In light of what has recently happened (that, which I cannot give details about, and I'm very sorry that I can't), I am glad that I am in a position to hopefully see some change come about.
After witnessing obstetrical atrocities in the hospital setting, I am more than ever sure about the path I am taking towards midwifery. Yes, there have been moments where I doubt my entire career as a nurse. There are times where I want to totally get out of labor and delivery. But, after reading about nursing in other clinical areas, and talking to other nurses, I realize: atrocities happen everywhere in medicine & nursing. You cannot escape them.
Better choice then is, since I am already in the hospital system (and the maternal health system), is work towards positive change. Let's face it, the whole maternal care system in the United States need an overhaul. Shall I go through the negatives alphabetically? Or should I just move on and look at what I can do to help change things?
One woman and child at a time. At this point in time, that is all I can do. I can educate and advocate for the women that come under my care. Women that come under my care do so for a very short period of time in their lives. At most, eight hours (or more, if I stay over my shift).
I look around me while at work, and see how every one of us is failing the maternity system. I am frustrated that I can't "fix" everything.
I know I am not the only nurse who feels this way. I KNOW IT!! We get report on all of the women in the unit at shift change. We all mumble the same comments when something that is total BULLSHIT is going on. Yet.........who is brave enough to stand up and say that it's wrong, and it needs changed? Who follows through with making changes?
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Two day inductions that end up as c-sections for "failed induction". Same group of physicians. Repeatedly.
Not fast enough progress in labor. C-section by 6pm.
Pitocin to distress. Stat c-section. (Oh, we are making glorious headway with this one!! We are taking better control, as nurses, in how we "manage" pitocin drips.)
Induction -->pitocin -->epidural -->fetal distress -->c-section.
Too many laboring women to few nurses --> no one-on-one labor coaching.
Denial of VBAC option, or never being offered the option. Even when presenting in active labor and advanced dilation.
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One person at a time. One woman at a time. One birth at a time. Things WILL get better.
26 comments:
WHAT??? You mean there are people in the medical community who don't agree with all that??? I had panic attacks for about 3 months leading up to the birth of my first son because I totally believed I would end up an unnecessary c-section as all my friends had. Thankfully, my dr didn't do it but I really believe the only reason she didn't is because I absolutely DENIED any type of intervention, including an IV.
My third son was born at home with a midwife and it was a WONDERFUL experience! I would think it would be very rewarding for you to give women what they TRULY need during that vulnerable time in their lives - not pitocin or even an epidural - but support and peaceful guidance towards having a birth experience that is EMPOWERING!!!
I firmly believe that if the other OB at my practice had been on call for my first son's birth, I'd have had a c-section with him. As it was, the sole female OB (in the COUNTY, people) was on call, and she rocked. The nurses loved her too, which I found out from my midwife with son #2, who'd been an L&D nurse at the hospital during the birth of my first.
Change happens just a bit at a time, just one person at a time. You are awesome, AYC. I can't stress that enough.
I completely understand your frustrations! I have been a L&D nurse for almost 10yrs & I'm sooo OVER all the BS! I have been blessed to work with some really great CNMs and have been able to witness birth at its best. I too plan on becoming a midwife. I'm not sure if I want to go the CNM or CPM route. I enjoy reading your blog. Thanks for sharing.
It amazes me how much care varies depending on the doctor or nurses available at the time of delivery. I know there is tons of "grey area" and weighing of various risks when it comes to making decisions about care, but it is frustrating to think that if I happen to go into labor when Dr. X is in charge I'll get to try for a VBAC, and if it happens when Dr. Y is in charge they will insist on a c-section. (Not a perfect example, but you get my drift...)
I'm SO GLAD that you are sticking things out in your field. Real change can only happen if health care professional such as yourself STAY in obstetrics. So thank you, thank you, thank you!
Just remember - maybe today you can't change the world of obstetrics, you can change the world for one patient. That's a really big deal.
I'm so grateful to know that you are out there and fighting the good fight. It matters so much!
--Steph
I've said it before, and on this blog and I will continue to say it. The attitude one woman/one baby at a time *does* make a difference. I remember the nurses who were such big supports to me during the births of my children (8 so far) Some moreso than others like Lyndee, the nurse who was there for my first VBAC, the VBAC none of the nurses-except her- thought would happen. I've gone on to have 6 more successful VBAC's since that day in 1994. If Lyndee hadn't spent the time with me, the intense 1-1 care I required for almost 4 hours I probably would have had a C-section and getting a VBAC after 2 C-sections? Good luck. It is near impossible in most areas.
I can only imagine how bad the bad days and bad experiences can be but the good days, the ones that you go home with a smile on your face? They stay with us mom's forever.
