Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Don’t Let This Happen To You #25 PART 2 of 2: Sarah & John’s Unnecessary Induction April 8, 2009

Please see, Don’t Let This Happen To You #25 PART 1

 

After our conversation about her birth plan and induction, I focused my attention on providing Sarah & John with the support they needed to have a successful, empowering, and fulfilling labor and vaginal birth, despite the less than optimal circumstances. 

 

The first thing I did for Sarah was get her out of that bed!  At that time all of the portable telemetry monitors were in use by other patients (unfortunately we only have a few on the floor) so I couldn’t let her walk the halls.  But I explained that I could let her go as far as the cords would take her; basically she could sit in a rocking chair, stand at the bedside, and take “unlimited” trips to the bathroom for as long as she wanted (my own personal way of getting around the continuous monitoring.)  Sarah said she was most comfortable in the rocking chair since her back was bothering her in bed. (I bet!)  She reported at that time that the contractions mostly felt like “bad menstrual cramps.”  The next few hours I was in and out of the room since Sarah and John had things pretty much under control and I do believe that couples deserve privacy.  They were really cute together I have to admit.  While Sarah was rocking John was reading her poetry out of one of her favorite books.  It turned out to be the perfect amount of distraction for Sarah.  And Sarah did say to me that being in the rocking chair made her feel like she was actually “doing” something, as opposed to “just sitting in bed.”  Isn’t it interesting how just getting a mother out of bed can change her perspective for the better!

 

Over the next few hours I titrated the pitocin up or down depending on how frequent her contractions were coming, how Sarah told me she was feeling, and how strong the contractions felt when I palpated them.  Since we had talked extensively about her birth plan, I let Sarah know that Dr. F was planning on coming in around 2:00pm to check on her and break her water and that she had the right to refuse that procedure.  I explained to her that it was not an unreasonable request to ask him to wait.  I also told her that despite what Dr. F would probably say, it was NOT going to “slow down her labor” if she wanted to wait until she was more active, maybe even 7 or 8 centimeters, or just wait until her water broke on its own.   I also told her that I would support her decision and “stick up for her” with Dr. F, but that she was the one that had to tell him what she wanted first.  If not, it just makes the nurse look “pushy” and the doctor is less likely to abide.  

 

At 1:30pm, right on schedule, Dr. F came into the room.  After some quick small talk he asked Sarah to get into the bed so that he could perform a vaginal exam and break her water. 

 

Sarah: “Umm, I was hoping we could wait a little bit longer to do that, until I am in more active labor.”

 

Dr. F: “Well, if I break your water it is really going to rev things up and put you into active labor.”

 

(Side note:  Dr. F is just plain wrong.  He, like so many mislead obstetricians, was utilizing his own anecdotal evidence instead of scientific research when he made his claim that amniotomy would “rev up” her labor.  A 2009 landmark study published by the Cochrane Database of Systematic Reviews concluded (after reviewing 14 studies involving 4893 women),“There was no evidence of any statistical difference in length of first stage of labour [between the amniotomy alone vs. intention to preserve the membranes group].  Amniotomy was associated with an increased risk of delivery by caesarean section.  On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care.”  This study hangs in the doctor’s lounge at my hospital and I have actually shown it to quite a few physicians who believe in early and routine amniotomy.  And they ignore it and do what they want anyways.  It’s infuriating!  It’s like they only care about research that supports what they already do and if it goes against their practice, they pretend it doesn’t exist!)

 

Sarah: “I’d really rather wait.”

 

Dr. F: (visibly frustrated) “Well I at least have to check you!”

 

(Oh lord, I love the “have to”!)  Dr. F’s exam revealed that Sarah was 4 centimeters!  Yay!

 

After helping Sarah to the bathroom and back to her rocking chair, I stepped out the catch Dr. F at the desk.  “Thanks for holding off on the amniotomy, it was really important to her birth plan,” I said, trying to “smooth things over” and (gently) remind him that the patient was in charge!  “Yeah well I’ll be back around 4:00pm to check her again and if she hasn’t made any progress I am going to break her water,” he said, grudgingly. 

 

He started to walk towards the elevator but then turned around to me and said:

 

Dr. F: “You have the pit at 20 right?”

 

(Note: The way pitocin is administered for induction in my hospital (and many others) is that you start the pitocin at 2mu/min (or 6mL/hr) and increase by 2mu/min every 15-30 min (or more) to a maximum of 20mu/min (or 60mL/hr) until you obtain an adequate contraction pattern (or, 3-5 contractions in 10 minutes).  So what does that mean?  That means that you do NOT just crank the pitocin until you get to “max pit,” rather you TITRATE it until you get 3-5 contractions in 10 minutes that are palpable and are causing cervical change.  Bottom line is everyone is different.  I personally could take a whole box of Benadryl and not so much as yawn while my husband can take one tablet and all but hallucinate!  It is no different for pitocin.  Some people are extra sensitive and only need a little bit, and others tolerate “max pit” very well.  I seem to have this same “fight” with physicians all the time at work.  They insist you “keep cranking the pit” when all you are going to do is hyperstimulate the uterus and cause the baby to go into distress.  But I digress….)

 

Me: “No, I have her at 10mu/min.”

 

Dr. F: (sarcastically)  “What!?  What are you waiting for?! 

