So, after watching BOBB (The Business of Being Born) and doing my current reading about the history of midwifery/hospitals/medicine, my eyes have been opened, yet again (still!) as to how harmful the hospital environment can be towards childbirth and women.
Yes, hospitals, medicine and nursing care can save lives. However, ever notice the trickle down effect of us *causing* some of the problems in the first place?
I have been guilty of thinking far too medically as a nurse on L&D. I feel guilt for being that medicalized thinking nurse. I'm not talking about truly sick people, I'm talking about normal labor and births.
As a new nurse, you're taught one way. You are more than likely fearful of retribution or a good scolding by other nurses or the almighty physicians if you don't do as your told. After all, those people have the experience, so they know what's correct, right? So, the new nurse will pit-pit-pit the mom til she is begging for an epidural. Or until the baby crumps. After all, the doc is bugging you, telling you to keep "upping the pit!".
Then you start to gain more experience. You realize, you have more autonomy than you thought. You need to look at the entire picture. You have control over that pitocin. You do not have to "up the pit" to distress (maternal or fetal). You assess and reassess the entire situation, continuously.
Where am I going with my rambling? I don't freaking know. All I know is, burnout is approaching. I'm doing my best to diffuse it and process it. I see so much medicalization of birth that it sickens me. I can't fix everything. I can only advocate one woman at a time.
What really goads me: a woman presents for induction of labor at term. She gets a prostaglandin gel placed for cervical ripening. It works too well, causing tetanic contractions. The baby crumps. We work to fix the horrendously long contraction and help the baby recover. The worst part of it all? She and her husband verbalize that they have *no clue!* why she was being induced. NO CLUE. She's not overdue. She's not having pregnancy complications. No medical complications. Just a normal pregnancy for a normal woman. WHY did they go along with the induction? Because the doctor told them they were going to induce her labor. Yes, full and complete trust in the physician. No informed consent on what the induction actually entails, and the risks involved. They had no clue that something like this could happen (and does happen often, especially with certain physicians).
Do you know how many times the above scenario happens where I am? All the freaking time. Sometimes several times a week - that I know about. Mind you, I'm only there 4 shifts per week. What's going on the rest of the week? Same shit, I guarantee it.
Our maternity system is broken. I'm sick to my stomach about how women and their unborn babies are subjected to such bullshit that they do not need and that actually cause negative effects.
I'm really, really trying to hang on here. I know that I can (and do!) make a difference in women's births. One woman at a time. I can't help all women, though I wish I could. I question physicians, and even midwives, on their rationale for doing this or that. I am very careful about adjusting pitocin infusions. I labor-sit my natural childbirth ladies. I give verbal and physical support and encouragement. I educate about options, pros and cons, and allow the woman to make the decision without my trying to sway her one way or another.
You don't know how tempted I am, sometimes, to put in a request to transfer to a different department in the hospital. Some place where I am not working with such a vulnerable population. But that's the easy way out folks. That's running away from the problems. That won't fix a damn thing.
So I stay. I vent. I blog. I eat chocolate. I drink alcohol from time to time. I exercise. I hug my kids. I paint. I read fiction books.
I plug away at my midwifery education, so that I can someday be a better provider than what I am and what I have witnessed.
xoxo
AtYourCervix
43 comments:
I so so so wish you had been my nurse at my last delivery. Even though it was a major medical drama, I really could have used a nurse with such compassion.
I like your mantra "one woman at a time". I hope that carries you through a lot of difficult times. Remember - you may not be able to ever change the world, but you can forever change the world for one person.
--Steph
Hang in there! A good midwife is hard to find these days.
I was turned down by 3 of them last year due to "protocol". I moved to another state while with child and since I did not have "prenatal care" no one wanted to assist in the delivery of my baby. I am an experienced homebirther without ever having any complications but still not one out of 3 would assist me???
You know my situation, and I've had some excellent nurses who have made the difference in my births. Every time you are there instead of a bubble head nurse or an ignorant nurse, you are giving better care to the woman that she may have gotten without you. If a nurse is truly trying for me and I need an intervention FOR REAL then I will not feel as violated/let down/depressed after the birth. There are consequences to every intervention that may follow the woman long in life. If you help women prevent some or all of those interventions that are unneeded, you just might be saving their bladders, their abdomens, their rectums into elderly years. You may be also protecting them from more depression. I know after my last birth it took a few days to figure out why I felt so sad. It wasn't hormonal, it was the feeling of being overpowered, violated and victimized by my nurse. Truly. I think the depression they feel is from being coerced or down right forced into things they know (even if only inside deep somewhere) are wrong. You don't do that to women, that means a better chance of happiness when they go home.
