A lovely TBS fan who is a nurse shared her experience in L&D during her training to become a nurse.
My favorite semester of nursing school was my maternal-child class. I spent a couple of days on a post-partum unit, a couple in the NICU, and was scheduled to do two days in Labor & Delivery. In both days there, I saw zero vaginal deliveries. None. Zip. Nada. My instructor scheduled me for a third day on the unit so I could observe vaginal deliveries. I saw two: one with an epidural, one natural. The woman with the epidural had a quick delivery, but I just remember watching the epidural placement and thinking how painful it looked and how awful it would be to have that tube just sticking out your back.
The second delivery was much longer. She had been laboring for so long, she was completely exhausted. She was wearing an oxygen mask, and was in bed on the monitors. She looked miserable. The nurse and midwife were coaching pushing, counting to 10 three times during each contraction. The father wept when his baby was born, and we took the baby straight to the warmer. I remember thinking how cool it was that my classmate and I got to do the newborn exam all by ourselves, since the nurse was busy helping the midwife control bleeding. As far as I could tell the mother was starting to hemorrhage.
Personally, this is one of my biggest regrets. I stood between that woman and her child. If I could go back now, I would take that baby and put him right back on his mama’s chest. I can’t imagine after such a difficult delivery not being able to hold my child. I wish I could apologize to her. I wish I could go back and encourage her to breast feed, which would also help with the bleeding. In fact, if I could go back there would be a lot of things I would different.
When I found out we were pregnant with our first child, I embarked on a journey of enlightenment. As a nurse, I thought I was pretty educated about pregnancy and childbirth. I had no idea what I didn’t know. I knew nothing of birth hormones, of how our bodies are MADE to birth babies, how empowering birth can be when the mother is educated, informed, and in control. I had to ask myself, “Why didn’t I know any of this?”. After much thought, I’ve realized a few things about my education.
First, nursing education is based upon and centered on the medical ideology of birth. Nurses work closely with doctors, and therefore must know what to expect and how to treat clients under medical care. Our school only had so much time to teach us the massive amounts of information necessary for hospital births, including what to do in basically any medical emergency, as well as pre and post-natal care. Education on natural birth processes could easily be deemed not as important because most women don’t birth that way in a hospital setting, where a nurse would be working. What nurses are taught, what I was taught, is consistent with what nurses “need” to know.
Additionally, even if nurses were trained in natural childbirth, they would spend their shifts caring for women birthing in a medical manner. Any natural childbirth education would be forgotten among the days and nights of epidurals, Pitocin, IV fluids, monitors, coached pushing, bedridden deliveries, and unfortunately, failed birth plans. Seeing all this, it's no wonder nurses don’t have faith in a woman’s ability to birth naturally! And, because of our “sue happy” society, nurses may often feel that to encourage a woman to birth the natural way she desires could place them in the way of a lawsuit. Or a nurse may feel that if later on the woman changes her mind, she (the nurse) will be held responsible if the new wishes of the woman cannot be fulfilled; such as an epidural not being available due to the anesthesiologist being gone, or the woman being to advanced in labor to give pain medication.
Basically, it goes back to the mindset of birth in America. Birth is treated as a medical problem with medical treatments. And in some cases, it is. Nurses should continue to be trained in how to handle medical emergencies related to pregnancy and birth. However, as we continue to educate the public and change the general opinion of how birth “has to be,” being a voice to local hospitals, and lovingly educating the nurses caring for us, I hope that nurses will become more familiar with and be able to support and assist women who chose a natural birth.
*This article is simply the experience and opinion of one woman with a nursing education, and should not be taken as medical advice or recommendation. The author has chosen to remain anonymous and resides in California U.S.A.*
Active labor is often when it really hits home that the arrival of your baby is just around the corner. There are a number of physical, emotional, and mental changes that occur during active labor. If you know what to expect in terms of the physical aspects, you may find it easier to cope with the experience once you are in active labor. This article will help you understand some of the more detailed physical changes that take place during this time, as well as offer some insight about what you may experience emotionally. No amount of stories and descriptions will prepare a first time mother for the physical or emotional sensations of being in active labor; most moms I have talked to said they “had no idea it was going to be like THAT!” While it may be discouraging that you are likely going to be somewhat surprised by the experience, it may be easier you to utilize the techniques you learned in birthing classes and get into your own “zone” quickly if you know what physical changes occur during this stage. If you haven’t had a chance to read about the different stages of labor, I suggest you check out this article first.