 

Me: (said while biting my lip so I didn’t say something I would regret)  “She is contracting every 2-3 min and they are palpating moderate to strong.  She has to breathe through them.  And the baby is looking good on the monitor.  I want to keep it that way!”

 

Dr. F:  “But she’s not going anywhere!  You have to keep going up if you want her to progress.”

 

Me: “But she has changed to 4 centimeters…”

 

Dr. F:  “I was being generous!”

 

Me: “So you lied…”

 

Dr. F:  (annoyed) “Listen, keep going up on the pit, even if she is contracting every 2-3 min.  They aren’t strong enough.  Keep going up.  If we hyperstimulate her, we can just turn the pit down.”  (Note: These were his exact words.  I know this because I was so flabbergasted that he said it, I wrote it down in my notebook that very moment!  The fact is sometimes the baby is in so much distress after hyperstimulating the uterus that just turning the pitocin down isn’t enough!  And it really bothers me when doctors start sentences off with “Listen…”  Grrrrr.)

 

Me:  (jaw dropped, completely dumfounded) If I turn the pit up anymore, I am GUARANTEED to hyperstim her.”

 

Dr. F: “We’ll cross that bridge when we get to it.  I’ll be back around 4:00pm.”

 

By this point I was more than annoyed with Dr. F.  I explained the situation to the charge nurse and told her that I would not be cranking the pit on room 11 unless Dr. F wrote me an order that read “Regardless of hyperstimulation or contraction pattern, continue to increase pitocin until the maximum dose is reached.”  (By the way, he wouldn’t’ write me that order.)  She basically told me to do what I felt was right because it was my license at stake too.

 

So since I had her blessing, I kept the pitocin at 10mu/min.  By this point about a half an hour had passed and I went to go check on Sarah in her room.  When I entered I noticed that Sarah was breathing pretty hard during contractions and John was no longer reading poetry.  In fact, John looked like a deer in headlights.  “The contractions feel so much stronger since the doctor examined me!” said Sarah.  “That’s great!” I said reassuringly.  “I think I want my epidural now,” she said as she breathed through a contraction.  “Where are you feeling the pain the most?” I asked.  “In my back, my back is killing me!” she said. 

 

Let me digress for a moment to explain my three rules regarding epidurals: 

 

#1  You can’t ask for an epidural during a contraction.

#2  If you say “I think I want,” we need to try something else first.

#3  You can’t ask for an epidural if you are lying or sitting in bed.

 

If one of the three circumstances above is present, I have two techniques that I employ:

 

#1 The 3 Contraction Technique:  You have to try at least one position change for three contractions first and then we reevaluate how you feel.

 

 

#2 The 15 Minute Technique: You have to try at least one position change for 15 minutes first and then we reevaluate how you feel.

 

Since Sarah said “I think I want” it was important to try something new first J.  I always explain to my patients that epidurals pose higher risk of cesarean section the sooner they are given in labor and I did reiterate this to Sarah.  In my opinion epidurals and pain medication should only be a last resort when everything else in my bag of “nonpharmacological comfort” tricks has been tried.  She agreed to the “15 Minute Technique” so I (finally) obtained and attached her to a portable monitor, got her on her feet, showed her how to drape her arms over John’s neck as if they were slow dancing, and the showed her how to sway/squat during a contraction.  While Sarah and John were “dancing” I was rubbing lavender Bath and Body Works lotion on her back and applying counter pressure to her sacrum to relieve her back pain during a contraction.  And guess what…Sarah slow danced for TWO HOURS!  She had definitely drifted off to Laborland, where time does not exist and you take life one contraction at a time J.

 

“I’m starting to feel more pressure in my bottom like I have to poop,” she said.  What a great sign!  I explained to Sarah that eventually that pressure would not only be felt during contractions but between them as well.  Sarah was getting tired so we tried some kneeling on the bed for about a half an hour while John rubbed her back.  Around 5:00pm Dr. F sauntered on in to check Sarah and as he had said he would earlier.  All that hard work certainly paid off, Sarah was 6-7 centimeters dilated!!  “I need an epidural now!” Sarah assertively told Dr. F.  “Okay sure!  I’ll write the order.  But first I am going to break your water,” he replied.  So I took a deep breath and with my best impression of an adorable puppy dog I cheerfully asked, “Could we please wait until she has the epidural in place first before you rupture her Dr. F?  That way she won’t be leaking all over herself as she is hunched over for the epidural?”  (Sometimes you gotta do what you gotta do!)  Surprisingly he agreed and after he left the room I helped Sarah to the bathroom to pee. 

 

However, it turned out that at that time, another patient was in the operating room for a cesarean section and there were two other patients “in line” for epidurals before my patient was.  And since we only have one anesthesiologist in house and no others were available to come in, Sarah would have to wait.  I explained all of this to her and showered her with support and encouragement regarding how far she had come, how much work she had done, and how she could make it any amount of time longer until she got her epidural because she was a strong woman!  I don’t know how much of it she bought at that point in time because she was really really uncomfortable but regardless I couldn’t get her an epidural “now” so she would have to wait anyhow!

