I have read several comments lately that seem to feel that I come across as judgmental or non-supportive, or negative about whether a woman births with or without pain medication/epidurals.
Let me just clarify: I support a woman's choice in how she intends to manage the pain of her labor. Natural childbirth is my passion, of course. And I am constantly in awe of women who have a natural childbirth.
HOWEVER - that does not mean that I do not support or berate or even belittle women who choose to have pain medication or an epidural (or both). I had pain medication with my first two babies. Wouldn't that make me a hypocrite for judging women who want pain medication while in labor?
If you want an epidural, I will make sure you get one (as long as the baby is not ready to be born imminently - although, I have gotten women epidurals placed that late.) I will educate you on when is the best time to get an epidural, how it is placed, the possible side effects, and what you will feel once it is working.
If you want IV pain medication, I will tell you what it is, what you can expect from it, and how the baby will respond to it. And yes, I will be the mean nurse and withhold it if your baby is going to be born imminently. (Reason: respiratory depression in the neonate, need for Narcan and resuscitation, possible NICU admission if the baby fails to be properly resuscitated or has extended apneic episodes.) I will also tell you why I cannot give you pain medication so close to the birth. I will also help encourage you in going that last little bit of labor and pushing if I cannot give you pain medication to help your labor pains.
Truly, I do empathize with your pain! I remember begging for more drugs with my 2nd child, when I was 7 cm and moving fast.
I think that each and every woman is a powerful being, capable of such strength and amazement at being able to give birth. Does that mean that I am judging or leaving out the women that give birth by c-section? Do I think they are any "less" of a powerful woman? HELL NO!
I really hope that I have cleared the air.
YES - I am a supporter of natural childbirth.
YES - I will give you IV medications or get an epidural placed if that is what you want or need.
YES - I will support your birth choices.
NO - I do not advocate or support elective inductions for no medical reason.
NO - I do not advocate or support elective primary c-sections for no medical reason.
YES - I support VBAC, if it's the right thing for you.
YES - I support a repeat c-section, if it's the right thing for you.
YES - I will be your advocate.
YES - I will help to ensure that you and your baby have the best possible outcome.
YES - I believe that birth experiences are very important for some (many?) women.
19 comments:
Well said, AYC.
It is good to get that out there. By nature, people tend to believe that their choices/opinions are the only valid ones but each situation, each patient is so different.
I had one medicated childbirth and one natural childbirth. There were extenuating circumstances in both cases, but while the experiences were extremely different the results are the same--I have two healthy boys running around destroying my house--and that's all that I ultimately care about.
Eloquently said...this would make good reading for anyone entering the Ob/Gyn field as a provider of care!
Well done.
Completely agree with all said!
Love what you said. Not that I didn't know it already. :)
AYC,
I have been a long time reader and have never, not once, gotten the vibe that you have an agenda and try to push your patients into it. You sound like some of the top-notch nurses I have had. Women who have supported me, physically and emotionally through a C-section, VBAC's-both medicated and unmedicated. Some of the most memorable moments of many of my births involve my nurses and they weren't necessarily big and dramatic but small things that meant a lot.
For example, my nurse with #8 had had a homebirth and two unmedicated hospital births. I ended up choosing an epidural for this birth. During the placement I cried and kept saying "I'm sorry, I'm sorry" and she put her arms around my shoulders and stroked my hair and told me I had nothing to be sorry for, I had worked so hard for this baby already and deserved a rest. It was a 30 second interaction but really changed the whole tone of that birth for me.
The essence of good nursing care:
It's all about the patient.
It's all about choice.
Right?
I can't imagine where that came from! I have never ever read any non-supportiveness from you ever.
I love your stories and you tell them with such caring and concern....supportive all the way!
Well said!
I originally found your blog when a link was posted on a pregnancy message board and the women there were going on about how you were so judgmental about your patients. I came and read the blog myself - loved it! - and saw no judgment whatsoever for women who chose epidurals nor any signs that you were pushing women to go unmedicated if they didn't want to. People - esp. very pregnant people - sometimes get a bee up their bonnets for not good reason.
That was a few years ago but it wouldn't surprise me if you're seeing these comments now for a similar reason.
Great comments. I feel very similar to how you do. Sometimes I worry that I come across as too natural becuase that really is my preference, but truly all women should be able to make educated decisions. The key is that they are educated and are given choices. Such as, we can get in the bathtub, or you could get an epidural. Here's the consequences of both...
Thank you so much for posing this. I am an ex doula, new labor and delivery RN. I was so worried that working in a hospital would suck my soul out as my passion is natural childbirth, as well. But this is exactly how I have come to feel in a few short months. I want my patients to have a good experience first and foremost, and imposing my agenda on then ay that late hour is pointless and selfish.
