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

Wednesday, May 27, 2009

My Last Shift

My last shift as a labor nurse was today, and my last birth in this role was with a woman who was also a labor nurse. When I got report in the morning, and was told what she did, I thought it was an ironic way of ending my labor nurse career.

This woman worked more years than I as a labor nurse but worked at a different hospital. The hospital she works at is known for some major old school obstetrics. This place still does routine episiotomies, tethers women in bed, elective inductions as early as 37 weeks, and even have a few doctors that will do maternal requested c-sections. I get report from the off-going nurse and learn that she has recently received an epidural and plans to sleep until it's time to push. I hurried into the room so that I can catch her before she falls fast asleep (I hate waking sleeping women once comfortable with an epidural!).

So we chat some, and I offer her something to drink. She balked. "I'm supposed to be NPO!" (Nothing by mouth).

"We allow clear liquids here, even with epidurals," I said. I hate that the word "allow" is in there, but that is what it is.

She is clearly surprised but very happy to accept some apple juice. I get her settled, turn down the lights, give her the call light, tell her I won't disturb her for a little while unless she needs me or its time for some assessment.

Next time I see go in to see her, she is waking up. She's still very comfortable but curious how much further she's dilated. It hadn't been a long time since her last check, and I said since she was ruptured exams are kept to a minimum. Unless she was feeling an urge to push, the doctors will not be anxious to do an exam.

"Really? It's been two hours... our patients get checked every two hours on the dot without exception!" she said.

"We try not to unless necessary," I responded. Of course we have our exceptions depending on who's on call. But overall, if someone has been progressing in their labor, we just let it happen.

We continue to talk and then she asked, "If I am checked sometime soon, and I'm fully dilated, can I labor down?"

Laboring down is awesome. I can tell you I am all for it. It's a great way of helping a woman who would probably push for hours with a dense epidural with no urge to push and needing to be told each and every time when she should push. It cuts down on pushing time, and may help protect the perineal tissues from excessive trauma.

I tell her we use laboring down fairly often under certain circumstances. Again, she is surprised. Laboring down is not allowed at her hospital If you are fully, pushing must be started no matter what and the clock has begun to possible c-section for "failure to descend".

And so by lunch time she was fully, and not feeling any strong urge to push. Laboring down was the plan. She labored down for about two hours and then she started pushing. Her pushing was not all that superb so I tried all sorts of positions with her. She even said she wished she could sit to push, and I said, "You can!" She didn't believe me, because she thought this was not possible in the bed.

Now this is when I couldn't believe a more experience labor nurse had no clue how to manipulate a labor bed to help the woman in a sitting or squatting position. I even got the squat bar and showed her how to use it.

"I had no idea! Our patients with epidurals lay on their backs only," she explained.


She went on to have a nice birth, a beautiful baby boy weighing 8 pounds even, and put him to breast immediately. She offered him up to go to the nursery but I said there was no need to- it would be better for him to stay with her. Of course she was very happy to keep him with her.

As much as I was saddened and a bit appalled that this very experienced labor nurse had no idea some of the very basic labor support methods nurses can use, I was so glad that she got to experience them first hand. Hopefully when she returns to work she will remember what she learned and teach her fellow nurses.


Joyce said...

Sounds like the 1970's at my local hospital. The docs/nurses I used had a certain set of procedures they followed for their births if you didn't take a Lamaze class. No class, no veering from the rules. If I could turn back time, there wouldn't have been a spinal but I was young and didn't realize I could have said no and insisted no.

Reality Rounds said...

The culture in certain hospitals is mind boggling. It can be a very hard culture to change, but it can change. Hopefully this nurse will bring back the great care and techniques you gave her, to her own hospital. Who knows, it might be the first step to change.

Julia said...

Remind me never to give birth at her hospital. Dude. I'm glad that you were able to give her a different experience.

Anonymous said...

Good for you! You will be a wonderful midwife! But, doesn't this illustrate why women are so afraid of birth? Think of all the women she cared for who had to abide by those rules.

Heather T said...

Wow, I wish you could be there when I have my next baby. I wish you had been there when I had the first 15 years ago!

MomTFH said...