 

The next two hours or so (yup, the cesarean ran long and with two other epidurals in line, it took anesthesia two hours to get to Sarah) were spent walking around the room, hands and knees, side lying, kneeling, hunching over the counter, etc etc etc.  By this point Sarah was almost at her breaking point so I offered up one final suggestion: Let’s sit on the toilet.  Although skeptical at first, Sarah finally agreed to give it a chance and for the last 20 minutes before anesthesia arrived Sarah sat on the toilet, rocking back and forth.  (Turns out skeptical Sarah actually liked sitting on the toilet.  I asked for her to just give it “three contractions” and then we could get back to bed.  After three contractions she asked if she could just stay there until anesthesia came!  Hmmm, maybe this L&D nurse actually does know a thing or two J

 

By this point it was 7:00 pm.  The anesthesiologist had to poke Sarah twice to get the epidural in the right place, (Which happens a lot!  That’s another risk!  They are working blind after all!) and so we were not completely done with the epidural until 7:45-8:00pm.  I propped Sarah up on her side with a bunch of pillows, put the baby back on the monitor, shut off all the light and tucked her in.  She was snoring before I could leave the room.  At least she can take a little nap before she has to push, I thought to myself.  But what do you know, about 15 minutes later Dr. F came barreling down the hall.  I saw him coming so I jumped from the desk and said “Are you going into room 11? She just JUST feel asleep.  Please can we let her sleep for a bit?!”  No luck.  “What?!  No, I HAVE to break her water.  This is getting ridiculous now, its 8:00 for goodness sake!” he barked.  So I hung my head like Charlie Brown and followed him into the room.  He flipped on all the lights (is that really necessary) and Sarah sprung up from her sleep.  The good news however was that Sarah was 8 centimeters!!  I reluctantly passed the amniohook to Dr. F and he ruptured Sarah’s membranes.  Clear fluid…good!  I took the opportunity to change all the bedpads under Sarah and turn her to her other side.  “I’ll be back in a hour to check you again”, said Dr. F as he brushed out of the room.  I encouraged Sarah to take the next hour to try to rest as much as possible (no TV or talking on the cell phone!!) and went back out to the desk. 

 

As 9:00pm approached, I started to get a pit in my stomach.  I had a gut feeling that Sarah was probably going to be fully dilated when Dr. F came back and I was worried that because he wanted to get home (Sarah was his only patient on the floor) he would rush her into pushing before she could feel her bottom and we would end up with a cesarean section for “failure to descent.”  So at 10 minutes to 9:00pm I took a chance, went into Sarah’s room, and said the following:

 

“I remember reading in your birth plan that even if you are fully dilated you would like to wait until you feel the urge to push before you start the pushing phase.  Is this still true?  (Both Sarah and John answered yes.)  Okay, how are you feeling right now?  Do you feel the urge to push when you have contractions?  (Sarah told me that she couldn’t feel much of anything and did not have the urge to push).  Okay, so basically what I am trying to say is that I think it is a totally reasonable request to want to wait until you can feel the urge to push.  So when Dr. F comes to check you, if you are fully dilated it is okay to ask him to shut off the epidural and give you some time to start to feel the urge to push.  You don’t have to start pushing right away.  In fact, if you do, you will probably push for WAY longer than you have too.  I will back you up.   I know it sounds scary to shut off the epidural but trust me, pushing isn’t going to be so scary because you can actually DO something about all these contractions and pushing when you can feel the urge is a lot easier.”

 

Both Sarah and John agreed.  I had said my peace and turned to leave the room but at that time in came Dr. F.  He checked her and what do ya know, she was fully dilated!!!  (But still at a zero station).  “Okay, let’s start pushing!” he said as he pulled over the delivery table.  “Umm, I don’t really feel anything yet so can I wait until I can before we start?”  My whole face lit up with excitement; I was SO proud of Sarah for advocating for her birth plan!  So then I chimed in, “It’s part of her birth plan, Dr. F, can we shut off the epidural and give her at least an hour before you check her again?”  “Well let’s see how she does first,” he said annoyed, and asked Sarah to give him a “practice push.”  Thankfully this convinced him that she certainly could not feel her bottom and he agreed to come back in an hour.

 

The best part was that after Dr. F left the room John turned to me and said “Wow, did you call that one or what!”  I have to say it made me feel better that someone noticed how predictable doctors can be J

 

I shut off the epidural and for the next hour sat with Sarah and John and coached them through transition.  Although nauseous Sarah never threw up, but the pressure in her rectum was certainly getting more intense for her.  We worked on breathing for about 30-40 minutes and the last 20 minutes I showed her how to grunt during contractions and do little baby pushes to relieve some of the pressure she was feeling.  And then she said the magic words “I think the baby is coming!”  Those words ring like a choir of angels to my ears!  As I was leaning towards the call bell to page Dr. F into the room, the door opened and it was him.  He checked her and with a look of surprise said “Wow! You are a plus 2 station now!  You have done a lot of work in here!!”  I was smiling so big I thought my cheeks were going to explode! 

 

Sarah felt more comfortable pushing on her left side so John supported her right let while I supported her neck, applied cold washcloths to her forehead, and offered sips of cold water. 

