Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Contact June 22, 2009

Dear Readers,

A few of my readers have encouraged me to start some sort of an “Ask Nursing Birth” section of the blog.  First off I would like to say that I am FLATTERED beyond belief that some of you amazing ladies would even want me to have a section like that!  Believe me, with the amount of comments I have been getting in the last few months (sometimes up to 20 a day!  Good gracious!) I have considered it.  But there are a few things in play here:

1)  Since I am not a nurse midwife or physician, nor have I ever claimed to be, I do not feel that it is appropriate to have an “ask the expert” type section on this blog.  As a labor & delivery nurse and self-proclaimed “birth junkie”, I feel that this blog’s main mission is to empower women to educate themselves on their birth choices!

2)  I prefer women to post their questions as “comments” in my blog.  Why?  Because I really enjoy when other readers help each other out!  The comment sections of this blog have blossomed into quite an awesome learning community over the last few months and readers of my blog include mothers, grandmothers, expecting moms, women who are thinking about becoming pregnant in the future, doulas, nurse midwives, professional midwives, nursing students, doctors, fellow L&D nurses, neonatal nurses, postpartum nurses, lactation consultants & educators, and fellow self-proclaimed “birth junkies”!  And since this blog has such an amazing group of readers I wouldn’t want to stiffle that by creating an “Ask Nursing Birth” section since I learn just as much from you all as you learn from me!!

3)  If I had a question-answer section I feel like I would spend way more time on the computer than I already do, which is too much!    Haha!  I wish this blog could be my main responsiblity in life but alas, it cannot!  I would hate to have people posting questions and me not be able to get to them for days or weeks at a time.

As a compromise I have decided to set up an email account specifically for this blog.  Therefore if you have a question or comment that is too long or involved to post as a comment on a blog post or if you have a question or situation that is off topic from any recent posts, please feel free to email me and I will try to answer your email as best as I can as soon as I can.  My email address is nursingbirth@gmail.com

PLEASE NOTE:  I reserve the right to post all or part of any email sent to me on my blog.  I pledge to change any identifying information in your email if I choose to post it on my blog.  Please, consider that you are sending me something like a “Dear Abby” if you decide to email me as opposed to a private discussion between us.  I am, after all, the author or a public blog and I am not a private clinician and therefore I should not be viewed as someone that you are receiving a professional consult from.  I cannot stress that enough!!

Thank you all again for being such an amazing group of people!!  After all, any friend of birth, is a friend of mine 🙂

All My Best,
NursingBirth

nursingbirth@gmail.com

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25 Responses to “Contact”

  1. Maria Says:

    Wanted to let you know about my Natural Childbirth movie: It’s My Body, My Baby, My Birth (www.itsmybodymybabymybirth.com) and my blog at wisewomanchildbirth.blogspot.com called Women In Charge. Would love for you to put it on your blogroll if you feel that it is worthy. Thanks, Maria

    • nursingbirth Says:

      Maria,….I was looking over your website and I was thinking to myself, “These parents seem familiar…” and then I realized that I have seen your movie at a local BirthNetwork meeting!! I loved it!! I will definitely put in on my blog roll! Thanks for commenting!

  2. Serene Says:

    Hi there.

    I am due to deliver my baby#2 by around 4th August and am very troubled with this issue about cord clamping.

    I am very interested in donating my baby’s cord blood but was informed by my gynae that delaying cord clamping and cutting would mean an unsuccessful cord blood extraction, meaning the amount would be too little to qualify for donation and would be discarded.

    I would really like to help yet the benefits of delaying the cord clamping is very appealing to me and husband. Son#1’s cord was clamped and cut pretty soon (I wasn’t sure and never stated in my birth plan to delay and they never asked), So I am quite certain they cut it soon(my guess is before it stopped pulsating). He was on total breastfeed 1st day on. He had jaundice which worsened a little over a week and we were advised to treat him with phototherapy, totally traumatic for us, we didn’t think the situation was that bad, but because of the “for the sake of the baby’s health” mentality the health care providers then were hammering into our conscience, we gave in and paid a huge sum to rent this equipment that didn’t help much cos our baby was too tall for it, and too active I must say, kept kicking the shield for protecting his eyes away. AND he kept hitting his head at the top of the equipment so it was just hazardous and heart-wrenching to see him so uncomfortable and he lost so much sleep because of it. So did we of course.