I know you don't give medical advice but theoretically.... what options would you offer to a first time VBAC mom at 42 weeks with a soft, effaced cervix at 2cm but no labor in sight..... waiting it out may mean being dropped from care (by CNMs), pitocin is not offered, the only thing offered is breaking water and seeing what happens or ERCS.....
Hey, I had a better birth this time because of you and a few blogging nurses/midwives out there. You informed me enough to help me be BRAVE enough to seek out a midwife instead of going the traditional OB route. I sometimes think I'm just picky, should just grin and bear it. However, because I switched to a midwife I had a healthy baby and a healthy birth experience emotionally. I also had a midwife do all sorts of good things in front of a nurse and the student nurse following her around. They witnessed a healthy and GOOD birth. They witnessed how it can be done. All this because of you bloggers, all this because I changed my provider, all this because my doctor's group added a midwife, and because she walks the line and still works at a hospital. Sure, it wasn't perfect (we still had a few interventions I'd prefer I didn't do), but overall I was treated with respect while giving birth, I was given choices.
So, thank you for being there! Thank you for sticking it out and sticking up for women like me.
Blessings!
Dawn
Dawn you don't know exactly how happy I am that you had the awesome birth experience that you had. :-)
Cassie - you're right. I can't give advice. Theoretically, there are several options:
- Elective repeat c/s
- Rupture membranes & see if labor starts
- Wait for labor to start naturally
- Using non-medicated methods to try to start labor (nipple stim, herbs, EPO, red raspberry tea, intercourse, acupressure, etc)
- If you're religious, pray. (This is not meant to be sarcastic.)
"One person at a time. One woman at a time. One birth at a time. Things WILL get better."
and this is why we all stay in the game! thank you for what you do, for standing up and speaking up for what is right! one birth at a time!
I wish I could do a homebirth w/a midwife for the next baby (if there is one) but it's a no-go in my state. I'm not comfy without a medical professional present during the pregnancy & birth.
Thankfully, I had a pretty good birth last time (not so the 1st time). The only interventions I had were 20 mins of monitoring and an IV for antibiotics (GBS+).
I loved by OB though and that made all the difference. There were about 3 in the practice that I would not have been happy to see though! I was so fortunate to end up with the one I saw throughout TTC and my pregnancy (aside from visits just to make sure I'd met all the docs)
Thing is, to me, it's the nurse that makes the birth...or that's how it was for me.
Wow, I'm rambling but I hated that I was at the hosp, nearing transition, and had to answer questions & have the nurse in the room clacking on the keyboard, why can't they do that w/pre-admission??
Thank you so much for writing about your experiences. I am going to start to TTC in a few months and your posts have given me a lot of information and most importantly confidence to know how I want my labor and delivery to proceed. I hope that you don't mind, but I shared a link to this post on my site. I think that it is so important esp. what you say about:
"Induction -->pitocin -->epidural -->fetal distress -->c-section"
thanks again
You should stick in there, but you'll probably have to become an independent CNM to be in a position where you can criticize physician practice without being fired, right?
That's what I didn't like seeing about OB nursing. American obstetric practice seems like the least evidence-based and most tradition-entrenched area of medicine (compared to, say, cardiac medicine), and OB nursing seems like the least allowed of all types of nursing to criticize those practices and behaviors. It's a shame, because the OB nurses I worked under where very smart and knew what they were doing.
To gain promotions at my new gig, you have to perform a research study, either an actual study in your field or a meta-analysis of other studies that suggests a change in how your unit practices medicine and nursing. That works well in critical care, but I wonder how they do that in the OB department!
Man-nurse: you hit the nail right on the head.
I've had three wonderful, positive, drug-free vaginal hospital births, thanks in part by people like you who have inspired me to educate myself about childbirth and my rights as a patient. I still remember the nurse from my first birth. Her name was Arin and she was 110% supportive of my desire to go drug free. You do make a difference -- keep up the good work!!
you made a difference to me AYC! Because of you and other L&D nurse bloggers, I was brave and felt informed enough to hold my ground and attempt a VBAC last year and I did! It was such a wonderful experience, hardly any interventions. You'll never know what a huge difference you have made and will continue to make in the future! Thank YOU!!!
"One person at a time. One woman at a time. One birth at a time. Things WILL get better."
I ditto this too. :-) That's why I'm a student hb midwife. You are only one person, but you can make a lot of difference for the women that you serve when you are on duty.
I aim to be an OB who takes the best of both midwifery and medicine.