 

At 10:45pm after only 37 minutes of pushing, Sarah (a first time momma) gave birth vaginally to Elizabeth Joy, weighing in at 9lbs 1 oz!!  She had a second degree perineal tear that required only a couple small stitches and never required an episiotomy, forceps, or vacuum extractor.  Sarah spent the first hour skin to skin with Elizabeth and got a great start with breastfeeding.  I only wished that I didn’t have to leave at 11:30pm and could have gotten to spend the whole 2 hour recovery time with them.  I left the hospital that night exhausted but empowered, drained but excited, and so incredibly proud of Sarah and John for sticking to their convictions and advocating for their birth experience.  I must have said to her a million times through my tears of joy, “You did it!  You did it!  You did it!” 

 

It is such a shame that it takes so much energy to fight for your right to your own birth experience during a hospital birth.  I think the mix between Sarah, John, & I was a great one, yet it still took a lot of effort on everyone’s part to avert unnecessary interventions and protect their birth plan.  And unfortunately, it was all made much more difficult starting from the very beginning when Sarah was scheduled for an UNNECESSARY LABOR INDUCTIION.  I thank God that Sarah ended up with a rewarding and empowering vaginal birth but things could have taken a turn towards CesareanTown at any point along the way, NOT related to natural labor, but related to INTERVENTIONS. 

 

The morals to the story are this:

 

1)     Remember LABOR & BIRTH are natural, INTERVENTIONS are risky, NOT the other way around.

2)     Even if you are planning on an epidural, uncontrollable circumstances may require you to labor without one for longer than you thought and therefore labor and birth preparation, whether it be reading books, taking a class, hiring a doula, or talking with other moms, is just as important if you are planning for an epidural as if you were planning for a natural birth.

3)     If you have had a healthy, uneventful, normal pregnancy up until your 37th week and your baby has a reactive non-stress test it is important to seriously question your doctor or midwife if they are suggesting, offering, or pushing a labor induction for you.    

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59 Responses to “Don’t Let This Happen To You #25 PART 2 of 2: Sarah & John’s Unnecessary Induction”

  1. nursingbirth Says:

    Sorry it took me a few days to post! I just got off a stretch of 12 hour shifts. Enjoy!

  2. Sandra Says:

    Wow… I can’t imagine a doc wanting to give me even one single vaginal exam, let alone multiple ones… or pushing any type of intervention at all, or being hooked up to a monitor at all! I guess I’m just a huge believer in the doc not playing a role in normal childbirth, unless he insists on catching (which the partner can easily do, of course)… I’m glad it all worked out in the end for your patient!!

  3. nursingbirth Says:

    Sandra, I totally agree! Multiple vaginal exams are completely unnecessary and doctors have no place in normal childbirth. It is just not what they are trained to do. It’s like asking an orthodontist to brush your teeth everyday. Totally unnecessary! Thanks for reading!

  4. Sandra Says:

    *giggles at your orthodontist reference*

    I did have four hospital births, and in hindsight I wish I would’ve just stayed home. My births were quick, painless, and had zero interventions… BUT – I went armed with information and didn’t just lay there and let a doc dictate what I needed. Sadly, I think a lot of people put docs on a pedestal just because they have a degree. Sure, they have more medical knowledge (sometimes, lol) but that doesn’t mean they know what’s right for ME. I really think a doc needs to be my PARTNER, not the dictator. And I’ve never had a doc give me a problem. With my last baby, I told them I would let them know when to catch, and I will be going home immediately if baby is healthy. Not a word was said. Even the “old” baby doc exclaimed that he wished more people would leave in 4 hours… they believe babies and mamas recover better at home, relaxed and comfortable.

    But I digressed again – I’m not telling you anything you don’t already know! I love your blog, m’friend!

  5. Molly Says:

    Oh I was soooooooooo expecting a sad ending! I was so happy when I got to the birth! Yippy Melissa! GREAT JOB!!!!!!!!!!!!!!!!

  6. Katherine Says:

    Wow! Thanks for that story — what a lot of fighting you had to do. So glad to hear that it all worked out! We could only pray that anyone who needs to have a hospital birth could have nurses as wonderful as you helping them!
    🙂

    Oh – and amen on #2! I’ve had soooo many friends who didn’t take any childbirth classes because their plan was to have an epidural, and, sadly, more than one of them ended up regretting it!

  7. nursingbirth Says:

    Sandra, I am so inspired by your attitude towards your births and your relationship with your doctor! I wish more moms were like you!

    Molly, the crazy thing is that it could have taken a turn for the worst at any time! And it wouldnt have been r/t labor or her ability to “birth” a 9 lb baby (obviously 🙂 ). Thanks for the encouragement! Thanks for reading!

    Katherine, thanks! I wish more moms like you read blogs like this and watched movies like “The Business of Being Born” instead of reading “What to Expect When You’re Expecting” and all the other crazy websites out there set up to scare moms away from natural labor and throw them into the arms of an overmedicalized birth culture. Also, I have met many patients that were like your friends!

  8. Mama Kalila Says:

    I am so glad she got what she wanted, good job. Reading this reminds me of mine though and how little of what I wanted happened. I thought I was prepared and flat out wasn’t. I know better for next time though!

  9. Alev Says:

    Thanks for a great story and a great blog. It’s nice to know that there are L&D nurses that are advocates for natural childbirth!

    I had my first in the hospital, but was afraid of interventions so didn’t go in until the last minute (9 cm). I am planning a home birth for my second coming in November.