    Also I had wanted always to donate baby’s cord blood since last pregnancy but never knew anything about donation for public blood bank only private banking purposes and so I felt it was a great opportunity when I was approached by a public cord blood bank staff if i was interested to donate. I wanted so much to help. There was a gynae at that hospital who strongly advocates cord blood donations and told the staff there was no difference in delaying and clamping the cord immediately. So she always advises her patients to donate. I am just in such a dilema.. I have this chance to help yet I would love to provide my baby with optimum health benefits from birth on. By the way I am planning a waterbirth, and my doctor is ok with the extraction of the cord blood while i’m still in tub so no issues there. He just feels that it is not really such a huge deal, not a priority to him, unless it were for my private banking purpose he would definitely respect my wishes and make a hell out of a good job to ensure a proper amount was extracted. OHHH what should I do… Please advise!

    Regards,
    Serene

    • NursingBirth Says:

      Serene, thank you for reading. I can imagine how difficult this decision must be for you. On the one hand, you desire to help other children and the donation of your baby’s cord blood could be used in research. On the other hand, you want to provide your baby with the best. I wish I could make things easier for you by giving you an answer but that is neither ethical nor the purpose of this blog 😦 Your gyno was right in the fact that generally delayed cord clamping does not allow for adequate cord blood extraction for donation. I think the research I provided in my post was adequate to dispel the myth that your OB believes which is “there is no difference in delaying and clamping the cord immediately,” however, I can understand how frustrating it must be to hear two completely different sides of the story telling you that they are right. In the end, you and your partner are the ultimate decision makers. I wish you the best of luck!!

  3. Renee Says:

    I found this blog by accident, as I’m not a blog reader or a blogger. I will say, I am soooo glad that I did. Although I have only read 1 1/2 posts so far, I wish that we worked together!

    I am an OB RN, childbirth educator, NRP Instructer and child passenger safety technician and am starting graduate school this spring for my CNM.

    In this journey, I have come to a point where although I L-O-V-E what I do, I’m becoming more and more disgusted with the way things are going, and where they seem to be heading. I wonder if I can change anything, make any difference.

    I will figure out how to subscribe or whatever I have to do to read each posting, and I’m sure I will have a great time doing it! Thank you.

    • NursingBirth Says:

      Renee, we must be soul sisters!!! I am SO HAPPY that an L&D nurse with your experience is going to CNM school!! YES!! I wish we worked together too! I know how hard it is to feel all alone in your philosophy! I am looking forward to your future comments as I know you have a wealth of knowledge to share with all of us!

  4. LIsa GArtin Says:

    I have found a sister in the East!!! I hail from Fresno Ca. As an RN I practice in Pediatrics, though all else I do is babies and Birth. I recently tried doing some “registry work”, was sent to one of the “baby machine” hospitals in our out lying area to work in post partum. It was a horrible experience, I will not go back, I have contacted JCAHO, and spent the next day in the fetal position due to the in humane care I saw. Mommies and babies deserve far better. I know 3 coupletts got good care that day, but I also know I can not do this anymore, how sad….. Bless you for staying strong, standing your ground, and staying sane. I have been out of inpatient too long to go back now. Hugs, Lisa. RN CLEC LCCE CD(DONA) and…. MOM!

  5. Joy Says:

    Hi Melissa,
    Let me start off by saying how wonderful a job I think you are doing with this website. You are definitely helping us women get our voice back and what an empowering feeling it is. I am a doctor, a doctor who truly believes that unless a woman has a REAL medical condition, birth can efficiently be handled by a midwife, doula and with as little intervention as possible.

    I am carrying my first child now (11 wks), and do not even want a doctor around me during my delivery. I am writing a plan that will keep my delivery as intervention free as possible with just a doula and a midwife.

    I am writing just to encourage you and emphasize to your readers that not all doctors are death mongers. Some of us desire to give our patients as much autonomy and power over their bodies as possible but it is also very important that patients speak up and be their own advocates.

    I am an avid fan of yours…. more grease to your elbow.

    Thanks!

    PS… What would you advise for people like me who live in a state without birth centers. Do you think we can get the same “close to home as possible” treatment and feeling in a hospital?

