Monday, January 7, 2013

Hospital Nurses and Natural Birth

A few weeks ago, I was in the emergency room with my son, thinking he had a staph infection.  Long story short, he didn't.  But it was an eventful night, to say the least.  I heard a nurse on the phone with a doctor, panicked, as a baby boy was bleeding profusely from a circumcision-gone-wrong (I don't know what happened - he was still bleeding when we left) and was quite traumatizedI also heard a room full of nurses talking about labor and birth.  I posted a few of the things on my BFBS Facebook page I heard (which were quite crazy if you asked me), and one of my former students-turning-Birth-Boot-Camp-Instructor, who happens to be a nurse, asked if she could write a blog post for Banned From Baby Showers about why nurses know so little about birth.  How could I refuse?  Thank you, Shazia, for helping us understand, not only the situation, but how we can improve the current state of affairs.

I have heard many stories from moms about a nurse being unsupportive and discouraging of natural birth. Perhaps you may have had one of these nurses attend your labor. I am a registered nurse and even I encountered a less than helpful nurse during the birth of my son at a local hospital. Nurses are often very knowledgeable and supportive of evidence-based practices in other specialties. If natural birth is evidenced to be the best option for achieving optimal outcomes for both mom and baby, why are some nurses unsupportive and even discouraging of natural birth? I hope to answer that question from a nurse’s perspective in this post.
A nurse’s knowledge base comes from their education and their experiences. To help me write this post, I polled several other nurses who work in various specialties and attended different nursing schools. I have my BSN from the University of Texas at Arlington. I went through a wonderful nursing program that consisted of 120 course hours. Birth was discussed in one 4 hour course. The course was a general women’s health course that covered pregnancy, birth, and the neonatal period. I was blessed to be taught by a Clinical Nurse Specialist who had homebirthed her own children and a Certified Nurse Midwife.
Not every nurse was so lucky during their nursing education. Some nurses that I polled stated that birth was such a small part of their nursing curriculum that they learned very little about birth. Some nurses said that birth was discussed more in depth, but comparing common maternity practices in the United States and evidence-based maternity practices were not part of the discussion. Not teaching evidence-based practices seems ridiculous to someone outside of nursing, but nursing schools in the United States are preparing nurses to work in healthcare settings in the United States. Labor and delivery nurses attend hospital births. Our hospitals do not routinely practice evidence-based maternity care. Nurses in the United States are expected to assist with planned cesarean sections, elective inductions, epidural anesthesia, and other medical interventions in birth. Unfortunately, that is what hospital birth looks like in our country. Natural birth that is intervention and medication free is rare, and most happen out of the hospital. Many labor and delivery nurses, much like obstetricians, have never observed a natural birth. In order to prepare a nurse for the patients and procedures she would encounter on a labor and delivery unit, the natural birth process is not always a priority for educational institutions.
I also polled a few nurses who work in labor and delivery. Their input was insightful. They verified that natural, intervention free birth was a rare occurrence on their labor and delivery units. They stated many moms came in to the hospital with a birth plan to have no pain medication and limit medical interventions. However, the majority had done NO preparation for their birth, other than typing out a birth plan. They said most of their coworkers view the birth plan as a joke, because most of the moms who write them end up asking for everything they wrote they did not want. One of my professors in nursing school said that you can plan all pregnancy long, but it means nothing if you don’t prepare. If you don’t take the time to prepare, you might as well forget the planning too. It’s like writing down that you are going to make an A on the test, but never actually studying for it.
When a mother is not prepared for birth, but seeks a natural birth, the demands of their nurse are drastically increased. Nursing units are often understaffed and nurses are overworked. There is a tremendous demand on a nurse when a mother is not prepared for birth, a father is not prepared to be a birth coach, and a doula isn’t present to assist mom throughout the birth process. This can create animosity towards the patients that seek a natural birth, but due to lack of preparation rely on their nurse for all of their needs during labor. Even though more women are asking for a natural birth in the hospital, many still end up with unnecessary medical intervention due to their lack of being informed and prepared. Unfortunately, this means that even labor and delivery nurses lack experience in the natural birth process, because the majority of patients are not giving birth naturally. They also doubt the ability for women to birth naturally, because they see many unsuccessful attempts. When a well-prepared and well-informed mom comes in to the hospital, they are often faced with judgment and animosity because they are categorized with the moms who aren’t prepared and informed. They assume that they will be unsuccessful also.
What can we do about this and how can we ensure that women having a hospital birth have supportive nursing staff? We can demand evidence-based practices. We can choose doctors and hospitals that have practices in place to support the natural birth process. If we demand better care during our birth and evidence-based practices, we can work towards a society where medical staff at hospitals have seen natural birth and are experienced assisting moms who wish to avoid medical interventions and are well-prepared to do so. If we continue to blindly follow bad medical advice and fail to advocate for ourselves, hospitals will continue to utilize their policies that inhibit mothers from achieving the type of birth they want. The more we demand for better births, the more experience nurses and other hospital staff will have with natural birth.
If we can change the way women choose to birth and prepare them well, we can change the way our hospitals handle birthing women. If more moms educate themselves and prepare for an intervention free birth, we can ensure that our labor and delivery nurses gain experience with the natural birth process. If we change the norm of birth in our society, the nursing schools in our area will also have to change their way of teaching to prepare nurses who want to go into labor and delivery to effectively provide care to a birthing mom.  
~Shazia from Above & Beyond Birth blog can also be found on Facebook.