    I think women just don’t take the time to educate themselves; so many of my friends think you need to just “do what the doctor tells you.” Sad.

    I love the orthodontist reference, too! 🙂

    • nursingbirth Says:

      Alev, Thanks for reading my blog!! I love when mommas read my blog and tell me about their experiences! I am empowered as a woman and a nurse by your story of coming to the hospital at 9cm and the fact that you are planning a home birth! You rock!

  10. nursingbirth Says:

    Mama Kalila, I am sending all my positive labor and delivery vibes your way!!!

  11. Mama Kalila Says:

    Thanks! If you’re interested I have my story on my blog… Is under birth stories on the labels. I just reread it myself and am shaking my head all over again lol.

  12. Mama Kalila Says:

    Started to leave this on my post like normal and realized it could get me in trouble lol. Anyways, thanks! No pushing really needed. We are ready for #2… even started working on it lol… Unfortunately some things have come up that I’m not sure if we’re going to get to keep trying right now. We’ll deal with that after I test (tomorrow… eek).

  13. keekahoney Says:

    Wow… I got really choked up reading this! I am so happy that there are L&D nurses like you out there. I am currently approximately 5 weeks away from delivery of my 2nd baby and we are planning a homebirth with a midwife. My first birth (10 years ago) involved a lot of interventions that I now know were totally unnecessary, and that went against my birth plan. It’s so hard to stand up to the medical professionals, especially when you are in pain and feeling small and insignificant. Thank-you for what you did for Sarah and John and their baby!

  14. nursingbirth Says:

    Keekahoney, thank you for reading my blog, enjoying it, and sharing your story! CONGRATS on choosing the birth place that suits your needs best and advocating for yourself! And CONGRATS ahead of time on your labor and birth!

  15. Jessica Says:

    Woman, you are my hero!! How I wish that you had been my nurse for my first baby! I was young and uninformed back then, and even though I’m a nurse myself, it seemed impossible to me to advocate for myself in labor, especially knowing that my baby had a heart problem (I just trusted the Doc…who turned out to be a resident anyway…to do the right thing). Now I have been a nurse longer, I know a bit better, and my thoughts on birth culture have done a 180, and I fantasize about the day when I’ll be a CNM. I’m subscribing, so I can learn a thing or two from a seasoned L&D nurse with her head on straight!! 😀

  16. Amy Says:

    Could you come work at the hospital I doula at??? They need someone like you!!!! Good job 🙂

  17. originsdoula Says:

    I am so glad that there are nurses out there like you who advocate for your patients rather than blindly follow a doctor’s orders. As a doula I have to play that fun little game that you just described in order to help moms avoid the chain of events that often occur with “failed” inductions. Or as I would like to call them, unnecessary inductions!

    Keep up the good work!

  18. Becky S Says:

    Thank you so much for standing up for birth. I’m sitting here bawling because I’ve seen this too many times! I am a doula and do no have the authority or power to say the things that you can. I rely on nurses and families to speak their minds, and when they don’t, it’s a train wreck. Too many of my mommies are pressed into inductions and interventions that have little to no reasoning. Thank you!

  19. doula Christy Says:

    Wow! If more L&D nurses were as great as you I’d be out of a job. You are obviously a wonderful advocate for your patients and they are lucky to have you on their side. I wish I worked with more nurses with your knowledge and attitude. Keep up the good work.

  20. TO Doula Says:

    Wow – can we please clone you and distribute you liberally at all the hospitals I doula at? How refreshing to read this coming from someone inside the system. When you’re on the edges of it you sometimes begin to doubt the things you know to be true in the face of so much opposition, misinformation and stubborn protocol.

  21. I want to add my voice to the chorus of doulas wishing for more nurses like you! It’s so hard for us to say and do some of these things, and certainly not in our power to keep the pit turned down! (I recently heard of doctors giving the order to “pit to distress”…awful). Thank you so much!!!

  22. […] “Don’t let this happen to you”  part 1 and part 2 written by a labor nurse all about a birth that started with an unnecessary […]

  23. guinever Says:

    Every couple should have a labor nurse like you!!!! Keep up the good work.

    A doula in KY

  24. enjoybirth Says:

    I LOVED this post. I am a doula and have had quite a few moms induced for low fluid. After a few times, I now send my moms prepared with questions to ask specifically about this. Letting them know above 5 is in the normal range. So to ask specifically how low is it and really ask questions!!!!

    I just found your blog and love it! I love nurses like you who help support moms in their birth plans and avoid cesareans.

    Yay for you!

  25. […] From report I got most of the details:  Jessica was a 25 year old first time mom (G2P0) just a few days past her “due” date (40 weeks and 3 days).  Here health history was unexceptional: exercise induced asthma as a child that did not require any medications, tonsillectomy at age 7, and one miscarriage at 5 weeks two years ago.  Her pregnancy was normal, healthy, and uncomplicated.  The patient had arrived to the hospital at 1:30pm with her longtime boyfriend Jason.  Jessica’s day shift nurse had completely admitted her and started her on pitocin but because the floor was crazy busy all day, she had only gotten the pitocin up to 4mu/min and the residents had only gotten the chance to write orders and not to rupture her membranes.  (My thought = Yes!!)  [Note: For a description of how pitocin is administered check out: Don’t Let This Happen To You #25 PART 2: Sarah & John’s Unnecessary Induction]. […]

  26. atyourcervix Says:

    You are AWESOME!! As a L&D nurse, and advocate, patient educator, and writer. I am SO glad I found your blog. More L&D nurses need to be better patient advocates like you are.