Blessings future midwife!
Dawn
As a new CNM in a hospital, I feel your frustration. I feel pressure by my back-up to intervene when I don't feel it is necessary. It's to the point where I don't want to call him unless I'm POSITIVE that we need some intervention, because if he's there, he's going to intervene.
I have thought long and hard about working in an out-of-hospital setting. Unfortunately for me, that's near impossible where I currently live. We have no free standing birthing centers (and I feel that the medical community here is too strong to "allow" that to happen) and CNMs cannot legally attend homebirths. I'm trying to make a difference for the women I work with - and I'm trying to make that difference from inside the system. That's all I can do right now.
8 years ago whenI was pregnant with my now 7.5 year old son there were very few nurse midwives in my area. I was not going to have a NSVD due to well, me. I was fortunate to have a doctor who clearly spelled out the explicit risks in inducing a delivery with cervical ripening & pitocin, especially in my case-- term, 0cm dialated, 0% effaced, high risked. In all probablility I'd have ended up in pain, with more complications than I already had & an emergency c-section. I had a scheduled c-section with minor complications & some awesome maternal-child home health nurses who were also great patient advocates.
Thank you so much for sharing your frustration. I'm a nursing student right now, although my goal is to be a midwife. I can already feel my frustration building when my instructors talk about induction and pitocin.
I am a doula and CBE and want to encourage you to keep making a difference one family at a time! We need BETTER options for women and babies. I LOVE it when I hear afterward that couples from my classes got nurses like you. In our area women will drive a crazy long way past hospital after hospital to be cared for by compassionate midwives who practice evidence based care, and believe that birthing is normal. It is so worth it! Unfortunately, care like that is not the norm. More people like you joining the ranks can help make that kind of care the standard not the exception!!
Twenty-three years ago I gave birth in a hospital setting with a midwife. There were a number of interventions (done for good reasons, I was having an atypical birth) but throughout, because of the midwife, I felt I was in charge, making the decisions, in control. I am still grateful for their support. I had started out with an OB who (despite trying to find a "natural birth supportive" doctor) turned out to be automatic enema, automatic episiotomy, etc. We moved when I was 7 months pregnant and I was thrilled to find the group of midwives.
I had my second child with the group, and again had a wonderful, supportive experience.
I had twins my third pregnancy, and the midwife group didn't do twins, so I was back to an OB. He wasn't as bad as my first OB, but the experience was very different than with the midwives.
The point of this long story is that I am very grateful those midwives were available for my first two births, and the first part of my 3rd pregnancy. They made a difference for me. I am sure you will make a difference for many women and babies.
:-(
I'm not even a nurse, and I kind of know what you mean. Just talking about it, experiencing it yourself, reading about it - it sometimes makes me want to go over the edge, and I'm not even in your shoes. I can't imagine how unbelievably frustrating it is for you.
I totally know what you're talking about with the Pit thing, too. I blogged about this a few days ago - women who were asking for all the info they could about inductions, 'even though there's no medical reason for it,' blah blah blah. They have no clue what to expect and happily go along with it, even though they wouldn't so much as take Tylenol throughout their entire pregnancy. WTH? I am like, 'Then what are you doing it for?!" One woman actually said she 'didn't want to make her doctor mad,' but he wanted to use Cytotec! (this was about two years ago) and she had actually read up on it, thank God. And yet, she still didn't want to make him mad.
It boggles the mind .... but I figure, keep blogging, keep advocating, and know that you are helping people, some way, somehow.
As a good nurse, you'd experience this frustration no matter where you work in the hospital. You're making a difference as a patient advocate.
As someone who had nurses who let me believe my AROM was necessary and that I should go on and get the epidural, I so wish I'd had someone like you instead. You probably make more of a difference than you think. If I had ONLY had a nurse to tell me during the challenging contractions that I was doing fine--just that would have gotten me through. I didn't even have that and my husband and I were so scared. I had a homebirth the second time around (which was beautiful--I had an amazing midwife), but there is NO excuse for a woman not to get a compassionate birth in a hospital. So, while it would probably be less stressful for you to transfer, it sounds like you are making a huge difference in women's lives and they are so blessed to have you.
