I see this quite a bit where I work as a nurse: birth apathy.
Apathy:
–noun, plural -thies.All too often, I find myself caring for women (and their partner/family) that are complacent and let "us" do whatever we feel is best. It goes against my very core values to allow care providers take complete charge of a woman's health care. Do some women not care about what happens during their birth? Do they inherently trust their providers to "know what is best" and allow them to do whatever they please?
1. absence or suppression of passion, emotion, or excitement.
2. lack of interest in or concern for things that others find moving or exciting.
3. Stoicism, freedom from emotion of any kind.
The original post above by Birth Sense has this portion:
I cannot tell you just how many times I have had couples come across this way, both verbally and non-verbally. Please - make waves! This is your birth and your child we're talking about here! You are in control of this -- not your care providers. For far too long, care providers have come across as far too paternalistic and know-it-all. We (care providers) need to see each family as unique. We cannot treat everyone in the cookie cutter model.I had a couple in my office recently who were asking questions about routine newborn procedures, and how they could include their preferences for those in their birth plan. At one point, the father hastened to assure me,
“We’re not trying to be difficult or make waves. . .we don’t want to upset anyone”.
Thoughts? Comments?
25 comments:
I flat out told mt Dr. what i wanted and he respected my decision and did everything in his power to make sure that I got what I wanted for the birth of my child. If he would not have I probably would have found another Dr. because as I see it it is my baby and my body and my decision. Too bad I didn't get what I wanted due to severe pre-eclampsia and had an emergency c-section but his philosophy was to let his patients take as much charge over thier pregnancy and delivery as they wanted.
Unfortunately, we've been trained to trust our doctors. However, when it came to my delivery I chose a midwife who was willing to advocate for me. When there were problems late in my delivery and the attending had to be called my midwife knew that I could still push and she advocated for me. Otherwise I would have ended up with a c-section. Instead, because I had chosen someone who believed in natural child birth and my ability to see it through I was able to deliver my baby vaginally without any medication except the pitocen used for induction.
That being said with my husband and my midwife having made my birth plan very clear, the nurse still was offering pain medication towards the end. I realize she was only trying to help, but it was a distraction. It is difficult to go against the hospital system. Even if you prepare ahead of time. You have to be very sure of what you want and most woman are too afraid of possible pain to think there is any other way. I agree with you that this is a natural process and that we should be able to trust our instincts over the standard medical track that treats every delivery the same.
Good Luck with your studies!
Do you remember the family whose child was temporarily taken away from them because they didn't want a PKU done?
When parents refuse things like the eye drops or newborn Hep. B vaccine it raises eyebrows and sometimes parents are threatened with a visit from soc. services if they "make waves." I would not want that happening to me.
If I have one more baby I will do whatever the MFM says. When the reg. OB told me to go to the outpatient lab for pre-eclampsia bloodwork (bp was 175/100+) and then over to L&D I asked the nurse why I had to go to L&D. I should have phrased it "How long do I have to be there?". The OB overheard and possibly decided my question of "why" was a refusal to go and said I could wait at home for the results. For the rest of that pregnancy I regularly had bps in the 160/100+ range and he was fine with that (I was nervous about it). After an ultrasound a peri. called him and said "Deliver this baby tonight". I was sent over to the community hospital where he delivers and the house dr. sent me home after getting a normal bp reading after having me lay on my left side.
I learned in that pregnancy the OB wasn't interested in explaining risk factors. The next pregnancy, the MFM I saw in addition to the OB always took the time to clearly explain things so I would have no problem doing whatever he says. I might come across as apathetic to the L&D staff, but I won't risk anyone thinking I am refusing to follow recommendations.
I was talking to my mom about my birth and she said her doctor gave her pitocin without her even knowing until she was shocked by the change in her contractions. I was aghast and she said, "That's just how it was."
In ER nursing we would love to be in charge of it all.
Your point of view is very refreshing.
If a woman comes in demanding things, or even just merely asking things at *some* hospitals or with some nurses/doctors, then she's going to get treated like cr@p; other nurses are going to be like you -- willing to change and alter to suit them, rather than expecting them to suit you.
But the laboring woman has no way of knowing which she will get. In some ways, it's better to go in expecting nothing -- and then everything good is a nice surprise, than to go in expecting to be able to have this or that (no IV, allowed to eat or drink, etc.) and then have Attila the Nurse getting huffy. :-/
-Kathy
NYCRN - having been a patient in the ER several times, I fully intend to be at your mercy for whatever you deem is medically necessary for me to stabilize my medical condition. That is also because I trust the assessment and skill of the ER nurses and physicians. Birth, however, is different. Most of the time, childbirth is a normal physiologic process. It needs little to no medical interference. This is where the importance of "stand up for your beliefs/desires" comes in to play.