    • nursingbirth Says:

      atyourcervix, WOW I feel like a celebrity has graced the pages of my blog!! I am honored that such a kick-ass, super bloggin, L&D nurse is reading my blog! I am humbled! 🙂 Thanks for reading!! We RNs have got to stick together!

  27. Joy Says:

    Wow- I hope I have a nurse even HALF as amazing as you are at my next birth! Seriously, I love that you stuck up for this woman and what she wanted.

    Can you believe that my former doctor (I say former because they were AWFUL) walked into my room the day after I had given birth to my youngest daughter and said, “Next time you’ll have a c-section 2 weeks early”. Then she changed her tune to, “Next time we’ll induce you 2 weeks early” at my postpartum visit.

    The reason? My 8 lb 8 oz daughter had broken her clavicle at birth. My mom-in-law has attended many births and said she’s never seen a doctor pull as hard on a baby as my doctor did (being in labor I wasn’t paying attention).

    When I told my new doctor all of this his eyes got so big and he said, “There is no reason we need to induce you or sect you after you’ve given birth beautifully 2 times. I hate to sect women who’ve had great vaginal deliveries without complications.” So THANK GOD I have a wonderful doctor now.

    • nursingbirth Says:

      Joy, I am sorry to hear about your daughter’s injury during birth and i am OUTRAGED that your ex-doctor said those things to you! The sad thing is that your “ex-doctor” isn’t the only insensitive, rude, and sorrily mislead doctor out there. I once had a doctor tell a woman (after cutting the BIGGEST unnecessary episiotomy I have EVER seen…it makes me nauseous to think about it), and I quote, “You shouldn’t have any more babies…Clearly your body just can’t do it.” I FREAKED OUT when I heard her say that and I actually blurted out: “Dr. D! HOW COULD YOU SAY THAT TO HER!? DON’T SAY THAT!” THANK THE LORD you switched doctors! Thanks for reading!

  28. […] story of “Sarah and John” and the birth of their first child. A must-read! Part 1 and Part 2. She is going to be doing a series of “Don’t Let This Happen to You”, and here is […]

  29. terrajones Says:

    Wow!!! Amazing 🙂 I want you to be my L&D next time!! 🙂

    I too am glad there was a happy ending to that birth 🙂

    I look forward to the rest of your series 🙂

    • nursingbirth Says:

      terrajones, I can be your nurse in spirit!! 🙂 I dream about work almost everynight, haha, so maybe I will be your nurse in dreamland 🙂 Thanks for reading!

  30. I’m just a student nurse, but I’ll remember this story…I will know to stand up for my L&D patients next year when I get OB!!! (cant wait!!!)

    • nursingbirth Says:

      little d, S.N. It makes me so happy that a student nurse has found my blog! It wasn’t too long ago that I was in your shoes, very impressionable, eager, overwhelmed, excited, scared, etc etc etc! I am honored that you have read my blog and that you will keep Sarah & John’s birth in your thoughts as you begin your OB rotation next year. I hope you keep reading and help the cause by educating your fellow student nurses! I can’t wait for you to start OB either! Remember, nursing school isn’t forever. Hang in there!!

  31. paige Says:

    That is amazing! I hope there are many more L&D nurses like you, willing to stand up for a patient, even when she has a hard time standing up for herself. Sometimes all it takes is one voice telling you it’s OK to say no.

  32. Shotgun_Mary Says:

    All I can say is God bless you.

  33. Lynz Says:

    Thank you so much for your insight. With my first 3 babies I felt so much pressure to stay in bed and not move (mostly from the nurses I had). I had an epidural with all three… now I’m over 37 weeks with my fourth and have been really wanting to have more freedom without the epidural (and every other side effect from them).

    Why can’t more nurses be like you?

    • nursingbirth Says:

      Lynz, CONGRATS on your pregnancy and I am SO HAPPY you are doing more research this time around 🙂 I encourage you to continue to read POSITIVE birth stories. Have you read Ina May’s Guide to Childbirth? If not, I seriously recommend reading it. It is inspirational and empowering!! Good luck! I am sending positive birth vibes your way!

  34. Dana Schultz RN Says:

    Love you, love you, love you. You are what we need more of in the Labor and Delivery rooms across America.
    As a RN I knew better then to have my babies in the hospital and chose a midwife (Shari Daniels, best midwife ever! In Miami) to guide me through delivering my baby.
    If only we could clone you..

  35. Carrie D. Says:

    I absolutely love your 3 rules about epidurals. If everyone follows this there would be far fewer c/sections.

    I know I don’t have to tell you this, but if she had gotten that epidural when she first mentioned it, she would have had a c/section. No doubt in my mind.

    You are inspiring. What you do is so important, yet so hard. Keep it up!

    • nursingbirth Says:

      Carrie D. In my heart I feel the same way! Thank you for being so encouraging!! When I’ve had a really heartbreaking day at work and I feel like I am not making a difference I always read the comments on my blog! I appreciate readers like you!!

