Birth Advice from Labor & Delivery Nurses

By Tine Reese

February 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!

Deaconess Labor & Delivery Nurses Zibby Merritt (with son Tyler) and Rebecca Chadwick (with daughter Allison).

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?

  1. Plan your birth: Give a lot of thought to how you want your labor to go, whether or not you write a birth plan.
  2. 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.”
  3. 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.”
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.

Disclaimer: Views expressed here are those of the nurses interviewed and do not necessarily represent those of Deaconess Medical Center or Bloom Spokane. See our full disclaimer for details.

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.

Comments

By Hillary Barnett on February 19th, 2011 at 1:36 pm

What a great article. I loved reading about how things go behind the scene. Often as a patient we dont realize all the other work nurses are doing. I had both of my boys at Deaconess, had GREAT experiences!!! I love all the staff there. So thank you to both of you for sharing your stories!!!!

It’s amazing the race didn’t die out before the medical profession invented all these ‘necessary’ bells and whistles. Too bad all that CYA crap makes a very natural process so unnecessarily complicated and expensive.

Tine & Bloom: Thank you so much for sharing an article like this! As a nure and soon-to-be mother I really appreciated the insight these L&D nurses had to share! I think the majority of women do choose a hospital birth but some would like it to be as natural as possible! It’s great to hear there are nurses and local hospitals that want to aide mothers in having the experience they want! Thanks again!

Love this article. I would love to hear more from Zibby and Rebecca.

I would like to extend a warm thanks to Zibby and Rebecca for effectively bridging two worlds between traditional medicine and the burgeoning and powerful realm of natural birth practices. I’m a Physician of Natural Medicine in Canada and specialize in helping my patients to unload their emotional baggage before bringing it to the delivery room. I support Moms in conjunction their Midwives and Doulas, mostly with home-births using homeopathics, to help turn breach babes, deal with pain, and also support Dad’s. I love that more and more we are integrating our approaches to medicine in order to serve our Momma-sisters in the ways we too want to be served. Warmly, Allyson (applauding)

Great article! The only thing I took exception to was #7. Just because a mother chooses to give birth in a hospital doesn’t mean she must consent to every hospital protocol. NOTHING is non-negotiable. The patient retains the right to refuse any procedure or treatment.

Though studies show that homebirth is a safe option for most mothers, access to good, supported, legal homebirth care is not available in many parts of the country. Even where it is, often the midwives are limited by licensure from accepting certain types of patients (like VBAC moms).

If a mother feels that the hospital is the best (or only) option for her, that should not mean that she has to comply with every hospital protocol just because she walked through the doors. Especially when many of them, such as not allowing laboring mothers to eat during labor, are not evidence based.

Great article. Very truthful and exactly why I am no longer a labor and delivery nurse. I decided that the ability to truely advocate for your patient is severely limited and I was expected to white-wash what had been or was being done to the mother in the name of “good medicine”. I now work as a lactation consultant (IBCLC) and can advocate for the mothers and babies that I serve in a way my ethics dictate.

I liked this article for the most part. However I strongly disagree with the section where they say that

“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.”

Why are we blaming victims of the system for their poor experience? Then they stated

“They look to place blame and that blame often falls on themselves for not being able to achieve the birth they wanted.”

Yes. Women do blame themselves. Nurses obviously blame women too! It’s much easier to blame women than an institution whose goal is to medicalise birth. Remember that hospitals make money from medicalised birth, women don’t. Hospitals deal with birthing women every day, women give birth only a few times in their lives. Women blame themselves for poor outcomes, and so do nurses! And the system which is really at fault gets a free ride!

Then the L+D nurses tell women to just suck it up and allow EFM. So these are nurses who claim to love women who want normal physiological births … and yet they inform us that we must submit to monitoring which has never been linked to better outcomes? Never proven by one single scientific study to do anything but cause unnecessary surgery? If that’s the way they feel about it then I hate to see a nurse who is in favour of over medicalised birth!

I’m all for nurses, I think they get a really poor deal from the institution, and from many people in society as well. However when I go to hospital to give birth (and I have had three hospital “births” before my home birth) it isn’t about making things easy for the staff, it’s about me and my baby. If less women and families were concerned with being good patients, and if the system supported women to get the births they want (rather than fitting into a factory style of birth which is not supported by any evidence anywhere) THEN we might see better outcomes.