ER = emergency treatment. Please do whatever needs done.
L&D = giving birth, usually very healthy women. Much more flexibility in care plans.
To NYCRN and AYC,
I have always believed that the ER an OB are the most similar units in a hospital. Our patients just walk in off the street, and we deal with it. One difference is an OB floor CAN NOT go on bypass.
However I have also been in the ER as a patient and a mom of a little patient, and I had very blind faith in their care. The ER staff was fantastic.
In OB, patients are not "sick" (let the debate begin). It should be more of a team effort. Honesty, trust, compassion, empathy, respect and patience is what should guide OB nursing.
AtYourCervix--you're absolutely right! Unfortunately many physicians (I'm currently a medical student) are still trained to think of...oh...anything and everything related to female sexual functioning/ lifecycle events as medical anomalies. Birth has become completely medicalized, pregnancy is treated as a disease state, and menopause (which EVERY woman who lives long enough will experience, no?) is considered an illness. When one of our Ob/Gyn profs said in lecture, "The problem with menopausal women is that they're estrogen deficient," I nearly chewed through my pencil I was so pissed off. Still, he's a sixty-something male. Hopefully things will change as more communication-oriented professionals start practicing, and patients are encouraged to participate more in their own care. I hope?
I am 39 1/2 weeks pregnant with my first, and one of the reasons I cannot spend any time on any of the labor & birth support forums online is because they're populated by Britney Spears clones asserting that we should just "trust your doctor and do whatever he says" (and yes, it's always a he).
Some first-time mom who's not even due yet (38+ weeks) was all excited that she was going to be induced because she'd been "walking around dilated" just wanted to know if it hurt to have your water broken, because that's how her OB planned to start her induction. When I pointed out that this seemed like a bad idea, and she should really ask some questions (like why on earth she's being induced before her due date, and the risk of cord prolapse from AROM to begin labor, let alone the high chance that she'll run out on the clock if she's ruptured without any kind of contraction pattern and will end up sectioned).
Anyway, everyone jumped all over me for being a bitch and a fear-monger, and the variations of "just trust the OB" and let him do whatever just blew me away. It's the kind of thing that embarrasses me to be a woman. I mean, if your auto mechanic had said that we need to rebuild your transmission, you'd ask questions about why and if there were alternative options, but we're willing to let a doc possibly risk brain damage to your baby with a totally unnecessary induction started with AROM?
I don't get the unquestioning trust in doctors, but it is a very real phenomenon.
I didn't want to be labeled "difficult" nor did I want to be so rigid about how my birth would go that I didn't have a lot of specifics in my birth plan. It was hard for me to anticipate everything that could have gone wrong with my last two births. They were completely opposite in every worst way imaginable. This was due to negligent, unprofessional, and rude caregivers. It was rather shocking. Now I know so much more and would have hired a doula - no matter what the cost.
LCT4J - Sometimes life (and birth) is all about living and learning. And working towards making everything better next time.
I planned to birth my baby at a birthing center in water. I developed HELLP. As an L&D nurse I knew my plans had gone out the window...I just hoped I could have a vaginal delivery. My nurses and MD knew this and advocated for me. I was lucky and had a vaginal delivery. I have been thinking a lot about my experience. I did not question or make demands and had no birth plan. I tried very hard to be flexible and to as one of my coworkers said..do not try to be the doctor and do not try to be the nurse...be a patient. Being in the field helped me know which questions to ask and when it was time for an timely intervention. As a doula I believed that women need to be informed and to be a part of decisions w/ their birth. As a nurse I often see the patients who need to be questioning their providers act like sheep and the ppl who need interventions and to depend on their providers expertise not doing so.
There is a middle ground but again I am lost as to how to reach it.
I have 4 children and for me it's a delicate balance. I do a lot of research and ask ??s before I'm actually in labor. However, what *I* want has to be balanced with what my child needs. Labor is not just about me, it's about getting my child into the world as safely as possible. With my last delivery (baby #4, prev births of 2 sons @ 38 wks were 9 lbs 3 oz, both posterior, shoulder/body dystocia with 1st) I was very pissed with the dr that was on that night. She had poo-pooed my fears of another dystocia, my fears of another precipitous labor (#3, a girl, 45 min delivery, completely tangled in her cord) combined with the fact that we live 45 mins from the hospital, in Nov, in Alaska!