Active labor is a phase within the dilation stage of labor. It is the second phase that begins when the cervix is between 4 and 5 centimeters dilated and will continue until around 8 or 9 centimeters. It is during this time that the cervix dilates the quickest (though that does not mean this is the quickest stage of labor.) Thus, the intensity and frequency of contractions are at the highest point during this time. Contractions typically last more than one minute and occur between 2 and 4 minutes apart. These contractions are intense and it is during this time that women begin to experience “pain.” I place pain in quotes because while it is true that many women report these contractions to be painful (and it is at this point that many women request an epidural or other pain relief,) the “pain” of contractions can be managed in many ways other than medication and is not a sign of something bad or negative, but a sign that the contractions are doing exactly what they are meant to do; open your cervix to allow your baby to be born.
In first time moms especially, this part of labor may be the longest and thus the most frustrating and discouraging. The intensity of contractions may tire the mother out, especially if she has had little sleep in the days leading up to labor. For moms who have given birth before, this time may still be intense and tiresome, but is likely to last a shorter period of time. Active labor typically lasts anywhere from 3 to 7 hours, but may be as little as 20 minutes for moms who have had previous births. If this stage lasts longer and vaginal exams show that the cervix is not dilating (or dilating very slow), a mother who is birthing in a hospital may be put on a Pitocin drip to speed things along. As with any intervention, it is important to be sure that you discuss this with your caregiver prior to labor and outline your wishes to your support person(s), care provider and their staff as soon as you arrive at the hospital/birthing center/or your care provider comes to your house (even if you have a birth plan). It is also important to know at what point it may be beneficial for the safety of your baby and you to get Pitocin. Be informed and armed with the information before you go into labor.
For mothers in this stage of labor, regardless of their birthing location, this is when it is helpful for them to get into “the zone” and utilize the coping skills learned in birthing classes such as breathing techniques and visualization. Moms often lose their appetite, sense of humor and desire little interruption so they can stay focused on working through each contraction without distraction. Fatigue may begin to set in, especially if active labor is long. A mom in active labor may not be able to articulate her needs well and may be demanding and vocal, or may be withdrawn. Even the most prepared moms may not even be able to identify what would help, so they should be supported and encouraged to do whatever they want in order to cope. Sometimes mothers adopt rituals to get through and may begin rocking, moaning, and breathing rhythmically through each contraction and resting in between.
While many may argue that this is the prep work for the most important job yet to come (the birthing/pushing stage) this stage of labor may set the stage for the rest of her birthing experience. A positive and supportive environment will help her feel comfortable, be able to rest, and feel confident in her body’s ability to birth this baby. An unsupportive and intervention ridden environment may do exactly the opposite and may result in a birth experience that is disappointing or even traumatic. Active labor is a whirlwind of emotional and physical experiences that are best left to occur naturally when possible. As always, the more you know going into the experience, the more likely you will be to have a positive experience!
There are two common tools used to “assist” delivery when the head of the baby is near the vaginal opening; the vacuum and forceps. Many practitioners will perform an episiotomy before using one of these tools unless you explicitly request otherwise.
The vacuum is a suction device that is placed on the baby’s head and used to “gently guide the head.” The forceps function the same way, but are shaped like tongs. Assisted delivery is most common for women who are also using an epidural or other pain medication that is inhibiting her ability to productively push, or she has become exhausted. If a provider recommends assisted delivery to a mother who is not yet receiving pain medication, they will strongly suggest the use of a puedendal block (an injection of local anesthetic into the nerves just inside of the vagina).
Side effects of assisted delivery include bruising on the head and face of the baby, nerve damage in the baby’s face, and discoloration of the face or head. A small blister on the top of the head is also common for babies who were born with vacuum assistance, and will typically resolve within two months.