  36. Joy Says:

    My sister-in-law had an episitomy so deep and long that she was still in pain years later. So at her next birth her NEW doctor (yes, she got rid of the awful doctor who cut her wide open) couldn’t believe what she saw and promised to stitch it better. No more pain for her but you can tell it put such a damper on her birth and post partum experience.

    I can’t believe the things doctors say. I took what my former doctor said with a grain of salt, knowing full well I would never consent to being induced early or having unnecessary c-section. My new doctor said my pelvis is large and my baby must have had her arm up on her opposite shoulder (partnered with doc pulling on her so hard) so he saw no need to do unnecessary interventions. YAY for that!

  37. Ciarin Says:

    Nicely done – I can remember my days of doing this as a labor and delivery nurse. The biggest problem was that patients would often be unable to stand up for themselves – sad that they would even need to! Now as a midwife, I try to always be respectful of patients’ desires. I also believe that I if I feel it necessary to intervene, that intervention comes with an explanation (unless truly emergent).

    • nursingbirth Says:

      Ciarin, I am inspired by women like you who have worked in L&D, felt things needed to be different, and then went on to further their education so that they could help patients more directly! I wish I worked with more midwives in general (there are not many at my hospital) and I wish they were more like you!!

  38. […] “Don’t let this happen to you”  part 1 and part 2 written by a labor nurse all about a birth that started with an unnecessary […]

  39. hsp Says:

    I’ve really been enjoying these posts until this one. The language in the “rules” section is really off-putting to me. Could you elaborate more on how you apply these rules? I’m really uncomfortable with the feeling of “agenda” it seems to imply – which wouldn’t be any better than the dr.’s agenda being posted about. Is this something you use only in circumstances where a patient has spoken to you about not wanting an epidural or trying to go natural? I hope my words don’t seem accusatory, I don’t mean to be, I’m just trying to understand how these “rules” fit into a model of care that is meant to to support autonomy and encourage empowerment. Thanks.

  40. […] my discussion on this topic I would like to quote a blog post I wrote back in April entitled “Don’t Let This Happen To You #25 PART 2 of 2: Sarah & John’s Unnecessary Induction”.  This post is actually the first post I ever wrote for my Injustice in Maternity Care Series. […]

  41. leslie Says:

    so great! and i guess you answered my epidural question:)

    and i have to say it’s the hardest from “5-8” cm so the lady did a good job!!!

    • NursingBirth Says:

      leslie, glad you found this post!! I am always facinated when a reader from another country comments on our “American practices”! We can all learn so much from international moms and birth attendants!!!

  42. Renee Says:

    I so thought this was going to be a horrible story of unneccessary interventions and end with an unneccessary cesarean!!

    This was beautiful! The advocacy… the strength of momma not to give in to Dr. requests… just beautiful.

    I am a L&D nurse, and I often do this coaching before the doc comes in as well, and am surprised @ how often the patient does not do what I know they want to do. This must have been a special couple.

    • NursingBirth Says:

      Renee, I was so happy it didnt end with an unnecessary cesarean too but it certainly could have (and as an L&D nurse I am sure you have some whoppers yourself to tell!!) Scarey! Thanks for reading!! I love when L&D nurses comment! I love to hear how their experiences are different/similar to mine!

  43. Jael Says:

    I’m sitting here in tears – I wish that you had been my labor nurse for both of my deliveries. I thank God that I took the time to educate myself at least some about invasive interventions and their risks. My first OB broke my water without my consent. He told me he was going to examine me only (I specifically ASKED – he lied. My poor labor nurse was distraught profusely apologizing that she didn’t know he was going to do it). I was angry at the time but felt that any negative energy from it would only slow me down and prevent me from my ultimate goal which was a vaginal delivery.

    I did manage a vaginal birth with both inductions – but I firmly believe ONLY because my husband and I advocated strongly for me and my desire for a vaginal birth. I have PCOS – I’ve had trouble with my blood sugars before I was diagnosed with it. I was on insulin for both pregnancies almost immediately. Well controlled (HbA1c’s 5.1 to 6.0). I know the diabetes increased my risks significantly but weekly NST’s and biophysical profiles showed both babies were doing fine in there. I asked to see the placenta after each birth – they were pink and healthy no signs of calcifications whatsoever. The first induction happened near the end of 38 weeks. Second induction I managed to stave off the new OB until near the end of 39 weeks. Both doctors pressured me to have one, and I understand in part why (say diabetes and they freak out about the risks) never mind that I worked my butt off to maintain STRICT blood sugar control, my second baby was smaller than my first even! First son was 9 lbs, second was 8 lbs 14 oz and almost 2 inches shorter than his older brother. I had small tears with both boys but I’m not sad that I flat out REFUSED episiostomies

    I feel so lucky reading these stories that I pushed hard to be allowed to move, change positions (even if it meant only as far as the monitoring cords would allow)… I just wish I’d had a nurse like you – maybe I would have been able to avoid an epidural for both births. That’s my only regret – that I couldn’t stand the pain of the max dose of pitocin (well that and my bad reaction to the cervadil for the first induction – at least I managed to avoid that this last time!). At least I made it to 7 cm this time… but I’ll always question if I’d had more support could I have made it all the way to the ‘finish line’ with no drugs? I’m sorry this comment is so long and so jumbled… a lot of emotions washing over me right now

  44. SandraRh Says:

    OMG. Ok I knew that my pitocin was to high with my first birth. I felt it in my gut. But I was ignorant and thought they knew what they were doing. They had my pit at 26 and showed no intentions of stopping! I remember looking over at the machine and watching the nurse increase it again and remember thinking “I wonder if they will notice if I turn it down” but I chickened out and didn’t do it. I also was kept in bed the whole time.

