A Family Affair

It never ceases to amaze me when parents come to deliver and they bring others with them to "share" in their birth. Maybe I'm just being too "old school," but I always have been of the era in that I think giving birth to your child should be a personal experience between husband and wife and maybe a few close family members.

When did it become acceptable to bring your neighbors, your friends, and simply people off the street to watch your birth? Seriously. I've attended births where there are people in the room that can't even tell you the patient's last name!

You've got Aunt Jane twice removed armed with the video camera running around filming everything and as the nurse, you try to warn them that if they don't stop filming they'll run out of room on the tape before the "good" stuff comes. You've got Cousin Mary who you haven't seen in five years standing over in the corner eating her sandwich. You've got your neighbor from down the street there because she wants to see a birth. Really. Is it necessary? What exactly does this add to your birth experience?

Oh for the good old days when it was just mom and dad in the delivery room sharing in the private joys of delivering their child.

Birth isn't a personal experience any more - it's an "event." And it's up to the nurses to run "crowd control."

Birth Plan - A Critique

One of a labor nurses worst nightmares is the patient that comes in with a birth plan. Not because we disagree with them - but because we know that most of these birth plans are created by first time parents with absolutely no clue as to what to expect during the labor and delivery process. We also know that a birth plan is a setup for disaster and that most individuals with a birth plan will end up with almost everything that they don't want!

Hospital rules were not created out of, "let's see just how many rules we can put in place to annoy our patients." Believe it or not, they are really important to the life and health of your baby (and you!) Do patients forget that? You bet.

Let's all be realistic here. The vast majority of birth plans are a setup for unrealistic expectations - for the patient and for the family. I've attended hundreds of births where the parents had a wonderful birth experience and it didn't have to be scripted out point by point.

In the grand scheme of things - isn't a birth plan more of a self-centered document so that you can attempt to control your birth experience? Isn't a birth plan more for the mother's desires than what may be best for baby?

Here's a breakdown of a recent birth plan:

No medical procedure will be allowed without my prior consent. I have not signed the general consent forms and consent only to treatment that has been fully explained and for which verbal or written consent has been given.

Okay so why bother coming to a hospital? It's not rocket science. If you don't wish to consent to be treated by a hospital - why come to one?

We are performing our own version of a hypnobirth and as such do not want any labor coaching whatsoever unless it an emergency situation that we agree is an emergency.

And just what constitutes your definition of an emergency? When your baby's heartbeat is in the 60's we'll be sure to consult with you first to make sure you agree this is an emergency before making an attempt to save your child's life.

No medications. This specifically includes oxytocics, analgesics, barbiturates, tranquilizers and antibiotics. If we feel a need arises, we will discuss our options.

Okey dokey - we'll just let that Group B Strep infection go untreated. Of course it's fatal in 5 to 15% of newborns and babies that survive can be left with speech, hearing, and vision problems as well as mental retardation. But you're the expert, right?

There will be no routine fetal monitoring, either internal nor external. If there is a medical indication for continuous monitoring, I may consent to a brief period of monitoring provided I am able to choose a position.

Let's say we come to an agreement then - we won't monitor if you won't sue!

I will not be confined to bed during labor. If the birth is happening away from the bed, say in the shower, I do not wish to be moved from this position. This includes the birth itself as well.

By all means give birth on the floor.

The father will catch the baby. This is non-negotiable. If a situation such as shoulder dystocia or nuchal cord or hand, etc., occurs, coaching and assistance is welcome but we still wish for the baby to be caught by the father unless the situation is absolutely life-threatening.

Does he require a catcher's mitt as well?

The cord will not be clamped or cut until the placenta has been birthed and the cord has stopped pulsating, however long that takes. We will decide when it is an appropriate time to cut the cord. The cord will be left long (approximately 5 inches from abdomen). This is due to our personal beliefs on nervous sensation in the cord and is non-negotiable.

There are no nerve endings in an umbilical cord - but if you want a 5-inch scab hanging from your baby's abdomen for about 2 weeks - who are we to stop you?

My vote for all parents who wish to have a birth plan is to HAVE A HOME BIRTH!

Packing - Not For Travel

The phone rings at 2:00 am on our labor and delivery floor. It's a patient wanting to speak with Dr. S. Luckily Dr. S. was in our nurse's station and took the call. It soon became evident that this was not going to be an "ordinary" call. While we only heard one side of the conversation, it went like this:

Dr. S. - Hello, this is Dr. S.

Dr. S. - You swallowed WHAT?

Now we usually have pretty imaginative minds, but I don't think even the most seasonsed Labor nurse has received a call like this one.

As it turns out, the patient visited her dentist earlier in the day and had a tooth extracted. What she swallowed at 2 o'clock in the morning was her packing.

Asked why she would call Dr. S instead of her dentist, her reply was, "It's 2 o'clock in the morning! You don't think I'd bother my dentist at this time of hour do you?"

Yea - Obstetricians and Midwives sit up and wait all night just for your call. And if you believe that, I have some great property in Alaska I'd like to sell you too.

Shower!

Labor nurses everywhere would like to beg, plead, bribe - whatever it takes - but if you are going to come into the hospital and tell us you're ready to have a baby, would you please take a shower? A bath would work well too. You know - we'd like to know the color of your feet and that the black color that they currently are is not because your feet are rotting away.

We'd like to be able to do a vaginal exam without having to resort to wearing a gas mask.

We'd like to not have to fumigate the room when you leave because the smell that is left behind is so pungent that we can't admit another patient to the room.

"Rules of Labor and Delivery"

1. Don't ask me if my wheel can tell you if you got knocked up on the 15th or the 16th. That's too close to have 2 partners anyway.
2. Don't come into the hospital in the middle of the night because you've been throwing up for a week - and then ask me to get you something to eat.
3. If you fight with your boyfriend and need a little TLC, go to his mother's house, not the labor unit.
4. When I ask the patient a question, that's who I want the answer from. I don't need her mother to tell me when she last had sex.
5. Open your damn legs. If you were a virgin, you wouldn't be here.
6. Shave. If we wanted a trip to the jungle - we'd go there.
7. The fewer visitors you have with you - the better mood your nurse will be in.
8. Get rid of that one "know it all" visitor before it's too late. She can ruin the entire experience for you by pissing me off.
9. Hard labor doesn't just stop with one bag of IV fluids. We know a faker when we hydrate one.
10. If you have track marks on your arms, no you can not go outside and smoke with your IV. What do you think we are? Stupid?
11. Don't scream. We hate screamers. It gets on our nerves and we just sit at the desk looking at each other and grinning and making faces. It's definitely not to your advantage.
12. If you don't have custody of your three other kids, chances are you won't go home with this one either. We are calling Social Service. That's our job.

So You Want To Be A Labor Nurse?

It takes a special breed of nurse to work in labor and delivery. Some of the "requirements" to be a L&D RN include:

• the ability to hold your urine for 12-hour shifts
• the ability to not eat for long periods of time and when you do eat, it must be "on the run"
• the ability to handle doctors with large egos
• the willingness to be sworn at, hit, bit, peed on, pooped on, have various items thrown at you, and various other sundries that occur with a laboring mom
• the ability to deal with fainting fathers
• the ability to read "chicken scratch" written by doctors on charts
• the willingness to work evenings, nights, weekends, holidays and overtime
• the willingness to invest in caller ID so you'll know when the hospital is calling wanting you to work even more hours
• the willingness to work cheaper than what they pay the checkout people at your local grocery store

Sound like a job for you? If you're willing to "sign up" - you'll be working in one of the best departments a hospital can offer.

Hop on board - as we share our "stories" of our experiences as Labor Nurses.