Q. Should I have an elective induction of labor?
Q. I want to make sure that my OB is there for my delivery, should I schedule an elective induction?
Q. My mother is flying in this Saturday, can I schedule an elective induction for Friday?
Q. It is my first baby and I am already dilated to 1cm. I want to schedule an elective induction.
Q. I am 38 weeks and I am contracting 4 times an hour, I would like to schedule an elective induction.
Q. My ultrasound said that my baby was already 6 pounds at 37 weeks. Should I have an elective induction at 39 weeks?
Q. I really want my baby to be born on 1/15/15. Should I be induced electively?
Q. What about an elective primary cesarean section?
Q. If I have no medical reason to have an induction, should I let my baby choose his birthday?
I do not recommend an non-medically indicated elective induction of labor or cesarean section.
Inform yourself about the risks of inducing labor early.
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One of my favorite parts of being a labor nurse is to help a mom through unmedicated labor. Not all experiences are the same. It can be the best of time and the worst of times. The labor nurse has the supporting role in the drama of birth. She plays her part and then melts into the background so that the stars, mom and baby (dad too) can shine.
The best of times.
A mom was having terrible back labor. My arms shook with each contraction as I gave her counter pressure for two hours. Every time my arms would ease up on the pressure she begged me to please keep going. I usually would have her partner take over this physical intervention, but there was not partner in this delivery. That hurt my heart and made it more important that I help my patient in the way that she needed. When the baby changed positions the back labor subsided. She progressed into transition. Transition is the time that women change their minds about wanting an epidural, being pregnant and that they ever liked the baby’s father. Her eyes locked with mine and she reached for my hand. She asked me to not leave her. So I stayed. I stood by her side and tried to forget that I had not eaten all day, that my bladder was full and my charting was getting farther and farther behind. I was present with her through every contraction. I praised her through every break in the pain. When it was time to push she did amazing. Soon she was rewarded with a quick pushing stage and a healthy baby on her chest. It was easy to forget my aching arms when she asked me to lean in and take a picture with her and her new baby. I was pleased with her satisfaction with her birth. I was thankful that everything went well for her and her baby.
I love when I can play my designated part in the story. I don’t like when I am forced into the villain role.
The times that test.
Another nonmedicated mom was not the grateful variety. She was suspicious of everything I did. This is always difficult for me, as a nurse. I am 100% supportive of my patient’s birth plans. I do everything in my power to ensure the safety of the mother and baby, provide an environment that the mother desires, carry out the doctor’s plan, and fulfill my legal and hospital mandated responsibilities. These are difficult responsibilities to juggle at times. When I am crouching on hands and knees, chasing fetal heart tones while a mom is bouncing around, changing positions and barking orders to her family, I deserve a little respect. When I am plunging my hand into the bath water mixed with vernix and other bodily fluids to make sure your baby is not stressed from the heat of the water, I am not trying to control you. When I am holding your hair while you vomit and it gets on me, when I wipe away your poop so you don’t know it happened, when I breathe in your body odor right next to my face because you need someone to lean on, I’m doing it because I am on your side. When you get to the point where you are asking me for narcotics and its dangerous for the baby I am going to say no. When this mom got to her breaking point she demanded I give her medications and it was too late. She was so angry I stepped back a bit because I was afraid she might hit me. I knew that the baby was coming. I knew that if I gave her what she wanted the baby likely would not breathe when he came out. I let her rage and continue to labor. Her baby was born within 30 minutes and was perfect and beautiful and breathing. She never will never know that I was scared of her or that her words hurt me or that I gave up time with my family to stay late to help her.
Not every birth is fun or rewarding. Sometimes my thighs hurt from squatting by my patients side. Sometimes I’m exhausted from trying to help. Sometimes I stay after my shift for an hour to finish the charting that I couldn’t do while I was helping my patient accomplish her goals. When my patient is happy with her delivery it makes me happy.
Mamas thank your labor nurses. We are on your side. It is our job and we love it, but it is not easy.
I am frequently asked about the patient gowns that women are given to wear in labor. Mothers want to know if they should and/or have to use them.
Comfort is important.
Many moms worry more about how their feet will look or shaving their legs before labor begins than what they will wear in labor. It is good to feel comfortable in labor. If getting a pedicure before delivery puts a mother at ease, then she should get one! The clothes a laboring woman is wears during the hours of labor and birth may have a bigger impact on her comfort than the color of her toenails.
What are you allowed to wear in the hospital?
You do have a choice! I have labored mothers in everything from being absolutely naked. to being covered hear to toe. You are not required to wear a hospital gown. You can wear whatever makes you feel comfortable. There are some restrictions in the operating room. If you are having a scheduled cesarean section or end up there after laboring, you will need to wear the hospital gown. Hospital gowns are preferred in these situations due to infection risks and the types of monitoring equipment used in the surgery. If you still would like to wear something else to surgery discuss your options with your nurse or doctor.
Pros and Cons of the hospital gown
There is a fresh one waiting whenever needed.
