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 to One Nursing Care for Actively Laboring Mothers
Not all hospitals are able to, or choose, to staff their labor units according to AWHONN guidelines. Many hospitals recognize that one to one nursing care for actively laboring mothers is the gold standard and is safer for mom and baby. I have worked in both types of facilities. Nurses that are able to care for mothers one to one can give a great gift of time and attention to their patients. Mothers in labor do better when they have continuous support. I feel lucky to work at a hospital that strives for one to one staffing. I am making a call to labor nurses, go back to the bedside. I love working with you ladies and gents. You make me laugh. The nursing station is a fun place to joke around with people whom understand you in a way that even your family can not. I love swapping war stories and sharing photos of babies with you. As much as I love this interaction with you at the nursing station, I ask you to go back to the bedside. The mothers need us. Laboring mothers need continuous support. Remember labor sitting? We need to bring that back! With continuous support mothers are less likely to need medical interventions. You will be able to recognize subtle differences in your patient’s status. You will have more time for observation, assessment, education and supporting the mother and her family. One to one staffing is a great gift for both the nurse and the mother. Sometimes a mother will request less of your presence at the bedside. This is rare. All mothers should have continuous support during labor, even when they have has an epidural.
Quietly sitting, charting and guiding the mother is reassuring and decreases maternal stress.
It may seem awkward at first. It will become normal very quickly.
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The Red Tent of My Heart
(May Contain Spoilers)
I read the Red Tent, by Anita Diamant, when I was in nurse midwifery school. It was was an assigned book for the last class I took before I switched programs. I went tent camping with my husband and three children and threw it in my bag so I could keep up in class. Once I started reading it I could not stop. I was swept up into Dinah’s life. Sitting in woods, by a fire I read about the lives of women. I recognized the women from long ago in myself, my sisters, mother, daughter and friends. It may have been the romanticism of reading the story while living in a tent, but I fell madly in love with it. I was already infatuated with midwifery and birth. The way that Diamant described the interactions between women, birth and death struck me to the core. Although I did not pursue the midwifery path, I still feel the burn of the call. I get a glimpse of it from time to time in the hospital. Women supporting each other in the most intimate way while walking the line between death and birth. Although birth has become safer in many ways, birth attendants still feel and fear death lurking in the corners of every delivery room. I believe that is why a lot of well meaning over medicalization has occurred. Not all of it, but a lot. The novel did a wonderful job capturing the beauty and struggle of a guiding women through childbirth.
I was giddy when I fount that the novel was being made into a mini series. Lifetime did a decent job telling the plot of Dinah’s life. They were’t able to capture the beauty of birth and midwifery as well as the novel. The relationships between the women were recognized fully in the last few minutes, but were not given as much development as in the book.
I have recommended this book, over the years, to everyone that has the look of wonder in their eyes. I recognize the look right away. It is a look that belongs to a person that is in complete awe of birth and the power of women. I am not the only woman that loves this story. Red Tent communities have popped up all over social media and in real life. Women crave the type of connections found in the red tent. Many of us have few, if any, sisters, move far from our mothers, do not get along with our mother-in-laws and do not make time for our girlfriends. Twenty-first century life can feel so isolating. Births continue to bind us together. I step into a stranger’s room and become a friend/sister/mother within moments.
The bond of women during the sacredness of birth is strong. The trust they give me is an honor. Like Dinah, I will carry all the special women from my life with me. There is not a red tent for us to take refuge. I will carry my red tent in my heart. With it I will create the safe and beautiful places for my sisters to bring their babies into the world.
If you enjoyed the miniseries, read the novel. You will laugh and cry and love all the things Dinah loves.
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All nurses have rational and irrational fears that haunt our waking and sleeping hours.
Here are 10 of the top labor nurse fears.
What fears about labor and delivery keep you up at night?
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All babies are special, but first babies have the unique gift of changing a woman and man into a mother and father. There is something extra special when a family is welcoming their first child or grandchild. There is also something special about the first baby of the year. Nurses, all over the world, are betting on which mom will deliver the first baby of the new year. Each hospital wants to be the first in the area to claim the New Years’s baby. Newspapers will feature photos of the star newborn. The lucky first-of-the-year babies will be showered in gifts from hospitals and companies.
There is a lot of focus on the first baby of the year and nurses ensure that the birth is special and celebrated. This is a fun tradition, but that feeling fades quickly as the never ending line of pregnant mothers stream in for delivery. Even the most benevolent and happy nurse can forget that every delivery is someone’s special day. Some days feel like just another ordinary day at work. Nurses have bad days just like everyone else. The difference is that a labor nurse’s bad day can darken a family’s memory of their birth forever.
