Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Thoughts on Becoming a Midwife…. April 2, 2010

Filed under: Ramblings — NursingBirth @ 9:12 AM
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I have written before about my aspirations of becoming a midwife.  The more and more I care for birthing women as an L&D nurse, the more I meet moms out in the community at birth circles, ICAN meetings, etc., the more I read and see and hear about birth and birth politics, the more midwives I meet, the more and more clear it is to me that becoming a midwife is something that I need to do…someday.

I stumbled upon a blog post entitled “Apprentice Midwife Material?” over at Navelgazing Midwife the other day and it really spoke to me.  Throughout the beginning of the post the author goes into detail about the many sacrifices that midwives make in order to do what they love to do.  While reading them over, none came as a surprise to me.  However, no one can really understand what its like to experience them until they become an apprentice and even then your world is still a bit sheltered.

The author then writes:

“I imagine women’s spirits sagging by this point, those sitting in front of me and those reading this, but there are AMAZING parts of being a midwife, too. But if you don’t want… no, CRAVE… all that I said above, then reconsideration of this career is called for.”

I reflected on this statement for a while and I realized that I DO indeed CRAVE it all….the good, the bad, the ugly, the awesome!  But it is still undecided when exactly my time will come to put myself to the test.  Until then I must continue to form relationships with birthing women through my work as an L&D nurse and through my blog.

Thanks for listening 🙂

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Hey NursingBirth!!! Where the HECK have you been?!?! March 29, 2010

Filed under: Ramblings — NursingBirth @ 11:57 AM
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“Hey did you hear what happened to Nursing Birth?  I heard she was struck down by a bolt of lightning when she encouraged one of her patients to push in an upright position instead of on her back in stirrups!  She hasn’t been the same since!!

 

“No, no no…you’ve got the story all wrong!  I heard that the government had to put her into the witness protection program after she suggested to a  room full of obstetrical residents that a woman could indeed deliver a baby WITHOUT pitocin!  And it didn’t help matters when she then told the group that women do not have to have a vaginal exam every two hours while in labor!  That really set them over the edge!!

 

“I heard she was captured by an angry mob of obstetricians after mentioning the possibility of a TOLAC for a woman who showed up on the ward in labor after 5pm at night!  They held her captive on a deserted island where she was forced to listen to lectures touting the “benefits” of elective primary cesarean sections for all pregnant women!!”

 

“You know what I heard?  I heard she had a nervous breakdown after hearing 20 maternity nurses simultaneously utter the phrase “Why don’t you just let us take the baby to the nursery tonight and give him a bottle so that you can get some rest” while at the same time shoving a box of pacifiers into her mouth!

 

“No, you all have it wrong!  I heard that she had to flee the country after a group of anesthesiologists overheard her admit to a patient that indeed epidurals do carry some RISKS to both mothers and babies!  Rumor has it they chased after her screaming “HERETIC!  BLASPHEMY!”

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No you are not seeing things!  It’s really ME!  Your old friend NursingBirth!  I’m sure you all just did a double take when you saw my post pop up on your google reader but it is true, I am back!  However as hard as it is to believe, none of the above scenarios are true! 

Despite the fact of me being back, however, being “better than ever” is unfortunately debatable.  The last 5 months have been a whirlwind of highs and lows, with Christmas time with my family, a newborn nephew, and more than double the amount of sunny days being a few of the “highs” and the selling of my first home, moving TWICE and to a new state, dealing with the bureaucracy of multi-state boards of nursing, a panicked job search, a husband out of work, moving away from my very best friend, and starting a new job as being some of the, well… “lows.” 

When I wrote my last post back at the end of October, (WOW, I haven been “gone” for 5 months.  No wonder why my readers have been getting frantic!!) I truly did think that I would be back in action at the computer in only a few weeks.  But the multiple moves really took a lot out of me especially since we spent one of those months without the internet.  (AAHHH!  NO INTERNET!  Lame I know but I am crippled without it!!  Haha!)  However, the biggest hurdle that I had to overcome in order to return as “NursingBirth” was my “new” job. 

Why was my “new” job a hurdle you ask?  Seems like a new job would bring an endless amount of new material.  And in reality it absolutely has.  However as I stated in my last post, when my husband and I decided to move and hence leave behind my “old” job (which hereby will be referred to as “Big High-Risk Urban Hospital” or BHRUH) I started out on a quest to find and work for a hospital or birth center that was both truly mother-friendly as well as baby friendly in their philosophy, attitudes, actions, and outcomes.  I did not want “more of the same.”

But what happened is that I, NursingBirth, became a victim of the Ol’ Bait and Switch!!!!

What was supposed to be a beautiful beginning to a long career at a nice community hospital turned into a deep depression as day by day I realized more and more that I was in waaaaaaaay over my head.  However, I wasn’t in “over my head” as far as my nursing skills or knowledge was concerned.  In fact, I saw, experienced, and managed  situations at BHRUH daily that the nurses at my new job (which will be henceforth referred to as “Bait and Switch Community Hospital” or B&SCH) experienced monthly or even yearly.  (Not that that is good or bad.  No value judgements here.  I also fully acknowledge that there is still much I have to learn and have yet to experience as a nurse.)  I was in way over my head because the “mother friendly/baby friendly” hospital that I thougth I was working for was actually a:

 

“Don’t under any circumstances rock the boat or the nursing leadership will throw you under the bus–We do things here this way because that is the way we have always done them so don’t confuse me with the facts– If you don’t give me my way I’ll just take my patients to your biggest rival instead– Look at all our big screen TVs and SHINY THINGS while we distract you and seperate your baby from you at every possible opportunity– Your nursing license and the safety of the patients comes second to keeping doctors happy– Give them all an epidural at the door to keep them quiet– My C/S rate goes up when I am in a bad mood– Every admission to the nursery= More money for the hospital–No midwives allowed–You can’t do anything to change things here because nurses are not an equal member of the healthcare team” hospital.

