Can I clarify something?

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.

The birthing woman deserves all of the honors

I am seriously flattered when a woman I have helped through a very rough, long, difficult pushing stage, finally gives birth vaginally and the woman tells me how much she appreciated everything I did to help her. I am truly flattered and thankful that you are grateful for my help.

However, you - as the birthing woman - did all of the work. I was just here to help encourage you and ensure that the birthing process goes as smoothly and as safely as it possibly can be.

You - the birthing woman - are the true hero and inspiration!

You - the birthing woman - are a strong, amazing woman!

You - the birthing woman - are the person who deserves all of the heavy praise!


Can you tell who had a great birthing experience recently? (grin)

Natural childbirth

I've been having a nice run of natural childbirth patients lately --- and I'm LOVING IT!

One shift, I had two women, each having their first baby, both who went natural for their labor and birth. Super sweet!

Another shift, I had two multip moms who each went super fast - no drugs!

I had a mom who literally had no pain until the very, very end of birth. Really awesome to be a witness to a rare birth like that.

What a powerful experience, and such a blessing to be present at so many births.

And not to forget - God Bless Doulas!!!

Why a birth center in my area?

Yes, I am still on the birth center "high" from last week's trip.

So, one of the things we all did as participants was talk a little bit about our own experience (or none) of birth centers. Having not had any exposure to birth centers, other than looking longingly at them online, I talked briefly about my ideas.

Women in my area have basically one choice for giving birth in a facility other than their own home: my L&D unit. There are other hospitals in other directions that offer obstetrics, but it can be quite the drive for women in the immediate area -- especially the lower income/poverty level women, which I tend to see a lot of on L&D.

Basically, women don't have a true choice in my city. We have the monopoly on birth. There is no competition or alternatives (other than homebirth).

I see plenty of low income women who come in to L&D, unprepared for their birth. No childbirth classes, minimal education. Never being educated on their options for birth, they hear about how horrible and painful labor is from their sisters/friends/cousins, etc. "Get the epidural" they tell the woman, as their only source of education.

Now, tell me, how is that providing high quality care, when they are never educated on pregnancy, labor, birth, and their options?

I also see several women on a weekly basis who come in with birth plans, hypnobirthing preparation, or just a general verbalization of wanting to go natural with their labor/birth. Some take childbirth classes. Some are highly educated, and know exactly what they want.

The problem? You're coming into a high risk OB unit and wanting to have a low risk birth. The L&D unit, in general, does not support natural childbirth/low risk birth. It's about turning over beds as quickly as possible. It's not about one-on-one nursing care. Your nurse has at least one other laboring woman she's taking care of while you are there laboring. The environment itself is loud, bright, and in general, not conducive to a more home-like, relaxed, non-interventive atmosphere. IVs, fetal monitoring, epidurals, pitocin, and c-sections are the norm on the high risk L&D unit. Add in anything that even smells like a pregnancy complication, and you add in more drugs and interventions.

Natural, no IV, intermittent doppler, one-on-one nursing support? Not finding it here.

These are just some of the reasons why we need a birth center in this area. We need a place where women who are low risk in their pregnancy can be cared for by nurse-midwives, educated on pregnancy/labor/birth, and supported throughout the process by a limited core group of nurses and nurse-midwives. Women deserve to have another option, other than the high tech, high risk L&D unit. Not all women fit the "cookie cutter" mold that is the flow of L&D. Women need to be treated with more respect than just being another one of the many coming through the unit that day.

High risk pregnancy/birth, desire for an epidural in labor, need for induction = go to the busy L&D unit.

Low risk pregnancy/birth, desire for little to no interventions in labor/birth, desire for natural childbirth, no medical need for induction = go to the Birth Center.

Can it get any simpler than that?

Feeling better - Natural births

Your comments (all of you!) really perked me up. I do appreciate it!!

I also had two natural births in the last few days :-) It was totally, utterly awesome to see and participate in some non-pitocin, non-epidural births.

I could easily see the labor progression happening in both moms as I did my "labor-sit" with both of them. Yes, picking up on cues -- sometimes very subtle cues -- of what their dilation status was in labor. I find it difficult to put the exact cues into the correct words to describe them.

These ladies were A-MAZ-ING!!

I love how my picking up of the subtle cues were spot on each time. No cervical exam needed to confirm things. With one mom, I called the doc in -- told her, she's ready to deliver, no I didn't check her cervix. Mom knew baby was coming, I could detect those subtle changes about her that said the baby was coming, better get the doc in now, or else I'll be catching! Poof! Baby :-)

Side note: I was (surprise!) in charge for half of one of my shifts too recently. I'm getting better at this charge nurse thing. Although, I do admit, I was doing a little prayer in my mind that there wouldn't be a c-section called, because that can really mess up the tenuous staffing issues.