When labor nurses begin to lose sight of the magic of birth it is important to recharge, refresh and relearn what makes each birth special.
Here are 1o ways to bring magic back to labor and delivery:
1. Identify something you like about your patient. This may be difficult with some patients, but everyone has some redeeming quality. Find it.
2. Smile. If you smile your patient will feel welcome and it can change your attitude as well. Fake it till you make it.
3. Acknowledge and speak to all the people in your patient’s room. The mama is not the only one welcoming a baby into the world. The patient’s family is important and they will appreciate being recognized. Also they can be recruited to help get ice, hold legs and fan the patient. The people in the room will be the ones that will be there to support the mom at home when she is tired and needs help. Include the whole family in patient education so that they can help mom and baby transition successfully.
4. Include the partner or coach in conversations with the patient. A mother’s support person needs to understand and give input on the patient’s plan of care. The decisions are the patients to make, but they often look to their partner or labor coach for guidance.
Including the partner in the conversations with the patient establishes trust and is an element of family centered care.
5. Take lunch off the unit. This may be impossible at some hospitals. If at all possible, leave the unit for your break. Go outside and breathe real air. Take a walk in the sunshine and absorb some vitamin D.
6. Use your relaxation skills to relax yourself. You teach these techniques to patients every day, those same relaxation techniques can benefit stressed nurses!
7. Use your vacation days. Don’t hoard vacation days. People that take less vacation days have less job satisfaction.
8. Join your professional nursing organization. Keeping up to date on new research is exciting and stimulating. Challenge yourself and continue to grow in your specialty.
9. Go out of your way for your patient at least once a shift. They may not thank you, but you will know that you put in extra effort to make your patient’s stay better.
10. When the baby is born take a few seconds to look away from the IV pump, computer and delivery instruments. Witness a new person take his first breath. Watch as a mother holds her baby’s for the first time. Look at a father’s complete reverence and amazement at the miracle that has just occurred.
My New Year’s wish is for all nurses to be reenergized in 2015.
Take the time to make every delivery special for your patients.
For nurses it is just another day at work, but for each mother it’s a day that she will always remember.
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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.
THE BUS!!! I jumped up and ran outside to the bus stop when I realized I was late to pick up my boys. It was a nice day and I was picturing them alone waiting for me. In my rush I didn’t slip on my shoes. I slowed down when I saw that the bus hadn’t arrived. Then something unexpected happened. I became aware how wonderful my bare feet felt treading along the side-walk. I could feel ever pit mark and seam in the concrete. I felt the difference in temperature when I crossed from sun to shade. I arrived at the corner and let my toes wander into the grass. What ecstasy! I walked around relishing every texture. I couldn’t remember the last time I had been outside barefoot. I felt like I had as a child.
Being a birth nerd, I quickly realized my barefoot walk was similar to my unmedicated birth experience. My journey was comfortable and enjoyable. I felt the roughness of the cement, but it added to my experience. I noticed more about that walk than any previous ones. If I had worn shoes, I would have missed out on connecting with my environment. Wearing shoes simply does not feel the same as being barefoot. I feel the same about natural childbirth. Bringing a baby into this world is a miracle under any circumstances. Natural childbirth is the barefoot version of birthing. There is an added dimension that going natural brings to the experience. The difference between my medicated and natural births were marked and undeniable. I was more in tune with my body. I was at peace during the storm of contractions. I felt euphoric and energized after my 3 natural deliveries, which was a surprise after my first two medicated births.
The conditions were perfect for my barefoot adventure. If the temperature had been different, or if there had been broken class on the sidewalk, shoes would have been necessary. Similarly, it is not safe or prudent for every labor to be unmedicated. When the conditions are right we have a choice. Our society has become accustomed to a medicalized model of birth, just as we have become accustomed to wearing shoes. We forget that there are other choices. We absentmindedly slip on heels or tie on a pair of sneakers. In the majority of our healthcare experiences we trust in the safety and necessity of our medical ‘shoes’. Birth is not inherently medical in nature. We have been conditioned to believe that the monitors, drugs and interventions are just part of giving birth. Medical intervention is a luxury and a safety net for a natural process. If a mother chooses to have an epidural for comfort, great! If a mother needs to be induced due to a medical issue, we are grateful for the medical technology. Just as I chose to walk barefoot, natural birth is a choice. It doesn’t mean I think my birth is better than yours. It especially does not say anything about any one else’s choices. It doesn’t mean that I would want to have a surgery without medication, or try to heal my hypothyroid with herbs. Sometimes its just nice to experience life in a basic way. I experienced birth with all my senses and I loved it.