 

   And it wasn’t until I made the very hard decision to leave B&SCH that I have had the motivation and inspiration to start writing again.

But today I also come to you with good news!!!  As of May 3rd I will be starting a yet another NEW job at community hospital #2 which I will from here-on-out be referring to as “Birth Center in Disguise” or BCID!!  Luckily my decision to leave B&SCH coincided with a random, word-of-mouth, unlisted job opportunity at BCID that lead to an interview and job offer last Thursday!!!  I feel revitalized and excited and nervous and joyful as well as so many other emotions that I just had to write about them all!! 

I hope you will all stick with me over the next few posts as I process and debreif the last 5 months of my life.  I feel like there is so much I want to share with you about what I have been going through and I haven’t had anyone else to process all this with!  I also want to appologize for going MIA for so long.  It was so hard for me to come back but I hope that I am back for a long time.  I didn’t realize how much I really got out of blogging and I really missed how much I learned from all of you!

Thanks again for all your words of encouragement and pleas for me to return over the past 5 months.  There is no doubt that without them I would never have returned!  You all rock!!

Sincerely,

NursingBirth

 

NursingBirth is on the MOVE! October 28, 2009

Filed under: Ramblings — NursingBirth @ 8:23 AM

moving van

Hello Everyone!

I just wanted to give everyone a heads up that I will not be posting for a week or so since last time I went missing (in August) I almost had a few readers call in a “missing persons” report on me!  My husband and I are moving to a new state so that we may both pursue better job opportunities.  I am very excited about this change and will be sure to keep you all in the loop once we are more settled.

All My Best,

NursingBirth

 

The Good, The Bad, and The Icky on Vomiting in Labor October 19, 2009

vomiting logo

 

Submitted on 2009/10/18 at 9:43pm

Comment left at: Top Ten Things Women Say/Do During Labor (And trust me… they are totally normal!)

 

 

Dear NursingBirth,

 

Hello, I know this is an old post, but I’ve been searching information on vomiting during labour for a few hours (lol!) and can’t quite find what I’m looking for.  So with the housework waiting I thought I should just come out with it and ask!  Your post is very informative and you seem lovely so I hope you are able to help me! (Or others who have been through it!)

 

I have emetophobia (fear of vomiting), and find I am able to calm myself about the potential of vomiting (because I have had to face that fact that I can’t just escape it!), if  I

 

#1: Know that “everything will be ok” if I do vomit. (i.e. Mainly that people won’t be disgusted, or freaked out and that someone will be able to deal with, well, the result, if I’m not able to.  Even though I’ve never vomited anywhere except in a toilet, it’s just the potential that terrifies me!  My husband is a wonder, and it’s only actually since being with him that I’ve begun to get over the phobia because he’s not scared about it, and not fazed by it).

 

And

 

#2: Remember that I can handle vomiting much better if it isn’t preceded by hours and hours of painful nausea.

 

 

SO, I find myself trying to prepare mentally for the possibility of throwing up during labour, and I have some questions stemming from this for you (I know it is an irrational fear, and these questions seem trivial but they are things that really stress me out – I actually lose sleep over them – so I appreciate your answers):

 

#1 Will the midwives be ok if I throw up all over the place? Will the staff get disgusted or freaked out?

 

#2 Will the staff clean it up or will I or my husband have to?

 

#3 What happens if it gets in my hair?

 

#4 Will I choke because I might be lying down?

 

#5 Will everything be okay if I do vomit?

 

And, finally

 

#6 Is it a different kind of vomiting – one that just kind of happens, rather than following hours of terrible nausea?

 

 

Anyway, I don’t mean to waste your time, and many thanks in anticipation of any answers – I’m just trying to mentally calm myself so I can focus more on the really important things about labour – like my baby!!

 

Sincerely,

 

NervousMumToBe

 

 

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Dear NervousMumToBe,

 

 

First of all I am sending you one MAJOR cyber *HUG* right now complete with back patting and me saying “You can do this!!”  🙂

 

 

Second, you are NOT wasting my time so don’t mention it!!  I have written before about worrying, that is that “WORRY is the WORK of pregnancy!”  In her book Birthing From Within, certified nurse midwife Pam England tells the story about a patient of hers (Hannah) that worried a lot about having a natural birth experience after having had a highly medicalized birth with her first baby.  She writes that Hannah longed to hear her say things like “Don’t worry” and “Everything will be alright” but instead England encouraged her to face her fears.  She instructed Hannah to write down all of her worries and explore each of them with questions like “What, if anything, can you do to prepare for what you are worrying about?” and “If there is nothing you can do to prevent it, how would you like to handle the situation?” 

 

 

 England lists the “Ten Common Worries” of Labor as:

 

1)      Not being able to stand the pain

 2)      Not being able to relax

 3)      Feeling rushed, or fear of taking too long

 4)      My pelvis not big enough

 5)      My cervix won’t open

 6)      Lack of privacy

 7)      Being judged for making noise

 8.)      Being separated from the baby

 9)      Having to fight for my wishes to be respected

10)  Having intervention and not knowing if it is necessary or what else to do

I would like to add #11:

           11) Fear of pooping in labor/Fear of embarrassment regarding bodily functions

 

 As you know I am a labor and delivery nurse and have estimated that I have been present at over 300 births during my career and still, I would have to say that when it is my time to give birth, #1 through #6 are top on my list of worries!!  And I witness the amazing power of women everyday!!  So NervousMumToBe, don’t *worry* about “worrying” about vomiting!  I am so happy that you are FACING YOUR FEARS!!  If vomiting is something that you are really concerned about, no matter how trivial it might seem to others, it is important to you and that is all that matters!  So I applaud you! 