I hate inductions. And I did one recently (preeclampsia at term) that lasted for 3+ days...in a vaginal delivery. Didn't need to rush back for c/s as long as baby looked Ok and Mom was stable.
But we live in an irrational world...
Sounds like you had a rotten week. For all the "evils" you're experiencing, I just wanted to give a shout out to the highly skilled Perinatologist & massive amts of medical intervention that gave me my two miracle babies (yes, they were both necessary C-sections proven by my uterine rupture during my labor) and remind you that some very medically complex moms will benefit from your skills & education. For the moms who can carry successfully & deliver without pressure to have a C/S, I admit a tiny bit of jealousy, but after burying 3 babies born too soon, I am satisfied with all that my hospital did for me. Remember that there ARE happy endings & there are good MDs out there. My Perinatologist was 1 in a million but he was THERE for me, day or night, through my troubled pregnancies. I mean it, he gave me his cell phone # & answered emails, saw me same day, etc, and held on to hope when other OBs & MFM experts had none. And I have two healthy children because of that... I imagine THAT is the kind of success that is driving you to want to improve L&D care.
And AYC knows, after reading my last blog posting, that some women think it's "bad" to question a doctor. "After all, he has the letters M.D. after his name."
I've been saying this for awhile - I think healthcare reform should start with these a-holes who run up costs by doing so many unncessareans. Inductions that fail? Lemme guess - he broke her water at like 2 cm and nothing happened. wonderful. I think these people should be investigated for fraud by the insurance, and then anonymously reported to the medical board or whatever it is. If they're the same people on a regular basis, can you make an anonymous complaint?
we're rooting for you ... you are awesome and thanks for trying so hard to provide such a wonderful service to many women who often don't know how much they need it.
I agree the system needs reform...I hope to see it sometime in the next fifteen years before I retire.
one at a time...for now, one at a time. We can only do our best...to advocate, to provide safe care, to simply care.
I am sorry you have been through a difficult time and have felt discouraged.
~Julie
I totally hear you!
That's one thing I love about my hospital... we VBAC!!!
In fact women come from everywhere on our side of the the state to VBAC with us. Never had a ruptured uterus on a VTOL (personally), had only one in my career this far... on a grand-multip (non-post-C/S), scared the sh*t out of me!
Do you think it's a little like, what came first, the chicken or the egg? Women need to know these things about inductions, in particular....should it be their perogative to seek out the info, or should their medical professional somehow be responsible for all their education?
I do not understand how a pregnant woman can go into the hospital and not know some of the basic things about labour and delivery (some of the things asked on "Baby Story" on TLC). Or, they assume they want a 'natural' birth so they do nothing to prepare for it, or in case something must change. I do not understand how so many women have no interest in what is a normal delivery (and I don't even mean a 'tree hugging natural birth' type of thing). How they can be so passive and assume the doctor ALWAYS knows best and is only looking out for them. I see these moms on Baby Story and want to smack them, LOL.
Hugs!
I was just reading OBGYN Kenobi (sp?) this morning...with all the OB's on there complaining about how maligned they are.
But then one resident (who didn't have the guts to even have a screen name)...in response to my asking if it was *really* necessary to do a cervical check on a woman two hours after the previous one when the woman only had 3-4 contractions in that time said that it was necessary if she was in labor. Huh? Didn't I give enough information to establish that she really *wasn't* laboring? Sigh.
They don't get it. They really don't. Fish don't see water, and OB's don't understand how what they are doing is hurting women.
I read that resident's comment. Really? Rechecking a cervix after 2 hours and only 3-4 contractions during that time? She's NOT in labor. No need to check her cervix to prove that!!!
I was taught my OB in the USA...then I moved to Canada. The 4 hospitals that I have worked in here are NOTHING like the hospitals in the USA. IVs are not mandatory on admission. You can labor in any way u like including standing on your head. If you don't want pitocin post partum, ya don't have to have it. If you want to stay in the tub until you want to push...go at 'er. Most monitoring is done with the doppler q15min....and the BPcuff is never strapped indefinitely on the arm. If you want to go for a walk off the unit...feel free, but come back in the next hour to let me hear baby. One to One labor coaching rather than sitting at a desk in front of the monitor is encouraged.
It was a new way of L&D nursing and when I went back to the USA (a different state that the one I first did OB in)it was difficult to go back to the constant monitoring thing.
There were far less complications with the moms in Canada...and I am thinking because there was less "medical intervention". I LOVED working with the American CMWs. On the other hand - a lot of the Canadian GPs were a lot like Midwives in how they cared for the laboring mom.
A big plus also: fewer lawsuits in Canada .... in 33 yrs I have never had to attend court re: any medical lawsuit....for myself or for anyone else...
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