    • NursingBirth Says:

      Joy, I really appreciate your encouragement!! I am so glad to hear from you, especially as a physician. It gives me hope!!! I work with a handful of great OBGYNs, however unfortunately where I work, the bad ones outweigh the good ones (by far!) 😦 CONGRATS on your pregnancy!!! I am so excited for you!! To address your question, in my personal opinion it is not as easy to get a “close to home as possible” treatment and feeling as it is to get that in birth center and certainly not the same as home. Can it be done? To an extent yes, if all the factors work out right. You need a supportive birth attendant, supportive nurse(s), supportive hospital policies, and a “very well prepared, strong willed, not afraid to ask/fight for what you want/need” mother and labor coach(es). Unfortunately for the vast majority of mothers in this country, they are missing one or more key factors and end up with a cascade of interventions. But if all the cards play out right, it can really be special! (Check out my post entitled “I Needed to Know My Body Could Do It!”: A VBAC Story to see how when everything falls into place just right, hospital births can be empowering and special. https://nursingbirth.wordpress.com/2009/03/26/%e2%80%9ci-needed-to-know-my-body-could-do-it%e2%80%9d-a-vbac-story/ )

  6. Tonia Says:

    wow! I am and RN and L&D nurse who went into it after being inspired and empowered by my homebirth. My first day in L&D was culture shock, everyone on thier back and in stirrups!! I have since decided the best way to continue is to educate, educate, educate myself. I’m going to train as a doula, lactation consultant and childbirth educator. What i am wondering is if thier is a group of L&D nurses focused on the mother-friendly childbirth initiative. I am part of a birth-network here but am one of maybe 2 nurses. I appreciate your site, i wish i were more computor savy. Thanks and keep that mouth a flappin, Tonia Squires (NW arkansas) i also wonder if you have any tips on educating my peers without the rolling of the eyes!

    • NursingBirth Says:

      Tonia, that is something I struggle with everyday! Stay tuned for a great opportunity for MF nurses that I will be posting about soon!

      • Alethea Says:

        Looking forward to this post!!!! I too struggle with challenging the current birth culture that treats birth as a medical condition, regarless of presence or absence of maternal/fetal risk factors.

        My suggestion Tonia is patience, perserverance and leading by example.

        An example: at my hospital we always have a back up nurse for the baby at delivery. In addition to their presence in the event that resusitation is required, they typically weigh, measure, apply baby bands and administer “eyes and thighs” before they leave. I am a huge proponent of immediate skin to skin and discuss the benefits of it with every laboring mom before the birth occurs. Most want to be with baby right away, right? So when the back up nurse comes in I brief her on mom’s wishes. As long as the baby doesn’t need resusitation I encourage postponing all the routine admission procedures, even if it means I will have to do them myself later.

        Another example is to promote intermittent monitoring whenever possible. When I see a beautiful tracing on the central display I ask the nurse caring for the patient what is going on with them. We have some new nurses who are comforted by keeping their patients on the monitor, and I make it a point to discuss with them why they feel their patient can’t come off the monitor at this point in time (if it looks to me like there is no reason to keep them on).

        It is so easy to become burned out when you are passionate about normal birth, but you work in a hosptial. Believe me, I know!!!! Understanding your intentions and giving your best to your patients is your gift to the birthing women. Never doubt that your actions make a difference for the women you work with. Keep plugging ahead. I promise you will turn heads and change minds if you promote physiologic birth with your patients.

        Be gentle when challenging the status quo. Try to understand why people believe the things they do, and give them research that supports what you believe. Dont expect to change minds over night, but if your co-workers truely care about maternal/child health, they will come around (I hope!).

        I would love to be a part of a community of LD nurses focused on mother-friendly childbirth. Strength in numbers and through supporting each other to change the culture from the inside out. Let me know if you find one!!! Or maybe we could start one if there isn’t already someting out there!!

        Alethea

  7. Hi Melissa,
    I am a nurse, childbirth educator and birth researcher. Thought you might be interested in two other websites: http://www.birthsource.com and http://www.thebirthfacts.com. My blog is http://www.childbirthtoday.blogspot.com.