  

Okay now that the most important thing is out of the way (i.e. the hug) lets get down and dirty about the #2 thing on every pregnant woman’s mind…VOMITING IN LABOR!!  (If you are wondering what the #1 thing on every pregnant woman’s mind is it is POOP.  Don’t believe me?  Check it out here.)  I want to preface the following post with a few things in the interest of full disclosure:

 

  • I am drawing from both my experience as a labor and delivery nurse (as well as a medical/surgical nurse and nurse’s aide) and the research I have read on this subject to write this post as I do not have any personal experience with going through labor myself.  That being said…

 

  •  I have thrown up a time or two myself (I did go to college after all 🙂 ) and know how it feels to do so.

 

  • Some readers might have personal experiences that are different than what I describe.  However it is important to remember that if I make a statement like “In general I have found most women in labor to do x, y, or z” I do not mean to say that there isn’t anyone out there that had a different experience.  There are exceptions to every rule. 

 

  • Although I have only been working as either a nurse or nurse’s aide for approximately 5 years (which I understand does not make me the most experienced nurse out there) I have certainly been working directly with patients for long enough to know a thing or two about bodily functions, including when they are likely to happen, how to make someone feel better, and how to clean them up.

  

  • I cannot speak for every labor and delivery nurse and midwife out there.  After all, I have only worked in one labor and delivery ward (not counting nursing school clinical).  But since you asked me I will answer your questions as if I was your nurse or midwife.  I will also take into consideration what the other nurses and midwives I work with on a daily basis would do and how they too would react to the situations you present.   

 

 

Now to some answers!!  I will take your questions one at a time:

 

 

#1 Will the midwives be ok if I throw up all over the place? Will the staff get disgusted or freaked out?

Yes and No!!  YES!  The midwives and the labor and delivery nurses will be okay if you throw up all over the place and actually, they probably will not even bat an eye if you throw up!  And NO!  The staff will not get disgusted or freaked out if you throw up!  If bodily functions bothered us, we wouldn’t be working in healthcare!  I have been thrown up on before…more times than the average person for sure!  I have been splashed with blood, amniotic fluid, pee, spit, and mucus.  I have also cleaned up my fair share of explosive diarrhea.  And if I do get splashed with something I just kept on doing what I was doing until I have a break where I can go change.  (Remember L&D nurses usually have to wear hospital scrubs just in case they end up in the operating room.  The other bonus to this set up is that if you get splashed with something gross then you just go in the locker room and change into a new pair of hospital scrubs!)  I am sure over the course of time there has been some burnt out nurse that has said something really nasty or insensitive to a mother if she has thrown up but in reality, it’s all part of the job and the vast majority of nurses and midwives don’t get bothered by vomit!

 

 

#2 Will the staff clean it up or will I or my husband have to?

This question is assuming two thing:  #1 That you are going to vomit (remember not all women vomit in labor) and #2 That if you do vomit that you will make a mess (remember not all women who vomit miss the bucket or don’t have a chance to throw up in a bucket).  That being said…

 

I know I can’t speak for every single nurse out there but I would NEVER EVER expect a husband (or any coach for that matter, including the mother herself) to clean up something like that.  After all it is the husband’s (or partner, coach) role to support the mother and if the mother did throw up, say, on the floor, I would ask the husband (partner, coach) to stay with the mother while I went to grab some towels to clean it up.  And then I would clean it up quickly.  And then it would be a non issue!  Done! 

 

One time I had a mother who was taken off guard by her need to vomit and accidentally threw up all over her bed.  She was very apologetic but apologies were not necessary.  I knew that she didn’t mean it!  With the help of her husband I walked her into the bathroom and had her sit down on the toilet to pee.  Her husband stayed in the bathroom with her.  Within 5 minutes I had the completely remade the bed with clean sheets.  Then I helped her into a fresh, new, warm gown and then back to bed.  It was like it never happened!  We all moved on and no one mentioned it again.  After all, who was thinking about a little vomit when there was a BABY about to be born! 

 

I learned from that experience and ever since then I always make sure that I give every mom a bath bucket when she is admitted and I put it right on her bedside table so that if she needs to throw up, it is right there for her.  Because I do this, I have rarely ever had a mother throw up in labor and not use the bucket.  Since you have a concern about vomiting, I would recommend that you ask your nurse for a bucket when you get to the hospital, just in case.  And when I say bucket I mean bath bucket (or wash basin), not those ridiculous kidney shaped “emesis basins” that wouldn’t even be helpful to catch ladybug vomit!

 

emesis basin and wash basin

 

Remember, although it is not rare for a mother to throw up in labor, it is rare that she throws up all over the place, or has no idea that it is coming.  In my experience the vast majority of moms who vomit in labor do indeed make it into the bucket and therefore, there is nothing to clean up!  Also remember that labor vomit is different that “stomach flu” vomit.  That is, there is no risk to me as the nurse of getting sick from a laboring woman’s vomit because it is not caused by illness.  I’d rather clean up your labor vomit over my own stomach flu vomit any day!

 

 

#3 What happens if it gets in my hair?

If you were my patient and you started to vomit I would hold your hair back.  And I am sure that your husband would do the same for you too.  That way you wouldn’t get any vomit in your hair at all.  Have you considered putting your hair into a pony tail or clip while you are in labor?  If your hair was up it would be very unlikely that it would get any vomit in it.  Perhaps you can pack a few extra clips or elastics into your hospital bag just in case you need them.  If you don’t usually wear your hair back you may want to consider wearing a few hair elastics around your wrist so that they are readily available if you need them to tie your hair back if you feel nauseous.  I also have been known to cut the opening off a rubber glove and use it as a make-shift hair tie for just this type of circumstance! 

 

However if a little bit of throw up did get in your hair and if I was your nurse I would probably wet a warm washcloth and clean it out.  And then I would put your hair into a pony tail or clip for you to get it out of your face.  If it was really bad (I have never seen this but I suppose that technically it could happen) and if your midwife allowed, I would help you into the shower.  After all, many women find laboring in the shower to be extremely soothing and helpful!

 

 

#4 Will I choke because I might be lying down?