I am also a L&D nurse, and I am so with you. So many mom's come in and want to know 'which kind of nurse' I am. And my response is always 'One who is here to support you and care for you and your baby.' I am impressed by Mom's who 'go natural' but I am also impressed by Mom's who will go through any thing, meds, surgeries etc to make sure their babies are healthy! I love natural birth, and it was right for my family, but that doesn't mean that I won't try and page the best, most gentle Anesth resident that I can track down.
You Go Girl!
I looked at it this way...you support all women. However, you are passionate in your belief that a natural birth is possible for more women than who actually try. You see so many women that don't even try, who are victim to other's labour stories, etc, that when a woman comes in and has a very challenging labour due to Pitocin, but works through that to have the natural birth she (and you) know she's capable of, of course you're going to cheer! And I hope you keep cheering loudly!
As to that comment a couple posts ago about "Labor is painful"...I HATE when I see blanket statements like that. My labours were not painful. But I don't expect everyone to feel the same way. Right now, walking is more painful than labour ever was, but I'm not telling everyone that walking for them will be painful too, so just go get your wheelchair now!
As a music teacher, I see students with natural talents who don't have to work hard. Then, there are the students that love music, but have to work so hard. Shouldn't they deserve an extra high five?
I don't get that vibe either. I can see how people might make that mistake.
Through this site I discovered "My OB said WHAT?!?" and there, along with a lot of enthusiastic support of natural childbirth etc., there is a massive amount of angry, judgmental, bitter ranting directed at doctors, hospitals, and the allopathic model (I found it especially disturbing to repeatedly read attacks on vaccinations, GSB prophylaxis, vitamin K and erythromycin eye drops as unnecessary/tricks for physicians to make money. Really!)
So people may be identifying you with a particular "team" and attributing to you views that they think are typical of that "team." It's the Muslims-are-terrorists, Southerners-are-ignorant-hicks, Americans-are-fat-and-lazy kind of reasoning. Stereotyping, in other words. These commentors are treating you like a stereotypical angry natural childbirth partisan, which as far as I can tell is totally wrong.
It's a shame that people don't get judged on their own views but rather get lumped in with a "side" and then asked to defended/treated as an advocate of anything someone on their "side" has said or done.
PS: I agree with every line of your manifesto, along I am not especially passionate about "natural" childbirth. Good medicine should always be guided by the least interference with normal physiology compatible with health and safety.
-- MD and a fan
I never got that vibe from you (long time reader from infertility days and the baby is now 3 1/2).
I did want to share, I think epidurals are terrible. It's not a magic bullet. They really limit movement as in when the baby's hear rate dips and you have to change to see if you can fix that, it's really difficult. Try doing that every hour when you can't feel your legs and you start to see that epidurals aren't magic.
Although, I personally don't see how I could've avoided an epidural. My labor was so stinkin' slow, 8 hours of pitocin (after SROM) before I finally caved and got one because I hadn't dilated one whit and I needed to rest. Delivered after 36 hours.
Hated the epidural. Bright burning hate.
I wish they would work more with walking epidurals.
M
I wish you had been my l&d nurse when I delivered my baby 2 weeks ago! I have a low pain tolerance and definitely wanted the epidural, which instantly failed when I rolled onto my side. The nurse, who you think would have been supportive, didn't believe that I was having pain....I then precipitously delivered (went from 4cm to delivery in 20 min) with her rolling her eyes and acting completely irritated with me for yelling "ouch", ect...I was thinking that she should have at least pretended to be supportive, even if she thought I was a horrible patient! It's nice to know that supportive nurses are out there somewhere.
Just wanted to let you know that I found your blog to be a comfort when I was pregnant last year. I had to give birth in a hospital because of a pre-existing condition. I was terrified to do so. I really thought the hospital nurses would resent me for birthing naturally--as in, please just take the Epidural and fall asleep, I've got 5 other laboring moms and I don't have time for anyone who doesn't want a tube in her spine. Your voice was one that celebrated natural birth in the hospital. It gave me hope that there might be one, just one, L&D nurse at the hospital where I live that might feel the same way. I don't think you ever come across as judging medicated births as less than miraculous. It's just hard to celebrate someone for doing something they didn't feel happening. It doesn't mean you don't support their choice to not feel it happen.
Anyway, thanks for being a source of comfort for me while I was pregnant and anxious. :)
This was inspiring to me. I just graduated nursing school and, like you, am about to become an L&D nurse in a large teaching hospital. Trying to reconcile my support for natural childbirth with the interventionist tendencies of the hospital setting can be a challenge at times. It seems that you have found an awesome balance!
Best,
A
I really like your post because it is very interesting and informative. Its good to know this information so that we are aware of the said topic. Thanks for sharing! :)
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