    I will be adding your blog to my blog’s “top 10”

    Thanks!
    Connie

  8. Renee Says:

    I don’t know if you saw the incredibly biased today show segment on homebirths, but I wanted to send a link to get the signatures needed for the petition against the segment. We need reputable journalism.

    http://www.thepetitionsite.com/1/accurate-reporting-in-birth-options

    If you want to see the segment, here is the link to that!

    http://today.msnbc.msn.com/id/261848…95933#32795933

  9. Alethea Says:

    Hi Melissa,

    I am a fellow LD nurse, Birthing From Within mentor, and birth junkie! I was working with a mom yesterday in my role as BFW mentor, we were discussing her worries and fears about the upcoming labor, birth and postpartum period. She was beautifully centered and not outcome focused. I think she has prepared herself in a way that is empowering and will lead to a possitive experience regardless of if she gets her dream birth or not. Her one concern was with the IV. She is not thrilled about getting one. I asked her if she had spoken to her provider about this and she told me the physcian told her it was “non-nogotiable.” I always teach moms that if they are well informed about the risks and benefits, they are keepers of their own bodies and they can refuse anything… IV included. This got me thinking about a couple of beautiful hospital births I have attended recently where the mom did not have an IV. So the long winded lead up to the question at hand… Are you familiar with any research specifically about the safety of laboring with or without an IV? Through my own work with laboring women over the past 7 years I know it is not common for them not to have an IV in the hospital, but is it really “non-negotiable” and for that matter, is ANYTHING in health care “non-negotiable.” I also know what the risks are in not having one…
    1) Urgent or Emergenct cesarean birth (we need IV access),
    2) Mom wants and epidural.. we need IV access- but we can put it in at that point
    3) mom bleeds too much after delivery… do we REALLY need IV acccess? We can give all of the oxytocic drugs to stop hemmorhage IM or rectally. If we need to head to OR for a D&C, can’t we get one in at that time? They pop in emergency IV’s into unstable patients all the time in the ER and OR don’t they? Why can’t we?
    I happen to like the OB that this patient is using and think she gives very compassionate care to her patients. I have seen her make a homebirth transfer patient feel welcomed and respected. But after hearing that she told one of her clients that something in “non-negotiable” I have lost quite a bit of respect for her. It proves to me that the patriarchal system of modern maternity care is alive and well even in female providers.

    • NursingBirth Says:

      Hi Alethea, so nice to hear from you! LOVE that you are a BFW instructor! I LOVE that book!!!! Okay so about your client. I can understand why she is not thrilled about getting an IV. And I do not see why any low risk mother (and baby) planning a vaginal delivery who does not require induction or augmentation of labor or any IV medications during labor would need to have an IV. Both informed consent and informed refusal are patient’s RIGHTS! It really pisses me off that her labor attendant said that an IV is “non-negotiable” although I am not surprised because it is “non-negotiable” with quite a few OBs I work with. They will literally bully a mother into getting an IV. As far as the research on IVs in labor, please check out the book “The Thinking Woman’s Guide to a Better Birth” by Henci Goer. Chapter 4 is “IVs: Water, Water Everywhere, Nor Any Drop to Drink” and page 329-330 lists all the research articles regarding routine IVs in labor. As far as your risks of not having one (very complete list by the way) I’ll discuss some talking points for your client if she wants to talk to her birth attendant:

      #1) If your client’s birth attendant was so hell bent on treating her as a “potential cesarean section” instead of a mother planning a vaginal delivery (WAY too many people have this mindset…you know…the “every woman is a ticking time bomb” mentality) then would your client/ her attendant compromise on a saline lock? That way the BA has “emergency access” but the mother is not suceptible to the risks of a routine IV.
      #2) Wanting an epidural isn’t an emergency. IF the mother is willing to take that as a “risk”, that is, the staff not being able to get an IV in if she “changes her mind” then I think that is the mother’s right.
      #3) Pitocin IM, Methergine IM, Hemabate IM, and Misoprostol per rectally are some of the medications that can be given in the event of a PP hemhorrage that do not require an IV. In fact, in my hospital, if a woman comes ready to have a baby and we dont have time for an IV, we usually give her IM pitocin (if the doctor orders it) after delivery of placenta and that is it….unless she actually hemhorages. Also if this mother is planning on breastfeeding immediately postpartum that will offer some protection against PPH as well.

      As far as getting an IV in during an emergency….I personally have had women step off the elevator and within 12 minutes are in the OR having an emergency C/S for say, placental abruption. And guess what, I have never not been able to get an IV in. If I can’t , my charge nurse can. If she can’t, the anesthesiologist can. IVs can most certainly be placed in an emergency. I’ve seen my charge nurse place an IV in a patient once who was coding and seizing. Many nurses just don’t want to have to place one in an emergency. But it is done all the time. Think of ambulance EMTs and Paramedics. How many trauma victims have IVs in their arm when they get into a car accident or fall off their 4-wheeler. Ummmmm… ZERO! Nurses just generally don’t want to have to “worry” about getting an IV in during an emergency. But if your client is planning an unmedicated physiological birth and is planning on breastfeeding, her risk is significantly less for any complications. People don’t think of it that way though. Many L&D nurses certainly don’t. Because in reality the majority of patients in this country are having induced, augmented, instrumental, medicated deliveries. That is all some nurses, residents, and OBs know.