  45. Jessica Says:

    Hi!

    I am a certifying doula and have recently had an interview with a perspective client. She is 36wks pregnant with her first. She was strongly considering a doula, but everyone else in her family was on the fence, and pushing a “private” birth experience. However, they are planning a delivery at a university hospital, she has yet to see the same HCP throughout her prenatal care, she has no idea which one will be at the birth, or if it will even be someone she has met. They are planning a natural birth. She assured me that the hospital she is birthing at offers a multitude of birth options, including water birth, birth ball, position changes, etc… and the childbirth education from the hospital has given them confidence in thier ability to get what they want from this birth. After much “deliberation” they decided that they were not going to hire a doula, based soley on their confidence in the hospital to give them what they want, and their desire for privacy. While I can completly respect their privacy request, I fail to see how birthing in a university hospital will give her much if any privacy…AND if she doesn’t even know who will be her HCP at the birth…how is she confident that the hospital will give her what she needs? I wish there was some way to help open her naive eyes to the reality of birth in hospitals today. Her chances of getting to work with a mother friendly doc that understands and respects natural birth have got to be low! Reading your blog was comforting (b/c I know there are others who struggle with this) and depressing(b/c we have to stuggle with this). I don’t want to have her hire me for her VBAC next time around. I want her to have the birth she desires now. I realize there isn’t much I can do for her at this point, which is why I am here, leaving my frustration with a bunch of like minded individuals. I am hoping things will go well for her and in the mean time, I’ve let her know that I am and will be available until the baby is born. just in case. Thanks for the space to rant.

  46. Kimberly Says:

    I’m just reading this (almost 2 years later!) And I wish I had a nurse like you at my last birth (September 2010). While i ended up having a completely intervention free, natural childbirth, the only reason I got it was because my daughter came fast…so fast in fact that she was born in triage. I had the nurse continually ask me if I was “done trying to be a hero” and my attending OB (it’s a military facility, so I didn’t have a choice in who delivered me, and midwives are in short supply and didn’t arrive until 6am) didn’t even believe that I was in labor when I came in (I was in transition an hour later and gave birth to her 14 mins after my water broke).
    This is a great story with a great ending. I’m going to school to become a midwife, and I hope that while I’m in nursing school, I can help advocate for women who really want and need it.

  47. Cristy Says:

    My niece had to have an unnecessary c-section as well. I tried to advocate for her. I asked the doctor if he could wait until 12 midnight since she’d had her bag ruptured at lunch time. He started to talking to me condenscendingly to me and I got pissed and told him that none of this would’ve happened if he hadn’t broke her water at 2 cm. I mean come on why would you do that to a first time mom? The answer is it was late and he was ready to go home. I got mad and stormed out because I couldn’t handle it. So his reason for not waiting according to him was that the baby’s head was pushing against her pelvis and getting hung up. Well the baby was at -1 station, which is not even at the pelvic bone. So that was just a scare tactic he used to 1. make her feel she didn’t have the right to trust her own body and 2. force her into a c-section she didn’t want. I told her after I’d calmed down, that she had to right to refuse. Because the doctor tries to make it seem as though you don’t have a choice. Anyhow they gave her a c-section. The baby is looking pretty good..

    The reason this bothers me so much is because doctors and hospitals rob women of a joyful birth experience, it should be fun and exciting. And they tell you that you can’t trust your own body. A woman’s body was made for childbirth.This undermines your own natural instincts.

    So not only did she have a c-section, the nurses told her that her nipples are flat, so now she’s convinced that her pelvis is too small and that her boobs are defective as well. I tried to explain to her that she needed to stop giving the baby formula and breastfeed only. The whole situation makes me so mad.

  48. Candice Says:

    Gosh I love this! It took me so much work to not be induced (I went to 42+1) and when I finally did go into labor, I got to the hospital an hour before I had my baby and had to fight for my birth plan the whole time! I ended up at the end of the bed pushing–with the nurses all at least five feet away from me telling me I HAD to lay down, they couldn’t do it that way, if they dropped my baby it would be MY fault. Finally the doctor walked in and said–let’s get an internal monitor on her now!
    I turned around and said–like hell you are putting one of those things on my baby. Then I squatted down and pushed her head out. The next push her shoulders came out, and my fiance caught her and put her on my chest. I think if I had a nurse like you, it would have been a much better experience. In the end, my “little” girl was 10lbs 6oz, completely medication free! (:

  49. Zstar Says:

    You are amazing. I wish every OB nurse was like you, with the patient’s best interest in mind, and able to help them get the birth they want. I bet if every nurse was that way, there’d be less c-sections. I applaud you for being so amazing, and extend that to all the other amazing nurses.


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