It breaks my heart to read many of the negative descriptions of labor &
delivery nurses in E-News. While I am sure that some nurses are
insensitive, uncaring, and uninformed, many of us are working very hard so
women can have the best hospital birth experience possible. Please do not
stereotype us as the "enemy" or judge us so harshly when we are trying to
do our best in a difficult environment.
-Anita Jaynes, RN, BSN
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I am a labor & delivery nurse in a small community hospital (187 beds). Our
birthing center has 18 beds. I am very frustrated in my job, because most
of my patients come in, and before they are 2 cm, they are howling for an
epidural. As a nurse, it is my job to advocate for my patients. I have a
lot of conflict because I am not a proponent of epidurals, yet I cannot
promote this view to patients. Our epidural rate is 65% and climbing. I
find it disturbing to work with all the technology and interventions, yet
the two OB/GYN groups in this area have the obstetric population sewn up
tight and believing all the interventions, scheduled c-sections, inductions
etc. are necessary to giving birth. How does a nurse promote changes in
this climate? How do you educate a population who is being educated long
before I ever see them?
-Anon.
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I am a midwife, I am a labor and delivery nurse, and at times I've been a
women's health nurse practitioner. These are all titles, some implying
higher status than others depending on the system in which you function.
When you look at it, ALL of them work with women (mit-frau, midwife) and
families. L&D nurses get the bad rap because they work within the system
(policy/police) and they're given little power. Ghanaian midwives work
within the system because the system accepts their work. The restraints are
not tight like in America. Basically they are doing the medical system a
favor by taking a lot of pressure off the doctors.
In a way I would say L&D nurses are the bearers of bad news: "I have to
start this IV; I have to draw blood; I have to hang this Pitocin; no, you
can't get up and walk, no you can't eat, drink and be merry." It goes on
and on.
I have recently started working again as an L&D nurse (through an agency)
at a New York City hospital. After being a "free agent" for many years it
has been a major adjustment. I am shocked at how conservative it is. Every
woman gets an IV and gets nothing by mouth except ice chips. Once Pitocin
is started women are not allowed to walk and must use a bedpan! If they're
on magnesium sulfate they MUST have a Foley catheter. Most are encouraged
to have epidurals. I find it shocking--this is the year 2000! What about
all the research?!
What we must realize is that women are making choices. The choice not to
choose is a choice. They don't even inquire about the rules and regulations
before agreeing to have their babies in this hospital. Most are not
attending childbirth education classes for all kinds of reasons, from
finances to time. Many speak no English and probably don't know they have
choices since they might not have had any in their native lands.
So, many L&D nurses feel they are just "doing their job." Many really
believe in the system's way because they've seen it for so long, it must be
right. Many feel the best way to "help" a woman is to give her an epidural,
i.e. take away the pain.
I was speaking with a midwife friend a few days ago and she mentioned
having to go to a hospital for something. She said she'd never seen such a
sad group of nurses. Everybody--L&D, nursery and postpartum nurses--looked
so unhappy. It was as if they hated their work. We talked about it a little
while and then she said, "Maybe they're just so frustrated about having to
enforce policies that they don't agree with and feel helpless and burned
out." So they shut down.
I found that as I start talking to the women I'm working with, none agree
with the policies, yet they feel obligated to do as they're told/follow
orders. Meanwhile they hope for changes in policy.
Personally, I try to insert lots of love in between the orders. I smile, I
pamper--after all, I work with human beings. I'm still a midwife while
working there. I try to give love to the families AND the other nurses I'm
working with. I tell women who are having their first baby that they can
choose differently next time by checking out their options and getting
information. This helps me stay sane because I'm only here temporarily and
know I won't be changing entire hospital policy.
Next time you encounter hostile nurses, remember they may be struggling
with their own issues and feelings of impotence turned to apathy. Maybe
that person wanted to be a "midwife" but was/is a single parent who
couldn't sacrifice time, salary/money--becoming a recognized midwife in
this country is EXPENSIVE and EXCLUSIVE!! L&D nursing may be just a job for
some but it may be the only way to be with women for many others. Lets' not
forget that we are all midwives working with women.
A woman came in last weekend with a blood pressure of 195/127. She was huge
with edema and was spilling 4+ protein in her urine. Friday we admitted her
and started magnesium. Saturday she had a c-section because her baby looked
horrible on the fetal tracing. Well, magnesium and Demerol will do that to
a baby, but with a blood pressure like that you can't play around. But I
know this woman and her family felt well taken care of (i.e well loved) at
least on our shift. All the nurses came in to greet her and help out when
needed. What we talked about after the birth is next time make changes
before something becomes an emergency. If she sees herself swelling up the
way she did in a next pregnancy, she can make dietary/lifestyle changes
before there's protein in the urine and before the blood pressure goes sky
high.
I really love what I do even though I love homebirth best.
-Harriet Kaufman
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I am an RN working on a postpartum unit and newborn nursery. I read all I
can about midwifery, etc. hoping to gain information for future work in
missionary nursing. This past year we have had several "Bradley couples" at
our hospital, which I think is wonderful. Many of them are very sweet and
we enjoy getting to know them during the few days we care for them and go
out of our way to do things the way they choose.
Some are not so wonderful and seem to have been conditioned to feel hostile
toward us. In deciding to come to the hospital, they need to be told that
they are going to have to follow a bit of a format. It doesn't sound nice,
maybe, but we have this horrid thing called "the chart" that must be filled
out correctly and protocols followed because we are responsible for who
comes in the door and for missing any problems.
Childbirth instructors, please be careful how you word things about the
hospital staff. We became nurses because we care about people. We are here
to help, not to push people around and make them miserable. Continue to
encourage loving care and protection of their infant, and remind them that
we, too, have those goals in mind. (Also, a box of chocolates is always
appreciated!!)
-J.W. Pensacola, FL
====
As a labor nurse and doula I see many uphill battles in the labor and
delivery room. The reason is that the doula is doing what the labor nurse
wishes she was able to do, sometimes. Also, many labor nurses are not
educated in labor support--they are not trained in that during orientation
to L&D. Yes, it is sad but labor support is something you have to learn on
your own (as an RN). The problem is that many nurses don't want to admit
that they don't know what supporting a laboring patient can do for a woman,
so they would rather give her an epidural and take care of the clinical
aspect of labor. Nurses many times don't understand the empowerment a woman
gains from having her desires met at her birth.
RNs have much to learn from doulas and midwives, but the teaching has to be
slow and unobtrusive to HER patient. I have found that you must always make
her feel in charge and let her tell you that it is OK for you to position
this patient, etc. Eventually she will begin to help you and hopefully help
others when there is no doula or midwife present.
-A.T.
====
Reprinted from Midwifery Today E-News (Vol 2 Issue 21 May 26, 2000)
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