NO!  You will not choke, even if you are lying down.  Only people that are unconscious, have an impaired gag reflex, or are debilitated in some other way have a risk of choking on their own vomit.  I have never seen a conscious laboring mother choke on her own vomit…NEVER.  Why?  Because every single healthy, able-bodied, conscious person sits up or leans over automatically when they start to vomit.  I have never even seen a mother who was positioned flat on her back and numb from the breasts down for a cesarean choke on her own vomit.  Why?  Because every single healthy, able-bodied, conscious mother in that situation automatically turns their head to the side to vomit. 

 

If necessary every hospital room and operating room has (or at least should have) a suction canister in it with a yankauer suction set just in case a mother does lose consciousness and her mouth needs to be suctioned.  You might not have seen it when you toured your hospital because most birthing suites keep that kind of equipment behind pictures or in cabinets so that the room doesn’t look too “hospital like.”  But they are there.  I personally have only had to use the yankauer suction set ONE TIME as a labor and delivery nurse and I used it because my patient had an eclamptic seizure (a rare complication of preeclampsia) and when she came too she was really out of it (“post-ictal”) and her mouth needed to be suctioned because it was full of secretions.  That’s it, one time only.   

 

 

#5 Will everything be okay if I do vomit?

YES!  In fact, labor and delivery nurses get excited when they see a patient vomit because vomiting is usually a sign of transition which is the last stage of active labor (usually 7-10 centimeters) right before a women begins the pushing phase.  Remember whether or not she has been eating throughout early labor, a woman may still vomit when she enters transition so it is not necessary to starve yourself on purpose because you are afraid to vomit later on.  In fact, some women vomit because they have done just that!  (I know I personally get very nauseous as well as get a headache if I haven’t eaten anything all day).  I always think of it as a way the body is “making more room” for the baby! 

 

Also since vomiting, like holding your breath or making a bowel movement, is a vagal response, it inadvertently helps your cervix dilate and hence, is a great sign to a labor & delivery nurse!  The body does awesome things to help the process along!  So really it is not just okay if you vomit, it is GREAT if you vomit because it may help you cervix dilate!  I also want you to know that you will not hurt anything if you vomit, including the baby or your cervix.

 

 

 

#6 Is it a different kind of vomiting – one that just kind of happens, rather than following hours of terrible nausea?

 

In my experience as a labor and delivery nurse most women who have a natural, unmedicated, spontaneous labor do NOT have hours and hours of nausea before they vomit.  Instead, once there labor really starts to ramp up for the last few centimeters they get a feeling of nausea that gives everyone enough warning to grab the bucket and then they throw up.  After throwing up, the vast majority of women have told me that they feel better.  It is very rare that I have taken care of a woman who continues to throw up once they are 10 centimeters dilated and begin to push or is nauseous for hours and hours before they vomit.  That being said…

 

Nausea and vomiting are very common side effects of narcotic pain medications (e.g. stadol, nubain, demerol, morphine etc.) as well as ALL forms of anesthesia (including labor epidurals as well as spinal blocks often performed for cesarean sections).  Because of this, some physicians and midwives prescribe an anti-emetic (aka anti-nausea medication) like Phenergan, Zofran, or Reglan to be administered with the narcotic, epidural, or spinal to counter act this side-effect.  Sometimes it helps, sometimes it doesn’t.  Because you have such a fear of vomiting I want you to be aware of this fact.  

 

 

So there you have it: the skinny on vomiting in labor!  I hope this has helped calm your fears and worries however if you have any more questions about this topic please feel free to leave a comment!! 

 

Thank you for writing in to me.  You are certainly not alone in your fears!!!  I know that your question will help other women out there who experience the same fears as you!  GOOD LUCK with your upcoming birth and CONGRATULATIONS to you!!!  And remember, although birth might be one of the messiest experiences of your life, no amount of fluids, cursing, farting, pooping, striping naked, howling, crying, peeing, bleeding, or vomiting will take away from how honestly empowering, mind blowing, and touching this experience can be for you and your family!!

 

 

Sincerely,

 

NursingBirth

 

Why Educating Our Patients is a Professional Responsibility and NOT About Guilt October 11, 2009

Filed under: Ramblings — NursingBirth @ 12:43 AM
Tags: , , , ,

Yesterday I wrote a very long response to a comment left on my blog regarding a post I wrote entitled New Study Hypothesizes Bottle-Feeding Simulates Child Loss Increasing a Mother’s Risk for PP Depression

 

I woke up this morning and read all of the comments left on that blog post.  I wanted to take this opportunity to thank everyone who wrote in with support and encouragement!   You all keep me blogging.  Although I have many issues with a couple of responses, overall they were positive and well written.  Thank you! 

 

I have read FearlessFormulaFeeder’s response on my blog and on her own.  I truly don’t think I could write anything better to respond than this article emailed to me by one of my readers:

 

<tongue in cheek> Confessions of a proud breastfeeding zealot </tongue in cheek> by Katie Allison Granju

 

I make a conscious effort every day as both a nurse, an activist, an everyday woman, and a blogger to never use guilt based techniques to support any certain “way” when it comes to choices in labor, childbirth, and breastfeeding.  That does not mean that some choices do not carry more risks than others.  Not all choices are equal in their efficacy or safety.  This is a fact.  I also know some people do use guilt, either intentionally or subconsciously, to influence their peers or patients; Even nurses, doctors and lactation specialists are sometimes at fault for this!  And it’s not just breastfeeding supporters that sometimes use guilt; both sides are guilty of using GUILT to further their cause.  However I am NOT one of those people and I feel that my past posts on controversial topics speak for themselves.  I certainly have a strong opinion but I never (until FearlessFormulaFeeder came along)  have been accused of making other mothers feel “bad” after providing sound, well researched, evidenced based information to my readers.

 

I promise you that I will continue to educate myself regularly on the newest research and practice evidenced-based nursing.  Furthermore I will continue to ask my patients appropriate questions at appropriate times in order to assess their knowledge base, background, and learning needs with the aim of providing them with age appropriate, culturally competent information and care to assure that any decision that they make is an informed one.   In fact, it is my professional responsibility to do so. 