What a nice yet ironic send off. Enjoy your new path!

Iris said...

So glad you were there for her and showed her those things were "allowed."

Anonymous said...

This post makes me want to cry -- for this nurse, and for all the women she "cared" for in the past. (Sounds like the hospitals where my sisters gave birth; and is also the main reason why I choose home birth.) But I am hopeful that you were able to teach her through this one experience more than she learned in her entire career up till now.

Good luck in your midwifery career! I'm so excited for you.


Morgan said...

Interesting how every hospital seems to do different things.

Nurse Practitioners Save Lives said...

My first love was maternity, but alas, I got stuck in med/surg and then continued on to become a nurse practitioner. Sometimes I wonder if I chose the wrong line. I make up for it by being present at every family member's births and coaching from the sidelines.

Anonymous said...

"But, doesn't this illustrate why women are so afraid of birth? Think of all the women she cared for who had to abide by those rules."

Uhm... yeah... women don't exactly look forward to birth if that's what they expect, but 99% of people who are afraid of birth are afraid of the pain, the recovery time, and the possibility of death or serious injury, not being strapped to a bed, even when they have experienced it. The only time I've ever met someone who described fear because of old-school birth tactics, she was having a homebirth, so clearly she wasn't afraid of birth. Women who are afraid of birth are afraid of the normal birth-- pain, suffering, long recovery and a looming possibility of death.

Anonymous said...

2nd Anon (responding to 1st anon's comment) -- you say that women who are afraid of birth are afraid of the pain involved. True enough; but most women who have experienced both home birth and hospital birth would say that the latter is much more painful. Also, most women who have experienced birth strapped down in bed (typical in many hospitals) and birth upright and mobile (standard for home births, not so allowable in many hospitals) say that the latter is preferable. So, what you basically have in this country is women who flock to the hospital out of fear of pain, and then end up having more pain in hospitals -- because of hospitals, and their nonphysiological way of handling birth.

Pain and suffering are much more likely to happen when being required to lie on your back in bed (one ctx like that when my midwife checked me during labor was enough to let me know THIS is why women have epidurals in the hospital. I had one contraction like that -- many women endure hours of them like that before caving). Long recoveries are no more likely to happen in home births, and are actually recoveries are more likely to be shorter, since most interventions (like forceps and the like) are not used at home births. The maternal death rate is quite low in the US, but is higher with C-sections and after other interventions than with natural birth (defined however you wish to define it), so, again, you can lower your risk of maternal death as a group by staying out of hospitals and away from interventions which may introduce risk without greater benefit.

Certainly, some women do better in hospitals and need to give birth there; ditto some babies. But if women give birth in hospitals solely for the reasons you've chosen, then they're better off to stay at home, and learn how to manage the natural sensations of labor and birth without being overwhelmed by the sometimes painful contractions, than to go to a hospital that does not allow freedom of movement, etc.


Anonymous said...

Labor Nurse, from what I remember of you when I was led to your blog from allnurses you and I are in a similar geographic area, and I can tell you that my hospital is very old school. My boss couldn't understand why I wasn't progressing faster in orientation... sure I could do the manual stuff and document, but I felt totally inept at actually supporting a woman in labor and no one seemed to care. There were a few supportive nurses, but most were resigned to pushing the pit and rushing to c-sections. Guess it's no surprise that as of 2006 -- the most recent year of data I could find on the DPH website -- my hospital had the highest c-section rate in the state... and we're a community hospital! Ridiculous! What really pissed me off is that the nurses who do care (and I count me in that list) take off because they can't deal with it and the women in the community (many of whom are underserved and vulnerable) are left with needless interventions not knowing that there's any other way to do birth. I am so glad there are people like you entering the field! Gives me hope that we really can move towards a safer and more meaningful birth experience for women and their families.

Michelle said...

That is generally the norm. Here I was an anomaly for wanting to labor without the epidural.

Even all the baby shows the women are flat on their backs being told when and how much to push.

I cant stand it.

I think your hospital is the exception...I never see that or hear that.

Kim said...

Wow. I'm so glad that you were her labor nurse! I hope that her experience with you might impact her in some meaningful way.