"Purple Pushing" (or directed pushing), is commonly used for women who have had pain medication and are not able to fully feel their body’s natural urge to push through the contractions. Purple pushing is directed by the nurses and the OB who will tell you to begin pushing as a contraction begins and count slowly to ten while telling you to keep pushing for the duration of the contraction. While this type of directed pushing can serve a purpose for a mother who is unable to feel anything below her waist, it often leads to an increased need for an oxygen mask, quicker exhaustion, increased chances of assisted delivery, and increased risk of tearing because the mother isn’t able to “listen” to her body by way of backing out of a push when it feels appropriate and stop when her body needs time to stretch and rest.
A spinal block is similar to the epidural but without the catheter. Medication is injected into the spinal fluid. Pain relief occurs almost immediately but only lasts for an hour or two. A spinal block is generally given only once during labor, as close to delivery as possible. Medications used for a spinal block are typically the same as those used for an epidural and thus carry many of the same risks. The benefit to a spinal block over the epidural is the shorter duration which may reduce the risks to mother and baby of the medications used.
The epidural is the most common form of pain management for laboring women in America. A catheter is inserted into the epidural space in the spinal canal (just outside of the spinal cord). Medication is then delivered intravenously through the catheter. This blocks pain signals from the lower part of the body to the brain thereby reducing your awareness of pain. Many women report feeling almost nothing below their hips while the epidural is in place. Pain relief usually begins within 10-20 minutes and can last as long as necessary with more injections of medication into the catheter.
Just because many women use the epidural, doesn’t mean it is free of risks. The medications that may be used include both anesthetics such as Lidocaine, Bupivacaine, Ropivacaine, and Chloroprocaine and Opioids including Morphine, Fentanyl, Sufentanil, and Pethidine. The most common risks to the epidural include slowed/stalled labor, increased risk of fetal cardiovascular and pulmonary complications, the newborn being lethargic and/or having latch difficulties when initiating breastfeeding, an increased chance of having an instrumental delivery (vacuum or forceps), or a c-section. Mothers may also experience headaches, fever, and blood pressure problems.
There are a number of studies that suggest the epidural is relatively safe, however there is no way to be sure that the effects of an epidural on the laboring mother are not transferred in some way to the baby. Even the studies that claim there are no risks to the baby are ignoring the basic fact that the mother and baby are in a symbiotic relationship. If maternal stress, diet, and exercise can affect an unborn baby, how is it that potent medications such as opioids won’t impact the baby in some way? This article is a great read for those of you interested in reading more about the risks.
When I was in labor with my first child I was frightened when a midwife and her student came in with a big crochet hook saying “we have to break your waters to get things moving”. Suddenly the pain of contractions became super intense. I begged for the epidural but my doctor refused trying to give me a natural as possible birth. Instead she gave me a dose of Demerol.
I realized after my second birth that the Artificial Rupture of the Membranes procedure (ARM) was actually a routine intervention. Even if you don’t need it you, may get it. I came into the hospital, in labor with my second child, and was 5 centimeters dilated. My hospital midwife broke my water because “we needed to speed things up” after only being there for an hour. I agreed not knowing I had a choice. After all, she was the doctor who knows best, right? Again contractions became unbearably intense. The midwife asked me if I wanted an epidural but this time I declined and instead asked for some Demerol.
I did a lot of research when I found out I was pregnant again and made a detailed birth plan including my preferences in case of an emergency. I found out I could decline any procedure and stated clearly I didn’t want an ARM. I changed doctors three times within that pregnancy until I found one that didn’t make a face or try to compromise with my preferences. I ended up having my third child at a birth center and the labor wasn’t as bad as my first two when my water was broken. It was painful but I firmly believe that because my water remained intact until the 2nd stage of labor it significantly decreased my pain and I was able to have an intervention and drug free birth to give my daughter the best start in her life. Altogether the labor of my daughter lasted 16 hours and 14 minutes, it was my shortest labor yet.