 

As a nurse I am so much more than an executor of orders.  I am an advocate, a caregiver, a leader, a listener, a teacher.  Since I do not personally subscribe to the philosophy that women should be guilted or bullied into making certain decisions I will not take responsibility for any other person who does choose to act in that manner.  I am only responsible for my own actions.  Likewise, if providing evidenced-based information, including the risks and benefits of a particular choice in a sensitive way at some point causes a person to feel guilty about one thing or another, it will not stop me from providing that information.  This includes reporting and commenting on the latest research. 

 

In my own practice as a nurse I often ask people the question, “Do you feel that you have received enough information on the risks and benefits of ______ to make an informed decision?”  (I have to ask about things like plans for pain medication/epidural, plans for VBAC/repeat cesarean, plans for breast/bottle feeding during my admission or triage interviews).  If a patient answers “YES“, I then ask, “Do you have any questions for me or your doctor/midwife?”  If a patient answers “NO” I ask more questions to find out what they still have questions about.  I have found this line of questioning to be the most efficacious when talking to many mothers/couples since the feedback I have received is that it is a non-threatening/non-judgemental way to open the dialogue between patient and nurse.  And boy have I stumbled upon some moms that have been given some misinformation! 

 

Here’s an example of an actual conversation I had with a patient once.  This mom was a 21 year old single white female with a long-term boyfriend.  She worked as a nurse’s aide, her boyfriend as a UPS carrier.  They had family in the area but lived together in an apartment in the city.  She was pregnant with her first baby and was being admitted for an induction for post-dates:

 

Me:  “Are you planning on breast or bottle feeding?”  [**see addendum below**]

 

Mom: “Bottle.”

 

Me: Do you feel that you have received enough information on the risks and benefits of bottle feeding to make an informed decision?”  [**see comments section**]

 

Mom: Well yeah, because I have to go back to work after 6 weeks so I can’t breastfeed.

 

Me:  “Many mothers feel overwhelmed about the fact that they have to go back to work very soon after having their baby.  However, some mothers don’t realize that any length of time that they breastfeed their baby is absolutely wonderful and even breastfeeding for the 6 weeks that you are home from work can provide you and your baby with many benefits.  Especially since the first milk you make, called colostrum, is filled with so many great antibodies that help your new little one stay healthy and grow during those very important first few weeks. 

 

Mom:  “I didn’t realize that you could breastfeed for only 6 weeks!  I thought if you were going to breastfeed you had to breastfeed for like a year!”

 

Me:  Some moms start breastfeeding without a set goal of how long they are going to breastfeed and just take it one day at a time.  Some mothers will stop breastfeeding before they reach 6 weeks.  Others will breastfeed up until they have to go back to work.  And others are lucky enough to work something out before they have to go back to work so that they continue to breastfeed even after they return to work.  The great news is that no matter how long or short of a time you breastfeed for, your baby will benefit from having your milk to help him grow and stay healthy!!  If I brought you some information in about breastfeeding would you be interested in learning more about it?

 

Mom:  Yeah!  That would be great!  Thanks!!

 

I had the priviledge of being a part of this mom’s birth and was honored to assist her in getting her son to latch on for the first time.  She breastfed her son throughout her hospital stay and did leave the hospital without supplementing with any formula.  Unfortunately I do not know what happened to her once she got home.  She could have had troubles and switched to formula, she could have successfully breastfed for her six weeks, or she could still be breastfeeding her 8 month old!  (This is one bummer about being an L&D nurse with no ability to follow up on patients.)  But I do feel that she learned quite a bit from our conversation during her admission interview and from the information I provided to her that she read during her induction and I am proud that I was part of the reason she decided to give breastfeeding a try. 

 

**Addendum**  After a great comment left by Lonely Midwife on 10/11/09 I have decided to make a change in my practice.  Instead of asking “Are you planning to breast or bottle feed?” she has suggested I ask “How are you planning to feed your baby?” as it is a more open-ended question with less chance of being perceived as judgemental.  I really like that and have decided to adopt that question into my practice.  This is also much more like the question I already ask about pain management in labor since during my admission interview with patients I ask “Tell me about your plans for pain management during labor” instead of the more common question “Are you planning on having an epidural or using IV pain medication for your labor?”  Thank you to Lonely Midwife for opening my eyes to some hidden judgement in my admission interview. 

 

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My point is that the “mommy wars” are out there.  I certainly am not looking forward to them when I one day become a mother and often speak out against them.  But I personally have made a conscious decision as a nurse to not use guilt based techniques to influence or educate my patients.  I use facts and regardless of my own personal beliefs, I provide both the risks and benefits of any choice or option when counseling patients.  And because I do that I do not and will not take any responsibility for another person’s guilt even thought it is true that I feel badly that a person might feel that guilt.  After all, guilt is a cognitive or an emotional experience that occurs when a person realizes or believes – whether justified or not – that he or she has violated a moral standard, and is personally responsible for that violation. 

 

Fellow blogger Stork Stories has shared with me some very important wisdom that she has learned over her very impressive career as a labor & delivery nurse and lactation consultant fro 35 years.  I would like to share her wisdom with you all.  THIS (NOT guilt based persuasion) is MY philosophy on breastfeeding education.  I couldn’t have said it better myself and I thank Stork Stories for sharing!

 

* It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.

* The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.

* The education process to a mother needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.

* With that in mind, try to provide her with the information she needs to make her decision.

* Never overestimate a mother’s desire to breastfeed her infant.

* Never underestimate a mother’s desire to breastfeed her infant.

* Listen to the mother; help her define her true desires and goals.

* Many times, the first question she asks may not be what she really wants to ask.

* The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.

* Support the mother, support the mother, and support the mother.

 

 

I’ve said my peace.

 

~NursingBirth

 

The conversation continues over at Stork Stories with her post:  **ROAR** on Breastfeeding Guilt 

Please check it out!!

