Tag Archives: nurse

Creating a winning birth team…

So you are going to have a baby!! The time is approaching and you are beginning to think about WHO is going to be present for the big event.  Will your mother be there?  Your best friend?  Your partner/husband? Did you hire a doula?  What will your nurse be like?  What midwife/doctor will be on call?

While to some these may seem like simple questions for others they cause extreme stress and anxiety.  The wrong people can create uneasy conflict in your birth room while the right team can create harmony and peace.   There are two primary categories of people who make up your birth team; your health care providers, and your family and friends.   The ultimate goal is a winning team where Together Everyone Achieves More, and where they work together to create a conflict free birth room filled with peace, happiness and love.

Let’s quickly talk about the people on your team:

Your midwife/doctor: IF it is very important for you to KNOW the provider who will catch your baby, you want to be sure you pick someone in solo practice or choose a group with only a few providers.  Make sure you are able to meet everyone of them more than once during the prenatal period.  Keep in mind, everyone needs a day off sometimes, so even with a solo practitioner there is the off chance that your provider may be unavailable.  However, if this is VERY important to you, you can minimize the chances of having a “stranger” in your delivery room if you choose the right provider prenatally.

If it is important to have your provider present throughout your labor, providing support and encouragement, be sure to talk to them EARLY in your pregnancy about your wishes to determine if she/he is the right provider for you. Generally speaking, if you really want your provider to give you labor support you should choose a midwife.  While not every midwife provides labor support, in general a midwife is more likely to be with you in labor compared to a physician.  The bottom line about your birth attendant is knowing that you cannot wait until labor starts to choose the right provider for your labor and delivery team.  This is a process that MUST begin the moment you find out you are pregnant.  Your provider is an integral part of your birth team and you want to be sure you are happy about your choice.

Your nurse: If you will be birthing your baby in a hospital, your nurse will be a critical part of your birth team. She will likely spend more time with you than anyone else.  Not every nurse is the perfect fit for every patient but with a little patience and open communication, you can make the relationship work.  Know what you want, and be prepared to discuss it with the nurse upon admission.  Having a written birth plan is not a bad idea but it is not required.  The most important thing is to know what you want and to have a CONVERSATION.  With open communication, your nurse can become your biggest advocate and friend. There are times when regardless of communication, you and your nurse are not a good fit. When this happens, you can ask for the charge nurse on duty and request another nurse. While this is not always possible due to various staffing and time constraints, it is worth trying if all else fails and there is a definite conflict.

Your doula: Doulas are not just for women who want to “go natural.” While this is where they are primarily used, they can be a valuable asset in any birth room.  Like your prenatal provider/birth attendant, it is important that you meet your doula BEFORE labor starts. It’s important to choose someone who you feel comfortable with.  You want a doula that is going to respect what YOU want, without trying to push her values and beliefs about birth onto you.  You want a doula that has the skill to speak up for you without alienating the staff at the hospital.  Nurse/doula relationships can create some of the biggest conflicts. Be sure to communicate with both the nurse and the doula to make sure they are a part of YOUR team, not in a competition.

Your family and friends: Some women feel obligated to let anyone into their birth room who says they want to be there.  I have seen women become visibly stressed out about trying to decide who should be there and feeling some obligation to allow this one or that one in the birth room although she really doesn’t want that person present.  Some of the relationships that I have seen create the biggest conflicts for women include in-laws and friends especially friends where she was present for their labor and birth.  Birth is a special time for the mother her partner and their infant.  Just because you were invited to her birth room does not mean she has to be invited to yours. Those wedding/party “rules of etiquette” don’t have any place in labor and delivery.  This is a very different experience and should be treated as such.  It is a private event and should include only the people you REALLY want to be present. Remember that during labor and birth, much of you may literally be exposed and if you are a having a natural/unmediated birth you will be in a vulnerable state.  EVERYBODY does NOT need to be there.  Labor and birth is not a spectator sport yet when you have LOTS of visitors during the process just “waiting for the baby,” this is what your precious birth experience has the potential to turn into. When you are trying to work with your contractions or rest after an epidural, the last thing you need is your family/friends standing around “speculating, and watching.”

To avoid in labor decisions/conflicts be sure to have these discussions with your partner, mother, in-laws, friends and doula BEFORE labor ensues.   An easy way to avoid some of the conflict is to keep your “I’m in labor” phone calls to a minimum. After you have the baby and you have had time to rest, THEN you can make all the calls you want. If they don’t know you are in labor there will be no stress about uninviting them from the birth room.

If you do end up having lots of people coming to visit, I encourage my patients to send non-essential visitors HOME.  Let your nurse or your doula be the “bad guy” to send them on their way.  It’s like you are the quarter back and we are the offensive line. We protect you. Ask us and your wish is our command.

