Many
L&D nurses are very knowledgeable and respectful, a great support for moms
and a pleasure to be around. Here are some things nurses do, or avoid, to make a
mother’s experience all that more positive. Thankful for the amazing nurses
that have been and are supportive of mothers in labor with a desire for natural
birth.
1. Support
the mom. Supporting
the mother’s wishes is very important for the positive progress of labor. On
the other hand it is great when we know our own limits and comfort zone. So it
is very thoughtful when a nurse doesn’t feel comfortable or supportive of a mom
and her birth choices, that she ask for another nurse that prefers natural
births to switch with. Moms pick up on those vibes and although some may have
the courage or mindset to ask for another nurse others may not.
2. The
myth that natural birth plans are a curse for a c-section. It is well known that some
L&D nurses when seeing a natural birth plan will think it is just a matter
of time before it ends in a c-section. Those thoughts alone can really affect
and derail a mother’s chances of natural birth. Supportive nurses check those
feeling at the door. It is normal that mothers with natural birth plans that
end up having a c-section stand out more than others, specifically because of
their strong wishes for a natural birth. However, in the US the c-section rate
is 1/3, and in some states and hospitals over 50%, so unfortunately it is very
likely that a mother will end up with a c-section, not because of her birth
plan but because of unnecessary interventions. Another reason to respect a
mother’s birth plan. Supportive nurses respect that birth plan, or if a deviation
needs to be made, explains why beforehand; most moms will be flexible if a true
need arises.
3. Don’t come in the room unless
absolutely necessary.
Moms know nurses have a job to do and will be glad to help things go smoothly,
but there aren’t too many things as disruptive to a natural birth as the
constant checking, monitoring, and above all controlling or even just watching.
Nurses that don’t have a good reason to come in, don’t, and when they do they knock, keep the voice calm and soft, don’t
talk amongst themselves, don’t talk to mom during contractions and keep the
lighting as low as possible, if more lighting is needed they ask the mom if
that is okay with her. They offer encouraging and supportive words (usually
between contractions) which are always welcome, those are the best kind.
4. Don’t linger. Just like not coming in
unless absolutely necessary, they don’t stay unless absolutely necessary, one
of the things that can slow labor down is for a woman to feel watched or judged.
However, if the mother doesn’t have a doula (or even if she does) and a nurse
feels she could use more emotional and physical support that is always a
wonderful thing for a nurse to do (of course if time permits).
5. Insisting on hospital
protocol.
Most mothers that want a natural birth
are usually pretty well informed and are
aware of hospital protocol such as:
hep lock, IV, restrictions about food and
water, monitoring, vaginal checks, etc., and the scientific evidence behind
those protocols. If a mother refuses to
follow protocol respectful nurses will not
continually insist on protocol; they share their training and the protocol
requirements and then listen to what the mother is telling her. If the mother
wants to go against protocol by making an informed decision, she has the right
to informed refusal (and informed consent) so it is wonderful when that is
respected by telling her she is understood and that her wishes and her decision respected and
noted in her chart.
6. Don’t ask pain level or offer
an epidural.
The mother doesn’t need to be reminded about the intensity of her contractions
or have to interpret or quantify her contractions, letting her experience it as
she is. Also, mothers who want a natural birth are very aware they have the
option to receive an epidural (and other coping techniques and medications),
they will ask for one if they want one.
7. Know a doula is there to help.
A doula is there to provide emotional,
physical and informational support to the mother and her partner, and at other
times to just “hold the space” when mom wants or needs space to go through the
birthing process on her own (so if you see a doula sitting in a corner for a
moment, don’t assume she is not doing her job, the doula is most likely
checking in on the mother and making sure her needs are being met). Often times
a mother that has a doula is well prepared to make evidence based decisions.
If a mother is doing something against
protocol it is not because the doula “told her” to do it, the doula is there to
support the mother’s decisions even if those decisions are against protocol or
even against the doula’s own personal beliefs or opinions. A respectful doula
will support the mother without getting in the way of the nursing staff, stay
by the mother’s side but step away when needed. A doula will also be glad to help
the nursing staff in any way she can, such as helping so that the nurses don’t
have to run back and forth with ice, water, towels etc. So if allowed and
helpful, nurses can show the doula where the water, ice, microwave, extra
towels, chuck pads, gloves, vomit pails etc. are; a doula should be more than
willing to help provide the mom with those things and help keep mom and her space
clean and comfortable. Here is a link to a study on doulas and nurses working together. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595283/
8.
