Birth Advice from Labor & Delivery Nurses
By Tine ReeseFebruary 18, 2011
In the U.S., approximately 90% of women give birth in hospitals. It is the cultural “norm” in this country and the birth setting where most parents feel comfortable. However, the latest studies point to an unnecessary overuse of technology during pregnancy and birth. As Jennifer Block writes in Pushed, “Decades of research show that the healthiest birth for you and your baby — and that means your partner, your family, and your community — is a normal, vaginal birth with minimal intervention and maximum support.”
Since so many of us choose to have our babies in hospitals AND want to avoid unnecessary medical interventions, I thought I would talk to a couple of local labor and delivery nurses about what really happens in the hospital. Zibby Merritt and Rebecca Chadwick are registered nurses working at Deaconess Medical Center in Spokane, WA. They have seen thousands of births and had their own children in the hospital setting—two of Zibby’s births were natural!
When I sat down to talk with Zibby and Rebecca, what I most wanted to know was what advice would they give to women who want to attempt a natural birth in the hospital. These are nurses who jump at the chance to work with moms trying to achieve an unmedicated birth and I thought, “Who better to ask than the women who will provide the great majority of your care during labor.” They were excited for the opportunity to share their knowledge and experience with us in hopes to better prepare future mothers before they walk through the doors of Labor & Delivery.
What advice would you give to moms wanting a natural birth in the hospital?
- Plan your birth: Give a lot of thought to how you want your labor to go, whether or not you write a birth plan.
- Ask for the right nurse: When you come to the hospital, ask for a nurse who wants to help support a natural birth. Zibby said, “There are some nurses who cannot stand to hear a woman screaming and it kills the nurse NOT to put in an epidural. And there are others of us who totally gravitate toward helping with a natural birth. It is OK to make your wishes known.”
- Bring your own doula: Zibby said, “I love it when a patient has a doula because doulas can do the things we’d love to do, but can’t.”
- Be educated: Education about birth is a huge component of what nurses do, but a lot of that should happen before patients walk through the doors of a hospital. That’s why these nurses are big supporters of the midwifery model of care. Zibby said, “On the whole, midwifery patients are better educated than physicians’ patients…not that physicians wouldn’t want to provide that type of care for patients, but the medical model that we practice under is so limiting in that regard.” Rebecca noted that she has recently seen quite a few moms use HypnoBirthing techniques very effectively in labor.
- Choose the right care provider: If you want a natural birth, find a care provider who supports your wishes and is prepared to assist in a natural birth experience.
- Get rid of emotional baggage: I asked these nurses what is the biggest difference, from their perspective, in the patients who come in educated and emotionally ready to give birth. Rebecca said, “These moms tend to cope better and know what to expect. They handle difficulties with ease. When you come prepared, you are better able to handle whatever gets thrown at you.” Zibby goes on to say, “Then there’s the whole issue of baggage. Not only is it the patient’s baggage, but it’s her mom, her sister, and her friends that are in the room who all have their own birth experiences.” Both nurses agree that being emotionally ready to give birth is just as important as being educated about it.
- Be prepared to follow hospital procedure: Zibby said, “If you are going to have your baby in a hospital, you need to understand that there are certain things that come along with that. If you don’t want to follow hospital procedure (for things like Electronic Fetal Monitoring), then you would be better served to have your baby at home.” The nurses stress that the hospital allows mothers options to a certain point, but there are things that are non-negotiable.
- Be flexible and open: Come to your birth with an open mind. Zibby said, “Every birth is different. Every birth is unique. There are some things you can’t plan for or understand until you are in the experience.”
What keeps women from having a great birth experience?
Zibby and Rebecca have been working as labor and delivery nurses for a long time and have seen a lot of births. I asked them why they think so many women have difficult and disappointing birth experiences. Their number one answer was that most of us modern women are not open and accepting of ourselves. Zibby said, “We tend to be pretty controlling beings. Having a baby is a rare situation for us [as individuals] because we’re not used to the lack control. For most women, this is their first experience in a hospital or in any real pain.” Women also expect a perfect outcome at birth and are often disappointed when things don’t go exactly according to their birth plans. They look to place blame and that blame often falls on themselves for not being able to achieve the birth they wanted.
This negative emotional response often leads to moms not being able to bond with their newborns and can spell trouble for breastfeeding. Zibby and Rebecca see this scenario play out all to often. “I don’t know the numbers, but I’ve heard there’s a link between postpartum depression and c-section delivery because the mothers feel cheated out of their birth experience,” says Zibby. It appears that the most current research does not conclusively show a connection between cesarean sections and postpartum mood disorders but anecdotal evidence is mounting as more and more mothers bravely raise their voices and share their own experiences. To read more on this topic, see Lauren Hale’s article Is There a Link Between C-Section and Postpartum Mood Disorders?
The Real Scoop on Epidurals
The vast majority of laboring mothers in our country receive an epidural for pain relief. Even patients who have planned for an unmedicated delivery sometimes find themselves requesting or needing one. Zibby and Rebecca estimate that about 50% of women trying to achieve a natural birth at Deaconess end up with an epidural.
I wanted to know what really happens when a woman chooses to have an epidural. Both nurses were quick to say, “You now have to play by hospital rules. Once you commit to an epidural, you WILL have managed labor and lose a lot of the freedom you might have wished for your birth.” This includes:
- remaining in bed
- no more trips to the bathroom (usually patients are catheterized)
- constant Electronic Fetal Monitoring
- blood pressure checked every 15 minutes
- birth positions are drastically limited
- many times an epidural necessitates a Fetal Scalp Electrode (FSE), IUPC (Internal Uterine Pressure Catheter) for measuring the exact strength of contractions and Pitocin
Zibby said, “Once you have an epidural we’re not afraid to ‘push the pit’ and get the baby delivered because you’re not feeling any pain. We will put you in what we determine medically is an optimal contraction pattern, which to a naturally laboring mother might be every 5 minutes, but to an obstetrician or midwife is more like every two to three minutes.”
