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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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 extremely sore today! I am not in pain from working out at the gym, playing soccer with my kids or golfing. I am sore because I labored two unmedicated births yesterday. Tired feet and sore backs are standard fare for a hospital nurse. Swollen legs are also common, due to long hours standing in an operating room or by a critical patient’s bedside. It may be surprising that laboring a mom, that wants a natural delivery, is a full body work out. My shoulders are stiff, my arms are aching and my thighs are sore.
Birth is magical regardless of the mode of delivery or the use of pain medications. That being said, I love unmedicated births. I love helping a mother work through the process of labor and accomplish her goals. I love the moment that the baby is born and is placed on mom’s chest as she sighs with relief. I love all of it, but it can be intense for the nurse.
Confession time, patients with epidurals are generally less work for nurses. Plain and simple, an epidural and a urinary catheter make my job a lot easier. Monitoring the baby is easier, since mom is generally resting and immobile. There are no hasty trips to the bathroom between contractions, because the catheter is draining to gravity on the bed frame. I can relax at the nursing station, charting comfortably while watching my electronic fetal monitoring strips. I am reassured that my patient resting comfortably, with the her call light within reach. Transition consists of some rectal pressure or napping, occasionally vomiting and shaking.
Moms that go natural need their labor nurses more. Transition is different without an epidural. Mom’s have looked me in the face and begged me to cut their babies out during contractions. Then, in between contractions, insist that they don’t need pain medication. I have learned to go with what my patients tell me when they are not contracting. I know my patient, with an epidural, is complete by watching the early decelerations on the monitor or because she suddenly says she needs to poop. I can tell when my natural mom is completely dilated by the involuntary pushing she starts to do at the peak of her contraction and the change in her demeanor from desperation to intense focus.
I have been in that patient keeping her nurse busy. During my first unmedicated birth, I begged my nurse to help me during transition. She thought I meant medication, but I wanted her presence. I knew I could have the baby without drugs, but I did not want to do it alone. I needed her there, to silently bear witness of my labor and remind me that it would not last forever. She ended up catching my baby during change of shift. The doctor was trying to gown up for the delivery. He had one glove on when the baby shot out. It made me secretly happy that my attentive nurse had been the one to catch my baby.
Now its my turn to catch precipitous deliveries and bear witness to women as they labor. When I am lucky enough to care for two moms in one day that are skipping pain medication I am elated. I am also worn out!
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.
“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!