After delivery, you will want to rest and spend some private time bonding with your newborn.  Encourage your friends to come over to your house AFTER you are home. You will feel more like normal and be more open to visiting. As a side note, I also make the suggestion that you ask friends to come bearing edible gifts!! Who has time to cook with a newborn baby!  While they love us the most, family and friends are often the ones who create the most conflict.  Be careful about who you choose to invite/allow into your birth space.

When it’s all said and done, you are the captain and your partner is the co-captain of your birth team. Together you have to decide what other team members will help you win.  Be sure to Choose Wisely because your birth team can have a profound effect on your birth experience.

In Birth and Love
Nicole ~ Follow me on twitter @SistaMidwife

Skip this Routine…

REPOST: From June 2009 Your Birth Right Blog…

It never ceases to amaze me the information that women are given and the procedures they undergo prenatally and during labor all in the name of “routine.” One of those things that always annoy me is the frequency of unnecessary vaginal exams/cervical checks.

While I personally don’t do frequent/multiple vaginal exams on a woman in labor, I do understand why some nurses, doctors, and midwives feel the need to do them. I don’t agree with their rationale but I understand it because I used to be a “frequent checker.”  What I have NEVER understood is the routine checking of a woman’s cervix prenatally when she has yet to have ONE contraction or any sign of labor.  Many providers do routine cervical exams on every pregnant patient  starting as early as 37 weeks.  Some wait until the 38th week and by the 39th week women are walking around wondering “Why haven’t I dilated past 1cm. I’ve been 1cm for 2 weeks now?”   These are often women who have had a FEW contractions that they might call “crampy” or “slightly uncomfortable” and otherwise have no signs of any sort of labor.  This sets up a cycle of fear of the inability of her body to have her baby. It is so important for a woman to have unwavering faith in her body and her baby.  The moment this faith is shaken, the cascade of fear can take over.

Let’s take for example the following…  The other day I received an email from a pregnant woman I have been doing some private consulting with.  When she emailed, she was 39 weeks pregnant.  She said…

“From my last week’s weekly OB appt {which means she was 38 weeks at the appointment}, my cervix is/ was still posterior and the station was high (-3).  I’m hoping to be somewhat dilated soon and am trying to get my cervix to be anterior. I’ve been swimming, walking, climbing stairs sideways and doing the head down with butt in the air wiggle wiggle exercise. Do you have any recommendations on how I can get my cervix to be anterior? I am going to have an unmedicated vaginal birth, so any advice you can give me will be totally appreciated.”

I took a deep breath before responding and then I said to her ….

“First I want to answer your question and I hope this does not sound too blunt…. you CAN’T get your cervix to be anterior.  When your body is in active labor it will naturally move anterior.

Now I have a question for you… Why did you have a cervical check last week?  Was it because you wanted one or because they said you needed one? The reason for my question is this…

Remember when we spoke, we talked about the importance of continuing to have full faith in your body and removing any outside forces that undermine your faith.  Well… unnecessary vaginal exams when you are not in labor and before your due date is one of the early/many ways that women begin to lose faith. When your body is ready to go into labor you will dilate and your cervix will move anterior. If it is not ready it won’t. If you are not in labor and contracting regularly with strong contractions you should not expect cervical change.  The question I always ask is this…. ‘Will the information gained from THIS vaginal exam change what we are going to do today?’ In your present situation, unless you are considering being induced a vaginal exam is irrelevant. What do I mean irrelevant…it does not change what we are going to do TODAY and things can literally change overnight.   Because of this, I encourage you to avoid all vaginal exams until you think you are in labor and are having a labor check or you are preparing for an induction.  I encourage you to let go of your current cervical change expectations and focus on getting your mind ready for labor and motherhood.  You can go from closed to delivered overnight.  It will happen. Don’t start to doubt and don’t start to worry.  Your body and your baby know the perfect time to move to birth. “

She responded, thankful for my reminder that her body knows best. She also let me know this…

“As for checking the cervix, I had no idea…the dr. just did the examination and said it was routine, so I didn’t question her until the whole posterior/anterior subject came along…”

Yep….  You read it right and it happens all the time … “I had no idea … the dr. just did the examination and said it was routine…” When did it become routine to violate a woman’s body without her permission? Why is it routine to check the cervix of a woman who has not passed her due date and has no signs of labor? Why do we continue to make women feel inadequate and incapable of having their babies? ROUTINE does not mean REQUIRED.  ROUTINE does not mean RIGHT.  Routine is a regular habit one that is done habitually. It does NOT mean something that has to be done.

Don’t let the Routine get in the way of RIGHT.  Your baby and your body know when the time right. Have faith.

In Birth and Love
Nicole