Cons of an Artificial Rupture of the Membranes
An ARM process:
Increases the risk for infection, prolapsed umbilical cord, fetal heart decelerations, and c-section1
When the cushion from the amniotic fluid is gone women have reported being more uncomfortable2, so it often increases the likelihood of the mother requesting pain medicine.3
Once the membranes are ruptured the mother will be running on strict time limits because the longer the water has been broken the more increased risk of infection there is which means she has higher chances of induction and, as mentioned earlier, a c-section.4
This process often results in one big cycle of interventions.
Pros of an Artificial Rupture of the Membranes
There are circumstances which make the procedure beneficial;
If your baby needs to be monitored internally then your waters will need to be broken so that they can access the baby.
Breaking the waters also allows medical professionals to determine if there is meconium present.5
If your labor has stalled or become sluggish the ARM may get things moving if performed at the right time. 6
With any intervention or medication you and your medical provider should weigh the benefits against the risks. Are the risks of the ARM procedure worth your doctor simply trying to speed things up? Or have you been laboring for hours and making great progress and things seem to be slowing down and your body just needs a boost? You have the right to decline any procedure but its your responsibility to be informed and know how to decide according to your circumstances. Medical providers aren’t following recommended guidelines and evidence so it is really up to you to educate yourself.
Hospital doctors and nurses claim to not understand how a woman would not want the best of both worlds - being an active part of their baby’s birth without all the pain. They boast that it is the greatest invention ever. However, the epidural is a drug and an intervention yet medical professionals are failing to fully inform women of the potential side effects.
According to the CDC’s National Vital Statistic Report Volume 59 #5, of those women who got the epidural 83.8 percent had a forceps assisted delivery and 77.3 percent had a Vacuum assisted delivery. 75.6 percent of those women had a prolonged labor 1. Childbirth Connection’s article on the "Epidural and Spinal" reports that women who got the Epidural require an IV, continuous fetal monitoring, frequent blood pressure monitoring and are more likely to require Pitocin, medication to treat a drop in blood pressure, and a urinary catheter 2. Transition to Parenthood’s article "Common Side Effects of Epidurals: Minimizing The Risks" states that studies consistently show that a c-section is more likely the sooner in labor a woman a receives the epidural 3.
Babies born to mothers who have gotten the epidural have also shown side effects. The CDC National Vital Statistics Report Volume 59 #5 notes 77.5 percent showed fetal intolerance of labor 1. The common side effect of a sudden drop in blood pressure results in the baby getting less oxygen and nutrients therefore causing abnormal variations in the baby’s heart rate. The American Pregnancy Association notes that though “research is ambiguous” most studies confirm that babies show difficulty getting started breastfeeding 4.
My point is that your doctor likely didn’t fill you in on all the possibilities either while you were discussing the Epidural during your pregnancy or while you were in labor, which would probably be the worst time. I am not trying to turn women away from the Epidural; I just hope to educate them a little so they can make an informed choice.
A film documenting the state of maternal care in America and showing the people that get hurt by the use of harmful procedures and drugs. The video warns of the extreme serious risks of the drug cytotec to induce labor which is still often used in major hospitals because it works better than pitocin and is extremely cheap. A major risk of being induced with cytotec is uterine rupture and mom and baby can both die, this happens far too often. The FDA says they have no way to stop hospitals from using this dangerous induction drug, even though the drug packaging clearly says "Not for use on pregnant women". Hospitals have been biting the bullet at times and settling for large payouts...that drug must be dirt cheap if one hospital can pay nearly 27 million in settlements. To make all this worse, the deaths are poorly documented with no real details of why mom and/or baby did not live. How can this improve when there are not proper records kept to facilitate accurate investigations? The drug manufacturer, hospitals, and the FDA must believe profits are more important than moms and babies and no one will catch on. Mamas spread the word...this is not right and women need to know the risks of induction!!
This is a video from Mother's Advocate (sorry it's dated) explaining how technology in birth doesn't necessarily lead to better outcomes for mom and baby. Women need to trust their bodies and trust birth. Hospital intervention of any kind, including stripping of the membranes and the pain reliever epidural can disrupt nature's delicate hormonal balance. This hormonal love cocktail assists a woman to give birth as nature intended with less discomfort and prepares her physically to meet baby and breastfeed. No epidural will mean mom is more alert and baby isn't too groggy for a good latch on the breast.