I ask, “When is an epidural a good thing?” Zibby responds, “We have seen time and time again, that when women give up fighting and let their body do what it wants to do, things will progress. An epidural is such a blessing for so many women who have gone through hours and hours of labor. Even moms wanting to go natural often realize that ‘Maybe this time, this is not how it’s suppose to be. Maybe this time I’m suppose to listen to my body and my body is exhausted. I need to sleep and I need to relax.’ Then 30 minutes later we have a baby.”
Zibby and Rebecca stress that “We don’t want people to have unnecessary or unwanted interventions. We are here to help you. Nurses are not there to push their own agendas. Epidurals can be a blessing for moms who aren’t able to release and let go. With an epidural you still have options, but they are limited. You are still the decision maker and have patient rights. Above all else, moms who get an epidural can remain active participants in their births.”
What are your biggest challenges?
Labor and delivery nurses are often torn between two opposing forces—the desire to act as a constant labor companion to every woman in their care and the ever-present thought that they are medically liable and must act in accordance with hospital policy to ensure they don’t lose their licenses. As Zibby says, “There is a freedom that is taken away by having RN after your name.” That freedom is the ability to devote themselves exclusively to one patient by supporting her physical, spiritual and emotional needs throughout labor and birth. Rebecca says, “When caring for a laboring woman, it’s not just her that I’m taking care of. The baby is also my responsibility and my patient. We absolutely need to document everything that happens in the labor room and all that we’ve done to ensure the mother and baby’s safety. Unfortunately, this is a must in the nursing world. If it’s not charted, it’s not done!”
Not only are there litigation and insurance issues to worry about, but nurses have very limited time due to the sheer number of tasks they have to complete—many of them involving hours of paperwork and carrying out standard operating procedures, even when common sense dictates they aren’t necessary. Rebecca and Zibby mention the many patients who check into the hospital before they are in need of medical care. In hospital lingo, the “ins and outs.” Nurses would like to be able do a quick assessment and say, “You aren’t in labor. You’re having Braxton Hicks contractions, which are totally normal. Go home and call your doctor or midwife to discuss your options and determine when you are really in labor.” Rather, these patients have to be admitted, examined, tested, deemed not in need of medical care and discharged, all of which takes nurses around 3 hours to complete. Zibby said, “That’s a LONG time when you have another active patient at 7 cm.” This scenario is not at all uncommon. The nurses I spoke to said that if women received better education about labor and what to expect, much of their time would be freed up to deal with the patients who actually do need their services.
Zibby says, “When you’re a doula, you’re there for the mother. When you’re a nurse, you’re there for the mother, the baby, the monitor, the physician, the midwife and the hospital. Plus, you may have one or two other patients.” Nurses are stretched thin yet constantly strive to provide the best possible care for each and every patient. Zibby strongly feels that being a caregiver and “mothering the mother” are her top priorities at every birth, no matter what else is happening. She and Rebecca say that this approach to nursing is the reason Deaconess nurses are able provide optimal care for the patients who give birth there.
Why do you LOVE your work?
After hearing Zibby and Rebecca talk about the limitations and frustrations of being labor and delivery nurses, I asked them, “What are the perks of the job?” Rebecca immediately responded, “I love it! I love babies and working with pregnant women. Putting the babies to breast and watching the daddy’s cry… Yes, it’s exhausting, but you go back and do it all over again.” Zibby adds, “Nothing is ever the same. Just throw away the manual. It’s different every time and amazing! It never gets old. It’s a huge gift and privilege to be there for women at the time when they need it most.”
About the Nurses
Zibby Merritt has an undergraduate degree in biology from University of Portland and was pre-med with plans to go to medical school. After college, she spent a year in AmeriCorp where she worked with HeadStart in Colorado Springs and volunteered at a midwifery clinic. It was there that she came to understand she wanted to work as a childbirth professional. After getting married, she went to nursing school at University of Washington. “In Seattle there’s a completely different birth culture. It is natural and about being into your body.” While in nursing school, Zibby also completed the doula training program at Seattle Midwifery School which she says, “was the best preparation for being a nurse. It taught me what laboring moms need…and that’s not always an epidural.” Zibby is the mother of three boys and now works as a labor and delivery nurse at Deaconess Medical Center.
Rebecca Chadwick attended nursing school at Montana State University-Northern in Havre Montana where she attended her first birth, transforming her life and leaving her hungry for more. After graduating she moved to Albequerque, NM with her husband where she worked as a labor and delivery nurse at Lovelace Health Systems, a birthing center where Certified Nurse Midwives and OBGYNs worked side by side. It was at Lovelace that Rebecca learned about the amazing Midwife Model of Care and became passionate about nursing. When her family moved to Spokane, she spent 2 years as a labor and delivery nurse at Sacred Heart before assuming her current position at Deaconess Medical Center. Rebecca has two children.
In Response to This Article
Since this article was published, Bloom Spokane has received a lot of reader feedback on this article concerning the topics of informed consent/refusal and evidence-based care versus hospital protocol (a.k.a. standards of practice). We felt it most responsible to address these concerns in a follow-up article titled, Your Patient Rights in Labor & Delivery. We encourage you to read it and find out more about your legal rights when having a baby in the hospital.