AYC, what you are feeling is absolutely no surprise to me. Been there, done that, got the t-shirt. I hated being a labor nurse more and more while in midwifery school. I tried to cinvince myself that I would win little victories where I could. But I became such an unpleasant to live with, I left bedside nursing and went into education while I finished my degree. It was the best decision I could have made for me.
Labor nurses are taught from a fear-based model. This isn't your fault. But now that you are getting more education, you will gradually let go of a lot of that fear, and along with it th medical approach to everything about women's health. You will transition to a midwifery perspective. It's eye-opening. Think of it as labor - painful, tough, requiring endurance and strength. But what an awesome prize at the end.
Hang in there.
I think what you are feeling is endemic in nursing,just like what Dreaming Tree said. However, I do feel there is more lack of autonomy for nurses in L&D than in almost any other area of nursing. Why is that? I could never be an L&D nurse and I thank God there are nurses like you out there. You are making a difference. It is why nurses stay nurses, even when the job sucks.
Oh, gentle hugs across the internet! we all feel that way sometimes! just remember that every woman you come in contact with at every birth you attend is just that better off for having had your support! I posted this on facebook, are you on facebook? Hopefully all my peeps will send you some gentle hugs too!
AYC! I feel your pain. here is to a better world of birth soon for all women everywhere!
I just want to share a story about my sister in law who delivered last week. She had a fantastic doula (midwives aren't allowed where she is, although her doula is also a midwife). She was induced and progressing fairly well, but her doctor told her she had one hour "to make something happen." If there was no progress at his next check, he was going to intervene despite her being in labor for less than 8 hours. When he checked her she had made some progress and he told her, "You just bought yourself another hour." To me, that sounds like something you tell someone on death row when they get a stay of execution, not someone who is having fantastic progress for their first birth, let alone an induced birth.
I haven't met you, never will, but I want to thank you for your care and compassion. Not only are you cognizant that there is something awry with the medical community's opinion that laboring women should be processed like meat at a butcher shop but you are actively taking measures to change it.
You can't win them all. It's healthy for you to feel conflicted, to vent, it humanizes you to your readers, and sharing your educational and professional experience helps educate people as to the choices that are out there. Thank you for taking your time to help.
I work in a large hospital too and know how you feel. We need more like you!
Thanks to nurses like you, I have had two wonderful natural in-hospital childbirth experiences (and hope to have another next month).
Keep up the good work -- you may not think you are making a difference, but you are!
Just echoing everyone's comments: you are making a difference, with the women at your hospital and through your blog. I had a horrible experience. I chose to be induced. I did not ask the right questions and I was not told of the risks. I simply went for it because my baby wasn't moving as much as she had been and I got scared, despite the fact she passed her stress test with flying colors. I felt like it was horrible, scary, I'd never do it again... Once I began learning from people like you, I felt angry, that I failed my baby, put her and I in distress unnecessarily.. But, most importantly, I now know how I want things to be if there is a next time and I do my part to try and help pregnant mommies educate themselves. This is all thanks to you and a few other L&D and NICU nurses. You rock!
Thanks for hanging in there for the women who need you! I know how tempting just giving in and burning out can be, but remember that you ARE important to women you attend. Not just natural birth moms, but those who really benefit from interventions.
I actually needed them, but having my granola nurse with a "meconium happens" button there to tell me that I was 75% effaced and therefore "progressing" meant everything to me when I was scared I'd end up with a cesarean. And I didn't - I gave birth vaginally to my beautiful healthy twins instead of developing fill blown HELLP. The other nurses had an obvious "I can see where this is going, just lay back and take it" attitude. Her wonderful support inspired hope and put the fight for my health and my birth back in me. :)
Great post, honest and real. You captured your preburnout perfectly and I'm hoping you have your chin up...good energy is being sentyour way...
From a purely practical point of view, as a CNM who has been in hospital practice for nearly 40 years, how will you function as a CNM, when on staff? You will be constrained by hospital protocols, and required to have medical supervision if your patient does not remain within the parameters the hospital protocols set. Even the MDs have some restrictions on their autonomy -- you may not see it, but departmental review committees do review cases where there is a bad outcome, or where a doctor repeatedly ignores hospital protocol.
If you choose to work outside the hospital setting, you are even more vulnerable because if anything does not go according to plan it is YOU who are held to account; you have no backup.
You know, it's not CNMs against the doctors, it is CNMs WITH the doctors -- each has his/her appropriate sphere of responsibility.