 

Why It’s Not Irresponsible to Research the Hazards of Formula Feeding October 9, 2009

Filed under: Ramblings — NursingBirth @ 1:48 PM
Tags: , ,

 

Submitted on 2009/10/05 at 11:23pm

In response to: New Study Hypothesizes Bottle-Feeding Simulates Child Loss Increasing a Mother’s Risk for PP Depression

 

 

Dear NursingBirth,

 

As so often happens with interpretation of breastfeeding studies, you are ignoring the fact that this study was observational. Yes, certain factors were controlled for; however, since it wasn’t a case where they took 100 women with postpartum depression (PPD) and forced half to breastfeed and half to formula feed, you have to look at the results with some perspective. One could easily take the opposite interpretation and say that the guilt inflicted on formula feeding women in our society (and by studies like these) can exacerbate PPD. It certainly did for me, and for many women I have interviewed for a book I am working on.

 

I am certainly not anti-breastfeeding; I think it is a wonderful thing. But there are cases where formula feeding is the best – or only – choice, and implying that formula feeding can cause PPD is just plain irresponsible, in my opinion. The LAST thing women struggling with PPD need is pressure to do anything. If they want to breastfeed, then great; however, it is often far more useful to get on antidepressant medications, which are not universally recommended for lactating women. There have been studies saying that the long-term effects on babies who’ve been exposed to antidepressants in breast milk are negligible, but as my own pediatrician said, “none have proven this without a doubt.”  If nursing is going to keep a woman from taking needed medication, then I do not think it is a healthy thing for baby or mother.

 

Just another opinion….

 

~Suzanne

fearlessformulafeeder.blogspot.com

 

 

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Dear Suzanne,

 

Thank you for commenting.  I appreciate all comments left on my blog, both assenting and dissenting, as long as they are not ad hominem attacks.  I also see that you are a new blogger and would like to welcome you to the world of blogging!  If you are anything like me, you will both love it and hate it!  I don’t know how long you have been following my blog but I invite you to take a look at one of my past blog entries entitled My Philosophy: Birth, Breastfeeding, and Advocacy.  Here is an excerpt:

 

“I believe that pregnancy, birth, and the postpartum period are milestone events in the continuum of life that profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.

 

 I believe that breastfeeding provides the optimum nourishment for newborns and infants which does NOT mean that I am not grateful for the advancements in artificial milk for those mothers and infants who truly require it.”

 

 

Now that you know a little more about me, I’d like to respond to your comment.  I will number the points for ease in reading:

 

#1  You write, “As so often happens with interpretation of breastfeeding studies, you are ignoring the fact that this study was observational.”  I fail to see how I am ignoring the fact that this study was observational.  For one, I posted a direct link to the original study in which the authors discuss the method of their study.  The authors write:

 

“We recently completed a study of over 50 mothers recruited through local pediatric offices at 4–6 weeks postpartum.  Consistent with previous reports, we found that those who [formula] fed their babies scored significantly higher on the Edinburgh Postnatal Depression Scale than those engaged in breastfeeding. The increased risk of depression among mothers who relied on [formula] feeding held true even after we controlled for such things as age, education, income, and the mother’s relationship with her current partner.”

 

No where in there do they claim that the study is a randomized controlled trial, often regarded as the gold standard for research as it is considered to obtain the highest level of evidence.  However not all research questions can ETHICALLY be answered with a randomized controlled trial.  You wrote:

 

“Yes, certain factors were controlled for; however, since it wasn’t a case where they took 100 women with postpartum depression (PPD) and forced half to breastfeed and half to formula feed, you have to look at the results with some perspective.”

 

 

The fact of the matter is Suzanne that that type of study is completely unethical in this situation and therefore completely implausible and therefore it is unfair to suggest that this is a flaw in the author’s study.  It is certainly a limitation but not a flaw.  This is a problem that is realized the by research community, that is, that you can’t always randomly assign patients/subjects/participants to a certain cohort because you, for example, cannot force someone to breastfeed or someone else to bottle feed.  Or force some to have a vaginal delivery and someone else a cesarean section.  Or force someone to have a hospital birth and someone else a home birth  Or force someone to smoke cigarettes and someone else not to smoke cigarettes.  For this reason observational studies may address these problems to some degree and might therefore be the best way to answer research questions that cannot ethically be answered with a randomized controlled trial.  The bottom line:  It is careless of you to dismiss the implications of this study just because it is not a randomly controlled trial. 

 

I also wrote about how this study was observational in nature in my post:

 

“The paper’s authors (who work in the Department of Psychology at the University of Albany/ State University of New York, Albany) recently completed a study of over 50 mothers recruited through local pediatric offices at their 4-6 weeks postpartum visit and evaluated them using the Edinburgh Postnatal Depression scale.”

 

Seems like transparent writing to me!  I fail to see how I was “ignoring” anything.

 

[Side note: I am truly interested in learning more about your educational and professional background as I feel that you may lack experience in reading healthcare research if simply for the fact that you continue to misuse words like “cause.”  Being that this study is a Level II observational study without randomization the authors by definition and design cannot (and DO NOT) claim or imply that formula feeding CAUSES anything!  They can only imply that formula feeding might be a risk factor for PPD, which is exactly what they do.  Being a “risk factor” for something and “causing” something are not one in the same.  For example Human Immunodeficiency Virus (HIV) causes AIDS.  Having unprotected sex with multiple partners and sharing dirty needles are both risk factors for acquiring HIV and hence developing AIDS.  Having unprotected sex with multiple partners and sharing dirty needles do not cause AIDS.  See the difference?

 

Proving true causation is very very difficult (and for some questions, theoretically impossible) and requires multiple studies at different levels of evidence that can be duplicated with different populations by different researchers at different times.  One book that I found helpful to learn more about research was Nursing Research: Methods, Critical Appraisal, and Utilization by Geri LoBiondo-Wood and Judith Haber.  I had to read it for a class I took in nursing school.  Even if you are not a nurse I still think it can be a great learning tool for you, or anyone, who is interested.]

