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Wednesday, March 3, 2010

Nursing culture

Nurses are taught to keep baby and mom safe. And rightfully so. That really is the most important part of childbirth. But what they are not taught, is how to attend to a mother's emotional and spiritual needs during this time. This is seen as something less important and also sometimes distracting from the main goal of keeping mom and baby safe. As a nurse, I struggle with trying to attend to both. And it is true that sometimes, I can't do both. So, occasionally the emotional and spiritual needs do take a back seat. This is why I so appreciate doula's.

The difficulty comes when nurses perceive that the emotional needs are overriding the safety. Often times, they feel threatened by women or their labor support who are demanding that the nurse pay more attention then they feel is needed to their emotional support. It can all be very tricky. I personally feel like labor is a very hard time to try and explain to a woman why you are doing what you are doing. And demands can be very high from everyone. Birth plans are also seen as a threat for the same reason. Often times they are seen as ultimatums....that at all costs the birth plan must be followed even if your baby is in danger. This bothers many nurses because it is going against what they feel their purpose is.

Now that said, we do many things in the nursing world that could harm the baby. Labors are rushed with pitocin or breaking the water, epidurals do hold risks, and inductions are pretty routine. But these risks are viewed as acceptable because we(as medical staff) are in control of them. The medical staff is the one accepting the risks that accompany those actions. For good or ill, those risks are usually considered ok. The ability to manipulate and control labor can sometimes allow the medical a great feeling of ease and comfort in regards to safety because it is more controllable. Therefore, anything that takes that control away from us, also is seen as suspicious and not trustworthy.

This is all of course my own thoughts and observations and anyone can take issue with them. I think it might be an interesting discussion. But, from my experience this is how our birth culture works in the hospitals.

So to answer Linds question from the previous post. Anything that you do that is perceived as putting your emotional health over you and your babies physical health, will probably be viewed as inconvenient, and reckless on your part. Birth plans, for the most part, will be viewed this way. On the other hand, if you ask for support and emotional help without a birth plan, you are more likely to be viewed favorably. A lot of this depends on your nurse. Most nurses that I know, really try and work with moms on what they would like. I would say it is only a few that are real sticklers with not attending to any of moms emotional needs. Part of the problem is that there is very little training for labor support, other than drugs. There is also very little training for understanding and dealing with the emotions that a laboring mom goes through. And of course all nurses have bad days.

What you really should understand, though, is that we as nurses are being paid to help you. You are the client, and should dictate your choices. You have the ability to ask for another nurse or request a different nurse if they don't fit your needs. That's the bottom line.


Cherylyn said...

I had a birth plan for both of my unmedicated births in the hospital, and I thought it was followed and honored pretty darn well. I never felt like the nurses or doctor were opposed to my wishes or upset that I had given them my birth plan. I did have a doula both times, so the burden was not placed on the nurse to provide the support I really wanted. I supposed it's possible that they were making fun of me behind my back, but I didn't see or hear anything that bothered me. Maybe they weren't bothered by my wishes because my doula was there to take care of a lot of that burden.

So, here's my question. If birth plans only create more tension and opposition, then how would you suggest a laboring woman clearly communicate her wishes to the hospital staff? I felt my birth plan was a good way of communicating my wishes for natural unmedicated birth, and it worked for me. What is the alternative?

Rachel said...

More often than not eyes are rolled at birth plans. But, nurses do try and honor them. Usually they aren't super rude about them, but there is a perception that when a women brings in a birth plan, everything will happen just the opposite. And there is a perception about the type of women who bring in birth plans.

I think the birth plans that are the most accepted are those that acknowledge that things may go wrong and address what the mother would like in those situations. For instance, if the mom would like to have baby right after birth, she could write that on her birth plan. But adding the phrase that if there are complications she would just like baby as soon as possible.

Or if a woman would prefer not to be continuously monitored, add that if it becomes necissary, that she would like to continue to move around if possible. Maybe even say she would like her doula or labor support to help hold on the monitor if necessary.

The idea is to let the staff know that you are flexible if complications arise.

These kinds of birth plans are viewed much more favorably.

Nursing Birth has a great post on writing birth plans. I can't find it right now, but here main page is

Cherylyn said...

I kept my birth plan to one page and I tried to limit it to the requests that were most important to me. I also had a part in my birth plan that allowed the doctor to make decisions based on medical necessity or emergency.

Linds said...

Thank you thank you for these comments. I am already feeling so many wonderful emotions about being pregnant and how I hope for things to go during delivery. It's nice to hear other people's experiences and advice. I completely agree that baby's health come first.

Again I very much appreciated this.

Rachel said...

Ok, I found the post. Here it is...

I really liked this post a lot. I think the value of the birth plan lies, not only in letting your nurses know what you want, but also in exploring your own options. Doula's very often will do this, but I would ask your physician or midwife to sit down and talk about options on a birth plan also.

I myself have had no complaints with the nurses that took care of me, except that they didn't know how to help a natural birther:) That was the one huge difference between the hospital and the birth center I had my first two in.

Linds-I wish you all the best:) Being pregnancy and becoming a mother are some of the most powerful, amazing, and difficult times you will have:) No matter your choices, life will change, you will grow, and motherhood will forever change you:)

Anyone else have any advise on how to present birth plans, and work with your care providers to achieve the best birth is welcome.

Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.