Unknown said...

I think this is a great post! When I told my OB that I wanted a natural birth, I could tell she was skeptical. But after I started asking DEEP questions about her practice and approaches to natural birth, I think she realized I was the real deal. I asked her how many of her patients wanted a natural birth and she said something like 60% then I asked how many actually achieve it and she said 5-10%. But like I said, her attitude changed once I started asking questions about position, natural induction methods, her approach/attitude towards doulas, etc. From then on, she was much more receptive and honest about my natural dreams. I prepared by taking Bradley classes, reading online and doing lots of exercises at home.

I was very lucky to have a hospital that is natural-birth friendly and my nurse even stayed an hour after her shift change in hopes that she could meet my little girl. Ironically, I never brought out our birth plan, I just told them I wanted natural and they went with it. But I think it was also because I did research on the hospitals in my area to find the most natural birth friendly one. Due to medical issues we felt it was safest for me to give birth at a hospital with an OB. I had to be induced which usually turns into c-section, but thankfully with the right choices in my birth team I was still able to have a pain-medication free 19 hour natural birth with a little pitocin at the end to help me. Education and preparation was definitely key to my success.

Karen Joy said...

I have observed this EXACT same thing in my 15+ years of being involved in the natural birthing world. A lot of women I know tell me they WANT a natural birth, but then they do little to nothing to actually PREPARE for it. I had never thought about a nurse's perspective and why she might not be supportive... I have encountered both supportive and non-supportive nurses in my five, unmedicated, non-induced hospital births. It's like you have to prove yourself before they'll offer support. That drives me nuts, but in light of this post, it makes more sense.

Ironically, in my slowest birth -- my fifth -- I was FTP for nearly 7 hours at 7 cm and my own L&D nurse was MAD and CRABBY and impatient and PUSHY to let my doc perform some intervention. But, the other nurses around the L&D unit, during my HOURS of trips around the halls, walking with my husband, were so very supportive and encouraging both as I labored and afterward. They rejoiced with me when I did stick to my guns and achieve that no-intervention births. One nurse even told me, "You're all our hero." That shocked and encouraged me. But after reading this, I can see that they have all probably encountered a lot of mothers who SAY they want a natural birth, but then don't DO the things that will lead to it...

Thank you for this guest post.

P.S. I'm pregnant with my 6th child and am planning a home birth, largely because of potentially unsupportive nurses and hospital policies. I have found that even if I choose an excellent, supportive medical provider (OB or CNM), we are still at odds with the culture of natural birthing and while I can -- and I HAVE -- go against the flow and fight to get what's my right, I'd rather, this last time, to just have a lovely, peaceful birth without having to fight for it or prove myself.

Jared & Adri said...

What a great post! I agree completely.
I am an RN and was working L&D when I got pregnant with my first. Even then I had a strong inclination toward natural birth and was dismayed at my co-workers' attitude toward natural birth. Most of the time, women would come in claiming they wanted to "try" to have a natural birth. They would have elaborate birth plans but didn't seem to prepare well for the marathon of labor. They would change their minds and ask for pain meds as soon as active labor got going. So the nurses were jaded toward natural birth. Also, natural birth is MUCH more work for the RN who probably has more patients then she/he can comfortably care for, and is overworked and overwhelmed. I remember my co-workers standing behind the nurse's station laughing at a birth plan and commenting about how ridiculous it was. The other problem was that these nurses knew nothing about natural birth other than the negative, un-prepared-for ones, so didn't suggest things like walking, squatting, showering, etc.
I confess I did the same thing for my own first birth. I didn't exercise enough to prepare and ended up with an epidural when my labor "stalled" (which I now know was probably fear). I was blessed to give birth the second time naturally in a hospital with a supportive midwife and an experienced RN who supported natural birth. I just keep going more "crunchy" and this last year gave birth to my third at home in warm water. What a difference natural birth makes! My recovery/postpartum mood/baby were all SO much better with natural birth. For me there's no other way to do it.

dianthe said...

i TOTALLY believe this! and knowing that RNs don't have the knowledge (or often the time) to commit to natural births, i now understand why my OB's first response to my wanting a natural birth was "awesome! who's your doula?"

like many women, i was committed to a natural birth but also wanted to birth in a hospital - the poster was right on when she said many women come in unprepared - i can't tell you how many message boards i've been on where women ask to see birth plans but never think to ask for recommendations for birth classes or birth support!

knowledge is POWER!!!