I really wish you could get beyond the ideology. I became a CNM in order to better serve all the women in my care, not to try and force my beliefs on them to have a particular kind of birth which I think is "better".
You say you can only work with one woman at a time; but what you want is a complete change of the system. You will continue to be frustrated if you try. Of course, if you are in private practice, you can cherrypick your patients and only take those whose ideology mixes with yours -- but in the world in which I work, CNMs care for all women, it's just that some I care for alone, and some I care for in conjunction with medical input.
I find you to be simply amazing!! I've always wanted to email you with a few questions (even though I know you are crazy busy!) and wanted to share my second child's birth with you, because like me, I'm sure you will find it to be a terrible birth story. It's been two years and I am still very upset, feel regretful, and am resenting the doctor who put me through a terrible birth. My sweet little baby did come out fine and people around me say I should be thankful for that and forget how she was born. But now I feel torned....because she ended up being a c-section, I don't know what to do when I have another child. Like the couple in this story, we were induced the day after my due date, for what reason, I have no clue. My child was diagnosed with a kidney defect at 20 wks. gestation, but that was no reason to induce me because there was no immediate danger with her issue. It's a long story and perhaps I will email you someday but it was a 15 hour long labor that ended up with an emergency c-section (I was put to sleep, my boyfriend wasn't able to witness her birth) because the heartbeat stopped (because she was NOT ready, poor thing was exhausted). I want a VBAC, no doctor whatsoever, just a midwife, no pitocin, no induction and all I know is that I will be interviewing everyone who will take part in my care and explaining all the research and facts I know...so that they will NOT do what happened to me previously. A lot of this has come from reading your blog!!! I'm just afraid and nervous for when I am pregnant again and feel incredibly stupid and embarassed for letting this happen to me. Truly amazing, I look up to you as a nurse (I'm a nursing student), a mother for being able to juggle everything, and as a future midwife!!
Thank you, thank you, thank you -- EVERYONE!! I have read each and everyone's comments and birth experiences, and am encouraged by your kind words to keep forging on. I'm not leaving L&D. I'm going to keep working with and for women and their babies, to help them along in this wonderful (and sometimes scary) birth process.
One woman at a time.
I was only 20 when my one and only child was born, and I knew even then when my MD asked when I wanted to be induced to reply, "I don't." I went on to birth my son 2 days before his due date with no epidural and very little medical interference. My labor was 5 hours total and I didn't require a single stitch. I am so grateful that I had my Mom, my husband (though he was only my boyfriend at the time) and a supportive nurse there to help me. Please keep doing what you do. You are making a difference!
Your blog and your writing are also making a contribution. Really, it's an awful situation we confront with maternal health care in this country, but you are a bright spot. Not only are you on the front lines in L&D, you are here, raising awareness and spreading the word through the internet.
I'm a labor nurse who trained as a CNM, and am now working as a nurse again because of the call issue. I was lucky enough to work on a labor unit where the nurses and CNMs drove the care given, but that's not the case now and it wasn't the case when I was practicing as a CNM. Birth culture starts with the culture of the providers, with the culture of the labor unit, with a respect for women. Hospitals aren't the enemy; home birth isn't the solution. I am too high risk for CNM care, much less home birth, but had a wonderful and respectful pregnancy and birth. It can be done.
I work in the mental health field & I totally get your burn out. I would say this to you, go easy on yourself, take care of you, acknowledge your feelings, and keep reminding yourself that although you are swimming against the tide, it will eventually turn. =0) While the things you do may seem small to you, they are huge in each woman's life. You ARE making a difference.
In answer to the why do people trust their providers blindly.. Have you ever read about Stanley Milgram and his research on Obedience to Authority? He was a social psychologist who conducted some amazing research. Look it up, very intriguing stuff about how we are conditioned to obey authority, and how far we will go.
Also, keep in mind how care providers react to patients who are informed, assertive, advocates for themselves. They are often seen as pushy, know it all, obnoxious. They get eye rolls and condescending if not nasty tones of voice. In some cases they are threatened, bullied, and harassed. Humans want to be liked, and often that desire for approval and fear of disapproval outweighs everything. Is it any surprise that in the face of such power and often abuse people cave?
I've given birth 8 times in 8 different hospitals. Varying experiences for tons of different reasons BUT almost every positive experience I had, if one person touched my birth and made it better in a good way it was almost always a nurse like you. Along with my mental images and memories of those days I can remember the names and faces and actions of those nurses who made a difference to me. It may have been little more than a touch to my forehead and a compassionate look in her eyes or a cold cloth on my neck but it mattered and still does. You *do* make a difference!!!