 

 

#2 You write:

 

“You have to look at the results with some perspective. One could easily take the opposite interpretation and say that the guilt inflicted on formula feeding women in our society (and by studies like these) can exacerbate PPD.”

 

First off, I do not deny that feelings of guilt regarding a variety of things can exacerbate PPD.  Secondly I do believe that the authors are interpreting the results of their study with “perspective.”  In fact their conclusion at the end of the article is written as follows:

 

“Bottle feeding practices and hospital procedures that simulate child loss may increase the risk of postpartum depression and fall within a growing number of medical issues that could benefit from an evolutionary perspective.”  [Emphasis mine]

 

In addition, in my blog post on the study my conclusions are as follows:

 

            “This is a fascinating article to me for a variety of reasons.  First off, it is written by psychologists, not health care professionals and hence, takes a look at this very important topic from a completely different perspective.  Second, it is a study/analysis that focuses “not on the advantages of breastfeeding per se, but rather on the negative psychological consequences of the decision not to breastfeed.”  Thirdly, for mothers who cannot breastfeed (as related to the health of the baby or mother for example) or choose not to breastfeed, this article shows us how important it is as health care professionals to assess these mothers thoroughly for signs and symptoms of postpartum depression as well as to educate these mothers and their loved ones about their potentially increased risk for postpartum depression so that they can obtain help and/or counseling if their “baby blues” turn into something more serious.

 

Sounds like a whole lot of “perspective” to me!!  NO WHERE in either the study or my blog post did the authors or I ever make any claim that the results of this study are completely definitive or that formula feeding your child will most definitely cause you to suffer from postpartum depression.  In fact the perspective the authors are taking is an evolutionary one.  As any good study does this one raises more questions than it provides answers to and it opens the door to thinking about breastfeeding from the perspective of evolutionary medicine, or human history.

 

To deny the existence of the complex cocktail of hormones involved in labor, birth, and breastfeeding as well as their importance is something that mainstream medicine has been doing for decades.  This study does not make judgment calls on women who either cannot or choose not to breastfeed and neither do I.  But it is foolish to not at least take into consideration that we, as human beings, are indeed MAMMALS and by design are intended to nurse our young and if we do not or cannot, that we and our offspring as mammals might suffer some consequences.

 

Second, as far as your “One could easily take the opposite interpretation and say that the guilt inflicted on formula feeding women in our society (and by studies like these) can exacerbate PPD” comment, you are incorrect.  In theory someone might be able to make the opposite interpretation but YOU cannot make such an interpretation (and neither can I) since YOU (nor I) have access to the study’s data and the authors did not elaborate on what else besides age, education, income, and the mother’s relationship with her current partner they controlled for.  They could have controlled for other emotions the mothers were feeling…no one but the authors know… and perhaps not controlling for “guilt” is another limitation of their study.  But neither YOU (nor I) can take such a leap without access to a more thorough description of the method (which was not provided by the authors) or the raw data itself.  If you feel there might be another explanation other than the author’s explanation for the results, it would take another study to test your hypothesis.  You cannot derive a conclusion from a study about a hypothesis that you didn’t test for.  That’s research 101.

 

Thirdly, you comment that “studies like these” will exacerbate a formula feeding mother’s PPD reveals your lack of respect for research in general.  The studies on depression that have been carried out over many decades have led to a better understanding about the disease and better care for people who suffer from the disease.  Don’t mothers who suffer from PPD deserve the same? 

 

 

#3  You write,

 

“I am certainly not anti-breastfeeding; I think it is a wonderful thing. But there are cases where formula feeding is the best – or only – choice, and implying that formula feeding can cause PPD is just plain irresponsible, in my opinion.”

 

I ask you Suzanne, why are you so afraid of the possible evolutionary and biological connection between the early cessation of lactation and neonatal loss?  The authors of the study write,

“The present paper focuses on the decision people make to unwittingly depart from one of the defining features of mammalian evolution: to [formula] feed rather than breastfeed their infants. For 99.9% of human evolutionary history the decision not to breastfeed would have been tantamount to committing infanticide. The technology that lead to [formula] feeding as a substitute for the breast (e.g., bottles, rubber nipples, formula) has only become available within the last 100 years.

 

Opting not to breastfeed precludes and/or brings all of the processes involved in lactation to a halt. For most of human evolution the absence or early cessation of breastfeeding would have been occasioned by the miscarriage, loss, or death of a child. We contend, therefore, that at the level of her basic biology a mother’s decision to [formula] feed unknowingly simulates child loss. The death of a child is a well documented trigger for profound parental grief and depression, and evidence shows that mothers tend to be more affected than fathers. Suarez and Gallup theorize that depression as a response to the death of a child may be an adaptive mechanism that functions to (1) punish instances of inappropriate parenting or neglect, and (2) trigger social and psychological support from close friends and relatives during the particularly difficult period following the loss of an infant. Because [formula] feeding simulates child loss at a physiological level it may also play an important role in postpartum depression.”  [Emphasis mine]

 

I ask you Suzanne, what do you find so objectionable about those paragraphs?  What do you find so objectionable about my own conclusions?  What do you find so objectionable about the possibility that formula feeding (and not using your breasts for breastfeeding) could be a risk factor for developing PPD simply for the fact that there are levels of HORMONES involved in breastfeeding that are not being released when you formula feed!!!  For goodness sake it’s BIOLOGY! 

 

Biology Fact #1: When an infant suckles at the breast as during breastfeeding, the pituitary gland releases both prolactin and oxytocin in the mother. 

 

Biology Fact #2: Prolactin is a hormone also known as the “motherhood hormone” that stimulates development of the breast during pregnancy, controls the production of milk, is responsible for nest building in animals, and triggers aggressively defensive behavior in lactating females.