      Hope this response helps!

      • Alethea Says:

        Melissa,
        Thanks for your promt reply! I just got the Henci Goer book from paperbackswap.com So I will read the chapter and possibly give her a copy of it to consider. Negotiating the politics of small town LD (we have one hospital and 6 physicians who deliver, no midwives) is a delicate topic, so I have to be ever cautious of how I presenet dissent from the status quo so that the physicians will keep refering clients to me.
        Keep up your awesome work on this blog! I and at least 3 or 4 of the nurses I work with are regular readers and we frequently discuss the things you bring up at work (often in front of other nurses who aren’t so like minded in an effort to get them thinking!!)

        Here’s to promoting healthy physiolgic birth!
        Alethea

  10. Lena Hong Says:

    Melissa,
    I was wondering if you have heard about the SepraFilm Adhesion Barrier to prevent the risk of internal scarring when having a C-section: http://www.csectionhealing.com/forms/csection-info-kit-v2.aspx?src=GoogleC+CSection&_kk=c%20section%20birth&_kt=c5b605ad-0d1e-4cb2-b451-09a856ccb507&gclid=CIW3ifmmuZ0CFShGagodw17VjQ
    Does it really work? Thank you so much.

  11. Sara R. Says:

    I was wondering what an “acceptable” c-section rate for a practice would be? I’m with a practice now for my first pregnancy that has a 17% c-section rate for first-time moms, which seems high to me. I know the national average is higher, but that would also be taking into account women having repeat c-sections, which would make the total percentage much higher, probably.

    My insurance covers the services of a midwife under the practice of an ob/gyn’s office, but there are none left in my area that are taking patients at this time. (I’m 26 weeks now, so I guess I”m a little late). The more research I do, the more determined I am to have a natural, intervention-free birth. So far my pregnancy has gone swimmingly and I have no complications or risk factors.

    Should I just do my research, write a birth plan, and make sure that those with me can support me instead of trying to find another practice? It sounds like I won’t be able to get one with a midwife, and if that’s the case, then it seems like my options are about all the same.

    The c-section rate does bother me, but since there are so many doctors at this practice- 5 or 6- there’s no way to know who will be there for the delivery anyway. Do you have suggestions for me other than writing a birth plan and having clearly in mind my preferences?

    Thanks!

  12. Hi Melissa,

    I found your blog a few days ago and can’t believe I didn’t know about it earlier! Sounds like you are having a great success with it — you have so many readers — I just wish you would post more often 🙂

    I had a natural birth and am still breastfeeding my 3 1/2-year-old son. I write a blog about natural birth and breastfeeding and many other subjects called Dagmar’s momsense.

    I added you to my blogroll and mention you as a resource on my birth/breastfeeding page now: http://dagmarbleasdale.com/breastfeeding/
    I’d love it if you added my blog to your list.

    Do you have a Twitter account? Do you drive traffic to your blog via Twitter? If not, I can help you with that. Just let me know 🙂

    Best,
    Dagmar
    Dagmar’s momsense
    @DagmarBleasdale

    Please keep writing!

  13. Jen Says:

    I found you blog in 2009 after the birth of my first child. We had a typical hospital induction that thankfully ended with a vaginal delivery. (Without the help of our nurse who was pestering the doctor to prep an OR.) However, I was incredible disturbed by the whole experience. After finding your blog, I started researching, etc and discovered a group that supports midwifery in our state. For my second pregnancy, we planned a home birth with a midwife. Our little girl turned posterior when I went into labor, was a brow presentation and her heart rate dropped super low so we transferred to the hospital. She however, had other plans. The ambulance ride must have turned her anterior and she was born before we arrived at the hospital. Her birth was such an empowering experience for me and your blog started that amazing journey for me (and our daughter)! Thank you!

  14. anxiousmom Says:

    My OBGyn was downright reluctant to even listen to the possiblity of delaying cord clamping…Can someone please help me find a midwife or doctor who understands? I live in Tampa, Florida


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