You don’t have to worry about getting blood, poop or vomit out of it later.
Some are designed for breastfeeding or monitoring ease.
They are made to accommodate a large variety of sizes and usually do not fit well.
Modesty can be an issue, especially while walking in the halls.
Hospital gowns can make you feel like a sick patient and less empowered.
What are my clothing options?
Occasionally I have labored a mother whom was only comfortable completely naked. These were all patients that were laboring unmedicated. I provided modesty when she requested it with sheets. Tank tops or breastfeeding tanks are popular. Sweat pants, shorts or yoga pants are easy to slip off for cervical checks and are comfortable for labor. Skirts are comfortable, modest and do not need to be taken off for pushing. There are specialty lines for labor clothes for example: http://www.prettypushers.com. The specialty clothing is designed to accommodate monitoring equipment and maximize utility and comfort. If you do not want to pay the specialty price, there are plenty of other options. In my most comfortable delivery I wore a breastfeeding tank and a maxi skirt with a wide, elastic waist band. The ultrasound and toco monitors fit in the band so that I did not need to wear the monitor belts. I moved around very comfortably and always felt modest. When it was time to push it was easy to pull the skirt up and out of the way of the delivery. I did not plan on wearing the skirt again, but I was happy to find that the evidence of delivery washed out easily. I wore that skirt multiple times in my postpartum months.
If you choose to wear the hospital gown for labor and delivery you can still wear your own clothes after delivery. It is good idea to bring 2-3 pairs of comfortable, stretchy clothes with you for your postpartum stay and the drive home. The hospital’s maternity underwear are disposable and great for giant pads. Some moms prefer to bring in their own underwear or brief type panties. Hospitals will often provide slip resistant socks for their patients. You can bring in your own socks or slippers if you wish. Breastfeeding moms will spend a lot of time with the baby skin to skin during the first few days. Nursing bras are not vital for the hospital unless you feel uncomfortable without a bra. You may want to wait to buy nursing bras until after your first week at home since your bra size will likely change.
The bottom line.
Its your bottom and you can cover it however you wish!
“Well, you are the expert; we will just do what you tell us.” Admittedly it is nice to be regarded as an expert, but these are dangerous words. There is something about wearing a white coat and a stethoscope that grants healthcare professionals great power over their patients. Intelligent women and men come to the hospital and abdicate their decision making power at the door.
Your perinatal team has varied knowledge, training, experience, bias, fear, and motivation. They are experts, but they are not perfect! They have seen a lot, but they haven’t seen everything. Some have not read a new research article in years, some haven’t slept in 2 days, and some had a maternal death patient with similar risk factors as yours. Sometimes they just want to go home on time and your labor is taking too long. Some of them are biased towards low intervention, others have never met a patient they didn’t want to take to the operating room.
When you are admitted to the hospital you will not know what is behind the smiling faces and monitoring machines. In most cases what you see is what you get. Doctors and nurses that are working hard to make ensure you and your baby make it safely through labor and delivery. There are many paths to that outcome. You need to be a part of the decision making.
The first step is to get educated prior to the delivery. Taking a prenatal class is an excellent way to prepare for childbirth. I personally recommend the Hypnobabies course, but there are many other programs available. Check with your local hospitals. They often offer low/no cost courses and you will be able to learn more about how labor is approached where you will be delivering. If you do not have time to attend a traditional class, there are self study options or online courses available. AWHONN, INJOY, and Evidence Based Birth are websites that have great information.
The second step is to make a birth plan. If a written birth plan is not appealing, you can still take time to discuss with your support person and your doctor/midwife your thoughts, goals and wishes for your labor and delivery. Having a mutual understanding can help make decisions during labor easier.
Third: Use your BRAIN! Every decision you make should be collaborative between you and your healthcare team. The most important person in the equation is you. Each time a decision is required, use the simple decision making tool BRAIN.
Benefits: What are the benefits of the intervention?brain
Risks: What are the risks involved? It is important to explore this and get the full list of risks. Many times healthcare providers will mention the most common or the most devastating risks. You need to be told all the risks to be able to make an informed decision.
Alternatives: Are there alternatives? Sometimes there are no alternatives, but in many situations there are alternative interventions that can be attempted. Find out your options and if you have an alternative in mind, suggest it.
Intuition: Take a minute to think and discuss with your support person. What is your gut telling you? Doctors and nurses use intuition to care for their patients too.
Nothing/not now: What if you did nothing? What if you waited an hour or three? Time can clarify most situations. In other situations doing nothing may cause a bad outcome for you or baby. How does doing nothing affect this particular situation?
Being empowered and educated will help you have the birth experience that is best for you and your baby.
Remember to use your BRAIN!
I learned a lot about labor from granola nurses and crunchy parents. Here are my favorite lessons that I learned taking care of laboring patients whom were skipping pain medications. It has made me a better labor nurse for all my patients. What lessons have you learned in the world of labor and delivery?