Positions. Encourage a mother to be in
any position she chooses. No one should ever tell a mother what position to get
into, if labor is evolving favorably and the mother is listening to her
instincts she will get into the position that is most beneficial and
comfortable for her. Some nurses tell the mother to lie down in preparation for the
OBs or Midwife’s arrival; if the Midwife or OB requests that the mother adopts
a certain position the mother should do so only if she chooses. Supportive nurses don't tell the
mother in what position to get into in preparation for or when pushing, again
if the mother is supported and the labor is progressing adequately the mother
should be encouraged to listen to her instincts and get into the position she
chooses.
9.
Pushing. Encourage the mother to
listen to her body, push instinctively without direction. Nurses respectful of natural birth don’t tell a mother
how or when to push. No: “Deep breath, count to 10, push, push, push!”, that is
purple pushing and not only unnecessary but harmful. The mother should not be “actively”
pushing at all, her contractions will be doing the necessary work to help birth
the baby. It is a common misconception that a mother needs to push in order to
birth her baby, her body will automatically be helping the baby down and out.
10.The baby is
being born and the OB or Midwife has not arrived yet. Sometimes babies come out very
fast, before there is a chance to notify the OB or Midwife, or while they are
on their way. Gentle nurses tell mom to listen to her body, encourage her to catch her own
baby and be prepared to help her if needed, making sure baby does immediate
skin to skin, and that the cord remains intact. Keep calm, help is right there
and everything is going as it should. So they don't need tell mom to stop, to not push, and don’t
put their hands on the baby’s head to keep him/her from being born.
11. Be
the mother’s advocate. Unfortunately
many nurses are often witnesses to obstetrical violence. It is a hard line to
walk between doing what is right for the mother and doing what their job
requires (this often happens to doulas too). It is best to err on the side of the
mother; it is better to do what you know is right than to silently sit by and
allow the mother to suffer unnecessarily (i.e. unnecessary episiotomies, fundal
pressure, purple pushing, mothers forced into positions they don’t want to get
into, talking down to a mother, etc.). What is helpful is to encourage the mother (or her partner) to find
her voice so that she can speak up for what she wants, deserves and is her
right.
12. Assets. A nurse is very valuable and has an
important job to do; monitor the mother
and the baby to make sure that labor,
mother and baby are doing well. They are often
more present than the OB or
Midwife, who often arrive towards the end of labor or during pushing. Which is
another reason nurses are so important, they can have a huge influence on a
mother’s labor. A wonderful, loving and supportive nurse can help a mother feel
respected, cared for and safe, and in turn help the progress of labor
tremendously. Unfortunately the opposite is also true, so in both cases a nurse
can directly affect how labor progresses. So before walking into a women’s
labor room, it is helpful to take a deep breath and find that space within
yourself, that space of love, support, caring and patience, leave everything
else outside and remember that inside that room is the
space of a woman
giving birth; which is after all one of the most important days of her life, a
day she will remember forever, a day that the nurse will always be an important part
of,
a wonderful opportunity to make a positive, lasting impression.
13. The golden hour. The first hour or two after birth is
extremely important, it is when the maternal newborn bonding occurs and is
strongest. The golden hour starts as soon as the baby is born, when the baby
should be placed immediately on the mother’s chest as the cord pulses out (without
being clamped until after the delivery of the placenta), no suction is needed,
no hat is needed. All the baby and mother needs is the closeness and the
opportunity for eye contact, skin to skin, breastfeeding and bonding. Eye ointments,
vitamin k, weighing, measuring and bathing can all wait until after this golden
hour or longer, and should only done if the mother chooses.
14. Latest
research and recommendations.
It is very important to continue reading up and educating
ourselves on the current recommendations for birth. It often takes too long for
science to back what we already instinctively know, and finally be pushed down
the pipeline to be implemented. So it is wise to be ahead of the game and be informed. If a
mother comes in requesting something a nurse has never heard of or understands, what a great opportunity to learn something new by looking
it up, chances are there is good science behind it.
15. The lesson is always love. In the end all that matters it to treat others with respect and love in everything we do. Birth is one of the most important times to practice that lesson so that we may welcome babies into this world with love and help the mother in her transformation.