She let me go to 40 wks 5 days, severe shoulder dystocia, didn't tell me, screaming at me to get in control and get my baby out NOW, whispering to nurses, next thing I know knees are behind my head, 2 nurses laid across my abdomen, baby's clavicle broken in 2 places. Hubby was horribly traumatized, our 4 yo dd was in the room, I was PISSED. I had continually asked through 8 hrs of labor if baby was posterior, that he was bigger than the others, that something just wasn't right. He was 10 lbs 3 oz, idiot dr was holding him saying not more than 8.5!
If the dumb ass dr would have TOLD me the baby was stuck, that there was a problem then I would have focused better and pushed more effectively. I even told them I needed a min to collect myself and they said no to push NOW. I was so angry that I was ready to kick the idiot dr in the head!
Besides that I have not had neg experiences, the hospitals have always been pro bf'ing, babies were given to me right away and left in the room, never taken to a nursery. They all had low blood sugars (no I was not diabetic) but we dealt with that by very frequent feedings and only a little formula, no IVs or unnecessary heel pricks.
From the original linked story, I note that the author is interested in what to do to fix the problem. I commented above, expressing my frustration at seeing this kind of apathy/"blindly trust the OB."
Having thought more about it, I think you have to realize how deeply entrenched beliefs about birth can be.
When I was approaching puberty, my version of the sex talk included my mother earnestly telling me that when I got married and had a baby, I had to tell my doctor that we had abnormally small pelvises that wouldn't allow us to have a baby normally, and that I would need to have surgery to give birth. She'd had all c-sections, beginning with me. I obviously don't have access to her medical records, but the c-section was apparently for failure to progress / CPD, although I was 7 lb 3 oz.
All my life I believed that I could not have a normal birth and would need surgery to have a baby. It scared the crap out of me. I avoided having children because of it. When my younger sister ended up with 3 c-sections, too, it just reinforced this ingrained belief that I could not have a vaginal delivery. When I asked my OB/GYNs, they'd say that there was a good possibility I'd need a c-section, based on my family history.
I couldn't work up the courage to try to have a baby until I was 33 because of this. It was a constant source of strain in our marriage, as my husband wanted to have children.
I finally found a midwife who said there appeared to be nothing at all wrong with my pelvis and no reason to believe I couldn't have a vaginal birth. I'm pregnant with my first, and his head is well engaged, so it seems like we're on the right track, but it's too soon to say.
But I think you can't overlook the effect of our mothers' birth experiences (and media depictions) on our perceptions of birth. I was almost phobic about getting pregnant, visualizing some life-threatening emergency at the hospital and being rushed into surgery. So many of our mothers had really messed up birth experiences, and may have honestly believed that they were conveying useful information to us. And virtually all media depictions of birth show helpless, childlike women in extreme distress who need to be rescued from birth.
Given that very few of us actually have heard positive birth stories, it's not really surprising that birth seems scary, overwhelming, and like something we may not be capable of doing. Possibly well-meaning doctors tend not to tell you something empowering, but reassure you that you can leave everything in their capable hands and they'll get you through it. In the face of that, putting your head in the sand and hoping that it will be over as quickly as possible and shepherded by some kindly medical personnel doesn't seem like an irrational response.
You make it sound as if it were "either-or", but I have always approached birth as a joint enterprise. Parents retain me because I am the birth expert and I have knowledge and skills they do not; I am always receptive to the parents' requests, and if there is any disagreement, I can usually explain my position well enough that the parents can see that their request is medically unsound. Very often it is their ignorance which makes them make the request in the first place, and quite a number of "issues" aren't really issues at all, such as delaying the first bath, etc. Other interventions such as induction of labor and indiscriminate use of pitocin don't even arise, as you are not an MD with carte blanche.
A little communication goes a long way. Don't ever forget that while it is "their" birth, if anything goes wrong, YOU are to blame!
I agree. It is a joint effort. I think of myself as a tour guide in the wilderness. You wouldn't let your tourist play with bears you knew would kill them! You would show them everything they might not know and enhance their experience in a safe manner.
I totally agree with you. That said, a friend linked recently to a forum for L&D nurses. What I found there was post after post making fun of and expressing anger towards...well, mst women, but most especially women who want natural births and advocate for themselves. Last pregnancy (#3) I was planning a home birth and was in a car accident @ 34wks. Of course I ended up in L&D, where I was treated HORRIBLY. I went out of my way to be compliant, at the expense of my personal comfort, and yet because I'd expressed a need for something other than the status quo I was punished fully (until my MW talked to the charge nurse and I was assigned a friendlier nurse!).
