn't figure out why they hadn't done it that way all along.

After our son was born, I was soooo glad I had an epidural and had it early. It wasn't a painless birth, but it was very pleasant and relaxed. I wasn't sweaty and exhausted afterward either which was nice b/c I was off to a better start taking care of a new born. Of course I couldn't get up an walk afterward but where was I going anyway? I was staying in a bed breast feeding.

Susan

Jody said...

Grrrr at the docs sometimes. They make fun of women who want to go natural. They make fun of women who have "birth plans". They insist on them getting epidurals when they're 9cms. It makes me crazy inside. I think if you've gotten to 9cms...then forget epidurals at that point.

Shesh. They just don't get it. And 99% of the nurses I work with don't get it either.

Nuff said..

Jack and Lexi's Mom said...

I had one baby with an epidural and one with no medication. I do not regret the epidural. I had been 4cm for four hours and really, really needed to relax. I practiced self hypnosis with number two. I had an eight hour labor. Six of those hours were pain free. The last two hours hurt. I will go natural again. I felt better afterwards. I gave my daughter her first bath. She was more awake and interested in nursing than her brother had been. I can see benefits to both but will go natural if I am ever blessed with another child.

evil cake lady said...

wow, the insensitivity of "care" providers can be apalling at times! it can be hard being the witness in times like that.

she was really lucky to have you there to support her choices. and good for her, for proving the attendant wrong!

Student Nurse Midwife said...

In my opinion, I'm all about choice. If you want an epidural, then by all means you should be able to have one. Unfortunately, a lot of women who want to choose an unmedicated birth face obstacles and have a hard time making choices that aren't readily available to them (ie. laboring in the water, freedom of movement, changing positions, alternative pain management -- TENS, pudendal blocks, sterile saline injections, etc.) I think the lack of choice is disappointing.

Although the doctor's reaction to the patient's request for an unmedicated labor is not uncommon or very professional, I think OBGYNs don't have a lot of experience with unmedicated births. It's scary to them especially when you're taught that pain is something negative that must always be "treated." We learn in school that pain is bad and a patient should never be in pain.

Sara said...

oh good grief.

I wish I had you when I was in labor. :) My nurse kept offering me drugs, and when I was pushing SOMEONE (not sure if it was her or the OB) told me it was "too late for an epidural) when I complained that they were tearing me with their "stretch the peri" pulling. :p I wanted to snap their heads off and tell them that I didn't WANT an epidural. :p

Sandra said...

I had a nurse like that at my first (of four) natural childbirths. I still remember her looking at me and saying, "Oh honey, you'll be asking for drugs" and chuckling.

I was so angry at that comment but speechless - and of course went on to have a pain-free natural childbirth - followed by three others.

What's wrong with people constantly thinking natural childbirth is NOT normal??????

Anonymous said...

It's so funny. I just had my 3rd baby 2 weeks ago and the labor nurse was mad that I DID get my epidural!

My first daughter was an emergency induction for severe preeclampsia. They told me I had to have the epidural before they started labor. I was totally ok with that. I got it before they started pit and still went fast 5 to 10cms in one contraction when they broke my water. 7 hours total.

My second daughter was an emergency induction. Except this time my ob didn't even try to ripen my cervix (different hospital and ob). They just started pit and broke my water at 3cms. I freaked because I went so fast with the first. Yep, didn't get the epi till 8-9 cms and it DIDN'T WORK. I was so upset. I did not want a natural childbirth. 3 hours.

So this time, I wrote on the birth plan that I went fast. I had the same ob and hospital as baby 2. I wrote the circumstances of the last two births. I put in there I wanted an epi as soon as I could. That I was not interested in natural childbirth. Don't bother offering it to me.

So this time I had mild pe. My ob told me I could wait and get sicker or I could agree to an amnio and do an induction 2 days later at 36 weeks if lungs were mature. I chose the amnio (good thing I did because bp skyrocketed the next week). Her lungs were mature and I came in that night for induction. They did the cervadil. The next morning the labor nurse removed the cervadil, checked me and said nothing. She told my ob my cervix was not ready. Ob came in 2 hours later. Checked me and I was 3cms and he said time to move to L&D. I promptly said good I want my epidural. He and the nurse looked at each other. I said I am not kidding. I am 3cms. I am eligible. I had no pain, no contractions, nothing. My ob said give it to her. We'll let the pit and epi fight it out. That nurse was sooo mad that I got it early. I don't care, I have had enough pain to last me a lifetime and had nothing to prove with natural childbirth. Got the epidural immediately after that. My ob came in and broke my water. Same thing again, complete in an hour and a half. We had to wait an hour for her to come down because she was so high up. I had dialated around her. She was born not even 3 hours after breaking my water at 4cms. I had the easiest delivery yet.

It amazed me how upset this nurse was that I got an epidural later. The fact of the matter was, it was my birth. If I wanted it early, so what. It made her job easier as I did not need help going to the bathroom or anything. I don't even think I used the call light till it was time to push. I was an easy labor patient.

So I guess it goes both ways. One where someone wanted to control when a patient got an epidural and another where the doctor told them you can't do it. You can't win.

Debbie Does Nothing said...

What the hell is wrong with doctors like that?

Iris said...

Good for you for supporting the mother!!

MomTFH said...

I don't know why people can't read a story like this, realize the attending was out of line, and not push their own desires about their own births on others.

This story has nothing to do with how much anyone loved their epidural or how they can't understand how other people can't come to their own opinions. No one should be shamed by a health care practitioner for making a legitimate health care decision, no one should be forced into an intervention, and no one should tell other women that what they wanted for their pregnancy is the right and only way to go.

Labor Nurse said...

momtfh, you said it better than I could have, and I'm not sure if I made it clear in this post that I wasn't pushing any type of birth, but rather trying to protect what the woman said she wanted.

Kristina said...

I've seen things like this said..and I suspect that statements like this from docs/nurses happen because they are overworked. Hire more midwives and you'll thin your workload!

And...what MomTFH said :)