But I state this again. IT IS NOT THE FAULT OF WOMEN. IT IS THE FAULT OF THE INSTITUTION.

Thanks to everyone who has read this article and commented. And especially, thank you to Zibby and Rebecca for wanting to provide women with helpful information before they decide on a hospital birth. I applaud them for doing this interview and being realistic about what it’s like to be L&D nurses.

When I sat down to interview them, I wanted to get their honest answers to questions that I perceived most women would have about hospital birth. I only wish that I had been able to read this article before I’d had my own hospital births! Our U.S. healthcare system and institutions are not perfect (something about which I think most of us would agree), but giving women the opportunity to hear from different care providers is the best way to help them make informed healthcare decisions.

Our goal is to take a hard look at the realities of childbirth in America, both at home and in the hospital. When women have easy access to this kind of information about birth, they are better prepared to make their own decisions about what’s right for them. We will also being interviewing homebirth midwives in the near future to bring their first-hand perspectives to our readers. Information is key!!

Over all this was a pretty good article, however after going through my first birth 8.5 months ago, I take offense to a couple things, firstly, saying that some things are non-negotiable, Patients have the right to refuse any procedure, but this just tells me that some nurse don’t care, I said NO several times to pitocin, I had gone into labor naturally and a wonderful contraction pattern that was regular, but because the nurse I had hated long labors, she literally held my hand down amidst my protests and put the IV in.
Another issue I have is the mention that if a woman gets an epidural that they push the Pitocin, as nurses they should know how dangerous that is! The same nurse that forced me to have pitocin, had me at 4x the FDA limit listed as overdose!! resulting in my hemorrhaging so bad I needed a Manual D&C to stop it.
and lastly the insinuation that if a woman has a bad experience that its HER fault, its not its the INSTITUTIONS fault!

It is wonderful that more nurses support natural birth, I just wish it were more widespread!

Andrea, so sorry to hear about your birth experience. You should not have been treated that way and ,unfortunately, you are not alone :(

You are absolutely right. Women have the right to refuse any medical procedure and receive full information about the risks/benefits from their care provider. We provide a page on our website with resources explaining patient rights, especially as they pertain to maternity care. http://www.bloomspokane.com/birth-information/patient-rights/

I think that as more and more evidence-based information about childbirth becomes available and we continue to discuss these issues in our communities, we will see more providers (nurses included) who want to support moms in a natural birth. Thanks for sharing your story!

By Sarah from Mindful Birth Options on February 21st, 2011 at 11:34 am

I dont like anything that perpetuates the “buy the hospital ticket, take the hospital ride” myth. If you show up at a hospital in labor, they legally have to treat you. They can not turn you away for refusing interventions. Just b/c something (like EFM) is “hospital policy” does not mean you can not refuse it.

I also take issue with the “you would be better served to have your baby at home” part. Not everyone has access to home birth. Some women HAVE to give birth at the hospital, rather due to financial reasons, lack of home birth midwives, high risk status, or just b/c they dont feel comfortable giving birth at home. That does not mean they waive their right to refuse whatever interventions they dont want.

I really applaud these two nurses. They really seem amazingly dedicated to laboring women having incredible experiences! Due to my own personal situation, I never had the opportunity to labor with either of my babies and honestly, I do mourn it some, but I know the outcome was healthy children, NOT the labor experience. I think some women get too wrapped up in the process and forget the ultimate goal- a healthy family- moms and babes. Also, I think when they said things are non-negotiable, they didn’t mean that they were going to wrestle you to the ground to make it happen, but that these were things necessary in that setting based on that setting. Finally, I always wonder why people pick a certain hospital or care provider (midwife, surgeon, etc) based on research and interview and then in the most critical moments, refuse to trust their years and years of experience. They are not the enemy, they are using their education and experience to deliver the best outcome. You are AMAZING Zibby and Rebecca- never doubt the gift you continue to give the women and families of Spokane!

Sarah, thanks for your feedback. We have received quite a few comments to this effect and realized that we should further address the issues of patient rights and evidence-based medicine. We have written a follow-up article to provide this information to our readers: http://www.bloomspokane.com/2011/02/22/your-patient-rights-in-labor-delivery/

Our new article also addresses the issue of women who don’t have the option of homebirth. We encourage those women to be especially knowledgeable about their patient rights in the hospital environment! I do believe the nurses interviewed made the comment about choosing homebirth to encourage women who are concerned about too many interventions to consider it as an option that might better fit their needs—it was not at all a derogatory comment on their part. As a writer, I’m learning valuable lessons about context.