Above and Beyond Birth said...

Thank you for letting me write this for your readers!

Mama Birth said...

Ummm- yeah. I love this a ton.

maguire708 said...

This is exactly why I chose out of hospital births, midwives, and to never meet an OB with my pregnancies unless there was a medical reason. If things had gone badly (no amount of preparation guarantees a 100% success rate), I would have been transferred to a hospital (there are literally 3 within 10 minutes of home!) and there the nurses and doctors would have done their jobs and they would have been the experts at that point. Blaming a hospital nurse for receiving a typical hospital birth, is blaming yourself for not preparing to the best of your abilities. Even the terminology "receiving" a birth experience, is symptomatic. As a woman with Multiple Sclerosis I felt it imperative that I educate myself on the best way to achieve a healthy outcome for my pregnancies, and all evidence told me to surround myself with people who knew birth, not people who knew surgery! I am aghast that every woman does not demand and receive even the smallest bit of preparation for birth. I am disgusted to hear "I want a natural birth, my doctor says I'll do fine!" By choosing my caretakers and birth assistants carefully I chose "officials" who encouraged research, study, and my questioning. I was never told "You aren't the expert, *I* am the one who went to school for this, how dare you question my orders?" (and yes, I was actually spoken to in this manner by a non-OB doctor once. Needless to say, I fired him and have been more selective ever since!) Every step of a pregnancy is a choice, in general, American women are not empowered by society or the medical community, so they never realize that *they* are the powerful ones and that *they* chose to surround themselves with people who only know one model of birth!

Angela said...

I agree with some of the other comments: If you are serious about natural birth, there's no better way to go than a midwife, either with home birth or birth center. They give you personal, whole-being care through the entire pregnancy and birth process. You develop a relationship and discuss preferences ahead of time, so there's never any power struggle.

Emily said...

I do love this, but I'm not sure what to do to be considered 'prepared'. Last time, we prepared as well as anyone could possibly prepare and were completely unprepared for back labor. Now, we're going to go in expecting back labor (and with a doula), but I don't honestly feel more prepared for this vbac. Except that I know that I will most likely have back labor again. I can look up coaching on the internet and relaxation exercises.. but does that make me properly prepared?

Above and Beyond Birth said...

Emily- a comprehensive birth class can help you prepare. Birth Boot Camp talks about variations of labor, including back labor, and what to do if it occurs! Did you see a chiropractor? If baby is posterior, it could mean your pelvis or sacrum is not in alignment.

Erin said...

Emily - I would also make a couple other suggestions to supplement "Above and Beyond"'s good advice.
Surround yourself with people who have a positive attitude about birth and real experience with successful natural birth. "Horror stories" do nothing positive for anyone.
Also, read Ina May Gaskin's "Ina May's Guide to Childbirth". It is SUCH an excellent resource, and not as "hippie" as Spiritual Midwifery.

Brook said...

This is a well written article and it does help to somewhat understand why we had such a less than ideal birth experience for our 1st child.

I have had a free standing birthing center delivery and 4 hospital births. 3 were planned hospital births and 1 was a transfer during labor from home birth b/c of fetal distress.

I had our first child in a less than friendly environment where even if the nurse wasn't taught about natural birth they weren't willing to let me walk around at all once labor started. That is why we were not willing to have a hospital delivery with our 2nd. She was our only free standing birthing center delivery. I LOVED it because it was my bodies timing and both the midwife and nurse attending mentioned it would have been worthy of recording because some ladies don't know how to let their bodies tell them what to do.

The other 3 were hospital births and I even had a nurse thank me after one because I was the first one she had seen do everything naturally and I was able to help her learn as well. She mentioned they do observe natural births there more than other hospitals do in their internships. But she was very surprised at how well it went when I went with my body and how it was such a smooth event.

Due to finances we were unable to plan a home birth for the last 2 children but we had a great birth experience at our hospital because we "happened" to have nurses we knew and nurses who were wiling to let us have our natural plan.

I am glad that the nurses at our births were so helpful and willing and I do also see a need for more instruction in what natural labor looks like and how to facilitate it in the hospital delivery room.

daniel gury said...

why is natural childbirth
such a no no? if you have the right tools then there are barley ever any problems.