 

Biology Fact #3: Oxytocin is a lactogenic hormone also known as the “hormone of love,” is released during suckling, labor, birth, sexual intercourse, and while sharing a meal with others and is responsible for uterine contractions, male and female orgasm, the ejection of milk from the milk producing sacks in the breast, and feelings of calmness and bonding during childbirth and breastfeeding.

 

Biology Fact #4: If a mother does not breastfeed, prolactin levels usually reach non-pregnant levels by 7 days postpartum.  Mothers who exclusively breastfeed have higher oxytocin levels over time than do women who supplement with formula or exclusively formula feed.  When a mother supplements with formula or exclusively formula feeds her infant, prolactin levels decline markedly and fall even further over time, and oxytocin levels remain depressed and do not climb. 

 

Biology Bottom Line:  Mothers who exclusively breastfeed experience levels of hormones that mothers who supplement with formula or exclusively formula feed do not.

 

(References: Breastfeeding and Human Lactation by Jan Riordan & Birth and Breastfeeding by Michel Odent)

 

What is so objectionable about taking a further look into these hormones and their potential link to PPD?!  What is so objectionable about educating gestating and new mothers about the benefits of breastfeeding the potential hazards of formula feeding so that they can make a truly INFORMED decision about whether to breast or bottle feed?  And if in the end these mothers choose to bottle feed, as health care providers, what is wrong with being more aware of the potential increased risk these mothers have to developing PPD, just as we would be more aware of the increased risk of developing PPD with mothers who have experienced a loss or with mothers who have a history of depression.  It’s called being a RESPONSIBLE HEALTH CARE PROVIDER and therefore I reject your claim that this study and by default my blog post are irresponsible!

 

#4    As far as your statements about the use of antidepressant medications during lactation, I believe that just as with the use of antidepressant medications during pregnancy, every mother should be counseled by her health care provider on a case-by-case basis where the risks are weighed against the benefits for both the mother and fetus/baby.  I personally am not an expert in the use of antidepressant medications in pregnancy or lactation but I understand that there is an important debate regarding this issue that I have to learn more about. 

 

In conclusion I am excited about all of the breastfeeding research that is out there, both past, present and future!  And as far as your position as a “fearless formula feeder,” one point that I agree with you on is that mothers (and fathers) have to STOP the guilt trips and senseless competition.  But unlike some other choices, I feel like the “to breastfeed or formula feed as a choice” question is not one that should be taken lightly (and I am not talking about the mothers or babies that cannot breastfeed for other reasons besides choice). 

 

The more research that is done on breastfeeding the more we are learning that breastfeeding should no longer be considered “just nice” or “better” or “best” and formula feeding should no longer be considered “good enough”.  The “choice” to breastfed should not be on par with the decision on what new car to buy [“Well the Lexus minivan is better but the Chrysler minivan is good enough].  Breastfeeding is NORMAL and more and more research is showing that formula feeding puts your baby AT RISK.  If the benefits outweigh the risks when it comes to formula feeding for you or your baby then so be it.  If not, but you still choose to formula feed, my only concern as a healthcare provider is that your choice is based on INFORED CONSENT and NOT misinformation, pressure from family or friends, untruths, or lack of support or resources.  There are too may women out there who want to breastfeed but lack the support from family, friends, nurses and even doctors as well as lack the resources, and/or knowledge to do so.  I am sorry but the cause of those women needs more attention which does not mean that I condone the “guilting” or judging of women who choose not to (and certainly not towards women or babies that cannot) breastfeed.  

 

I dream of a world where ALL mothers who are willing and able to breastfeed get the support and encouragement and resources they need to do so!  And I work everyday to make my dream a reality.

 

Sincerely,

NursingBirth

 

 

P.S.  I encourage you to read a couple of my past blog posts:

            My (Aggravated) Response to “Ban the Breast Pump”  and Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding)

 

No Doula in the Name of Privacy? Oh Come On! September 26, 2009

This comment was recently left by a reader named Jessica under one of my older posts.  Since I read every comment that is posted on my blog I happened to stumble upon it this morning.  When I read it I couldn’t help but think “I Hear Ya Sister!!!”and felt that it was so well stated that it needed to be its own post!  I know that there are quite a few doulas out there that read my blog and I just wanted to take this opportunity and give a shout out to them all and say thank you for all you try to do to educate women before they get to me on L&D!  Unfortunately, they don’t all listen but I hope you know that there is at least one L&D nurse out there that appreciates your efforts, both before and during labor!!!

 

For all you expecting moms out there please check out DONA’s website to learn a bit more about what a doula is, how you can find one, the effects a doula can have on your birth outcome and experience, and how a doula can advocate for you!

 

And just for the record, there is NOTHING private about a hospital birth experience.  Even in the most well meaning hospitals with the most well meaning birth attendant and the most well meaning nurse(s).  Albeit some women’s hospital births might be more private than others and I personally have had the priviledge to be a part of a few totally amazing hospital births.  But to not hire a doula for your hospital birth (especially at a university hospital!) because you want a “private” experience is a very VERY naive and misguided idea!  I am not saying that to hurt anyone’s feelings and I am certainly not judging anyone out there who decided not to hire a doula for one reason or another.  I am just telling it like it is.  Some food for thought…

 

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Hi NursingBirth!

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 health care provider 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 their ability to get what they want from this birth. After much “deliberation” they decided that they were not going to hire a doula, based solely on their confidence in the hospital to give them what they want, and their desire for privacy. While I can completely 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 health care provider 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 (because I know there are others who struggle with this) and depressing(because we have to struggle 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.

  

Sincerely,

Jessica

  

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Jessica, you can rant here anytime!!!  I Hear Ya Sister!  Loud and clear!!

 

And now I leave you with one of my FAVORITE Monty Python skits of all time.  I have seen it a million times but it is still as hilarious (and eerily true) each time I see it.  Notice how the doctor invites in an army of people to watch.  It often feels like that where I work no matter what I do!!!