Thank you to these nurses for having the courage to speak about this, I am sure they have received some flack. So great to hear their perspective. I see some are offended by the phrase “you would be better served to have your baby at home”. I completely understand where the nurse was coming from. After having one labor at a birthing center and then a VBAC trial at a hospital…. it obviously makes more sense to have your birth at home or a center if you do not want ANY inerventions. I do not believe she was speaking to women who are for some reason unable to have an out of hospital birth.

By Caitlin Sherwin on March 21st, 2011 at 4:38 pm

I was in the hospital for 23 days at Deaconess Hospital in Spokane. It was deemed necessary because of my gestational diabetes and preeclampsia. Although one of the doctors wanted to send me home that wasn’t going to be possible because of the complications. I loved ALL of the nurses I had even though one asked me if I went to childbirth classes. I wanted to but circumstances didn’t provide for me to go.

I am currently a labor and delivery nurse, it is a fine line that we have to walk. I want to give my mothers their every wish, but I also have to make sure their baby is taken care of too. I want to make sure both my mom and her baby are safe, in the end who cares if the patient has a natural birth if either she or the baby is seriously ill or dead. I think that while being overly medical isn’t the answer, that people should remember long ago many women died in childbirth and many babies died during or immediately after birth, medical intervention has helped to reduce those numbers drastically. If you are coming to the hospital to labor and deliver then it our responsibility to care for you. I don’t like the fact that I have to CYA, but in today’s world even McDonalds has to make sure people know their hot coffee is hot in writing as well or get sued (oh yeah it happened). In the end I want a healthy mother and child, and I’m not so particular on how we get there, I will do everything possible to ensure the mother has the birthing experience she wants and give her and her child a chance at the best outcomes possible.

I know most nurses are well trained and caring but there are some that are just flat out stupid or calloused and evil. I prefer to think stupid.You talked about nurses wishing that they could just do a quick assessment and send some women home. I went with my daughter to the hospital and they kept her for 3-4 hours and then told her to go home. Her pains were only 5-7 mins. apart and consistant but since her dialtion progress was slow, they said to come back when the pain was harder. We left but when her pain was getting too hard for her to take we went back. That was about 3 hours later. They checked her back in but I could tell this nurse had read some notes from the previous nurse and was convinced it was just braxton hicks. She hardly looked at my daughter in the face. My daughter had asked her Dr. ahead of time to plan for an epidural so she didn’t want to wait until it was too late. The nurse asked her how she would rate her pain from 1-10 and she told her 9. and the nurse rolled her eyes! It was obvious she doubted everything my daughter told her. My daughter had nausea she got the shakes. She told us that since her dilations still wasn’t progressing very fast she was going to send her home. We both protested. I told the nurse that as her mother she should consider my labor history since with all 7 of my children it took a long time to get dilated to 4 but then it went really fast to 10. She paid no attention. My daughter kept telling her she needed something for the pain. She returned after about 30 min.s and said the doctor on call said she could be given a shot of morphine and then she could go home. We found out later that the morphine was given in hopes of stopping her “braxton hicks”. The morphine barely took the edge off but we were told to go home. We begged the nurse to keep us and she said she had to follow the Dr.s orders. We told her that since the pains were so hard and so close that she wouldn’t know when to come back and it would be too late for her epidural but we were taken to the door and told to go reat and relax. My daughter went in her room to lie down and her husband left to go to clinicals at the same hospital that had just sent us home. Just 5 min.s after he’d left my daughter called to me to come in. She said it was too late to go to the hospital, she was feeling like she had to push. I called 911. I was preparing to deliver the baby and the head was about 1/3 of the way out when the paramedic arrived along with 6 other men to help. I was so relieved. She delivered a healthy baby girl just 15 min. after her husband had left. He was very surprised when I told him that she was born on the bedroom floor.
I think that nurses need to remember that if the contractions are consistant, close together and unbearably painful,but not effectively causing dilation, there could be a medical problem pr reason for it such as too big of head. From the 1st hospital check in till the baby’s birth was only about 10 hours which isn’t really that long. The hospital admitted it was their fault and didn’t charge them for her after care. I still get very upset when I think about what they put my daughter through. Some nurses should be banned from the nursing field. All we asked for was to be heard and she never listened.

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