So I totally agree with you that apathy is a bad thing. But I also believe that anything besides apathy will be punished fully and soundly by L&D nurses! That's what I choose home birth (I was reading that nurse forum and thinking "exhibit A: why normal birth can't happen in a hospital"). I do NOT think home birth is the best choice, but I do believe in the current medical climate it's the only choice for a woman who wants to advocate for herself.
Doctors get a ton of flack but IMO it's the nurses who are the root of the problem.
Sad.
I agree with you on a lot of levels. Women should be educated and be advocated for their own birth experience.
HOWEVER... the average women is NOT an expert. Recognizing this fact does not make the patient apathetic. At some point, patients DO need to trust their health care provider. I've found the women who think they are experts, and are most opinionated, are often the most misinformed.
I think judging a patient who is going with the flow and trusting the advice of a doctor as "apathetic" is extremely unfair. Perhaps they agree with the assessment of their doctor. Perhaps they recognize that their doctor is an expert and has a helluva lot more schooling and experience than they do. Blind trust of modern medicine isn't advisable... but blind mistrust is much worse, often agenda-driven, and almost always misinformed.
Nursing staff should avoid making such judgments of patients. I've seen nurses harshly judge patients for both being "too laid back" and for being "too demanding". They can't win. They'll upset some judgmental nursing no matter approach they take. (BTW, I'm not saying you are an extremely judgmental nurse... just reporting what I've seen.)
Let's give the patients a break and trust that they are approaching their birth in a way that they are comfortable. Just because you don't agree with their wishes (including the wish to hear the opinion of a doctor before making a decision) doesn't make that approach invalid. It is misguided and offensive to say that such women don't care about what is happening at their birth.
Love the blog and look forward to following it. Sorry my first post was a criticism - but I hope my points were taken well (and in the spirit that I very much agree with the basic premise of your post).
To everyone who has commented: I can see everyone's point of view on this subject. Yes, as nurses, we can be very judgmental towards our patients. However, a GOOD nurse is going to be able to integrate a birthing mother's wishes/desires into the plan of care WITHOUT being judgmental.
I believe that we also do need to TRUST our care providers - physicians, midwives, nurses - because they do have more medical/nursing knowledge about birth than we do. However - we (birthing women) need to question our care providers: is the care/treatment evidence-based? Is the intervention truly necessary?
It is the job of the nurse to ensure that each patient is educated on their choices and treatment options. Pros and cons. It is also the job of the MD/CNM to educate women on the pros and cons of interventions. Sadly, I don't see a whole lot of education going on - lots of paternalistic "we need to do XXX or XXX will happen."
Obviously, education about labor and birth is an ongoing process for everyone involved - those providing the education, and those receiving the education.
All I truly know is that I - as the nurse - try to provide the absolute best care and education for each and every woman that I care for.
What a fantastic topic. Thank you for this blog!
Yeah, that's I a) chose a holistic practice/midwife and b) have discussed this stuff since my 8 week appointment.
NO circ, no Hep-B, no eye gunk, PKU is fine, NO early clamp, etc.
I don't want to have to discuss that while in labor or shortly after delivery. They know how I feel and are supportive.
-Cathy
Kind of like those women who just want their baby out, doesn't matter how. They don't want to go into details, just do your job, blah blah blah and give me an epi as soon as I walk off the OB elevator. If someone tries to tell them any different then suddenly you have three heads or something. I think one lady I was talking to actually alluded to it not mattering or being a big deal, which ends up being a very big deal for someone else. (especially when you're fighting for a VBAC)
Argh!
Elizabeth,
I've talked to several women of my mom's generation - 60+ and many of them say they were practically forced to have an epi even though they didn't want it. One woman I know said the nurse practically insisted even though the baby was nearly crowning as they reached the delivery room. Another said she was given meds to dry up her breastmilk without her consent and was told, "Here, take these." Good grief.
My mom labored the entire time with me without pain meds. She was at the hospital alone, and was there nearly all day before I was born (at 11:38 pm.) She said she was put in a bed and left alone in the room the entire time. As if because she refused drugs, they were punishing her or something.
Knowing what I know now, I think I'd be like, "Yes, please! Leave me the heck alone!" LOL
I was talking to a woman today at the nail spa who is pregnant with her second child. We started talking about c-sections because I am also pregnant and we have both had one. I asked her why she had one and she said because her Ob said it was a better choice. I went on to try to tell her about VBACs and she wanted to hear nothing about it. She said her doctor thinks they are not a good idea. I gave her my number in case she changed her mind. It just blows my mind that women don't care to get involved with their own health care. She is just taking this doctors word. UHHH it drives me batty.
Post a Comment