I'd swear we work in the same hospital...then I realize that we don't, and that's even worse becasue here we are in different areas of the country and the same thing is happening. Women who come in for induction and don't know why, are told from their first appointment that their pelvis is tight - therefore they aren't surprised when they are induced for "postdates" at 40.1 weeks with a cervix we can barely reach and then they end up with a c/s. Sigh.
You are doing such a great job. I know it is hard to avoid burnout and BS. As a labor nurse, I could not appreciate your philosophies more. I have had more than enough run-ins with pit-pushers and docs that are quick to cut. All I can say is "I know and I am with ya in the trenches, sister."
I just wanted to take a minute and tell you that you ARE making a difference, one woman at a time, and no just in the LDR!!
I have been trying to decide whether to pursue a CPM or a CNM and reading you has really helped me understand what I'm choosing between. I thank you for your dedication, your time and your sacrifice, here, Mama. :)
When I think that maybe down the road I could go to nursing school , I think about this. How it would be nice to change from the inside, but how helpless it would be sometimes. Hang in there, you make a wonderful difference for many women and it will give you more experience and resolve to be successful in your midwifery career.
Our maternity sickens me as well! I chose to have a VBAC at home for that very reason.
Thank you for making a difference for the women that you do serve, and for us here in blogland!
I just wanted you to know, I feel your pain:) I work in l&d too and I have some very very frustrating moments. But then, there are those good ones...those ones when you know you made a difference, even if it was just let them know that you are there for them and that they can do this. I try and hang onto those times:)
I'm pregnant with my second, an aspiring L&D nurse and I hope when it comes down to this labor and delivery I get a nurse just like you! I'm wanting to go natural this time (preparing myself with self-hypnosis/hypnobabies) and really praying I have a great supportive nurse. If not, I'm preparing hubby beforehand to help me stand my ground. Thanks for sharing your thoughts.
"I plug away at my midwifery education, so that I can someday be a better provider than what I am and what I have witnessed."
I have been quietly reading your blog for a year now, and I love it. The stories you tell are compelling and your perspective is enlightening. This last paragraph almost made me cry, both because I was touched and because there seems to be such a lack of others like you out there who are motivated to be the change we need!
Thanks for this post. I haven't seen the BOBB yet, believe it or not. I do have their book "Your Best Birth", and I think it's pretty well done. It's amazing compared to a lot of the other birth books available.
I am so worried about my residency. I am afraid that I am going to end up in a very medicalized place (and, what ob/gyn residency isn't?), and I am either going to bang heads the whole time, or burn out, or both.
Chocolate is definitely going to be involved.
How lucky your patients are! What does it mean when a baby "crumps"? Sorry, social worker, not medical. LoL. Hang in there. We have a lot of policies and constraints placed by our agency and the courts too :(
have you seen this recent ad?
http://www.californiawatch.org/health-and-welfare/more-women-dying-pregnancy-complications-state-holds-report
I thought of you the moment I read it.
Thanks for all you do!
BLESS YOU for all you stand and all you stand for.
I'm a doula-in-training and a homebirth mommy.
We all need you in that L&D room... The epi ladies, the pit ladies, and the unmedicated ladies.
I cannot imagine how difficult it is to be in the middle of an organization that is usually at odds with your belief system.
Your blog alone gives me hope that we can all evolve the hospital maternity system for the better.
You ROCK. Breathe deep and know that you ARE MAKING A DIFFERENCE (at least to the few birthing families that allow you to).
THANK YOU!!!!!!!!!!!
Hang in there.
i don't check in as much as I should, but I wanted to say, that you are my role model.
I am currently starting the process of getting everything ready for nursing school (I am in the middle of my CNA right now), where L&D was the goal. And I have to say, that I've been dragging my feet so long because of the burn out that can come with the unit. For the fighting up hill, and for the big fight ahead that we as women need to be making to stop getting treated this way.
Then I look at your blog, and I feel a sense of hope. There is no doubt in my mind, just as there is no doubt the sun will rise tomorrow, that you are making a difference. Not just to the women that you treat, but even to the other nurses and the doctors around.
Bless you for doing such hard stressful work and trying to make this a better place. Bless for you giving some of us hope, that we might be able to make a difference just like you.
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