Behind-the-Scenes Advice You Need to Know From a Labor Nurse
Labor and Birth Education and Preparation Is Vital for a Positive Birthing Experience
I can't stress enough, the importance of prenatal education. This education should include a labor and birth class, as well as a tour of the hospital where you plan to deliver so you are familiar with the environment. Nurses are more than happy to educate you and answer questions, but if you have the bare-bones basics beforehand, I promise, your experience will go off without a hitch.
With my first pregnancy, in 1989 and before I was a labor nurse, I checked out and read every single book I could find at my local library on pregnancy and childbirth, in addition to attending Lamaze and Infant Care classes at the hospital where I was to deliver. My thirst for knowledge and what to expect, was insatiable and I could not imagine going through labor and birth totally clueless and unprepared.
If you are skipping the classes and consulting the University of Google, add the words "evidence-based" or "peer-reviewed" in your search for articles and information to ensure you are reading the most current and accurate data to date. There are many books on labor and birth, but this is the one I recommend reading: , which was published in 2018 by a board-certified obstetrician and includes alternate outcomes that are important for every pregnant woman to know. Natural Labor and Birth: An Evidence-Based Guide to the Natural Birth Plan
17 Things I Wish Every Pregnant Woman Knew Before Coming to the Hospital
1. We Have Your Back
Your labor and delivery, post-partum, nursery, and lactation team of nurses will be the most important people in your circle for the first few days of your newborn's life. There are a million things we want you to know, so I hope this candid article will help you have the best birthing experience possible.
Your labor nurse is watching you and your baby's responses to labor like a hawk and is highly skilled in knowing how much blood is too much, how far your vital signs can be stressed, when it's really time for pain medication, and when the baby is about to be born. Your nurse will recognize concerning changes in your baby's heartbeat and your vital signs in a hot second and will promptly notify your doctor. We are your doctor's lifeline between the two of you, because rarely are they present in the hospital during your labor.
We will fluff your pillows, change your amniotic-soaked under-pads, and bring you toaster-warm blankets when you are shivering (not because you are cold, but because your body is responding to the stress). We will bring you a never-ending supply of ice chips and popsicles, keep your bladder emptied when you are numb after your epidural, and put you into positions that make you wonder if we've lost our minds.
We will do all these things for you without batting an eye, but we want you to do your part, too. What is that, you ask? We want you to educate yourself and to not rely on everything you read on the internet, what your mother told you about her experiences, or how awful your friend's birthing stories are.
At some point in your labor, it's possible to have a slew of doctors and support staff suddenly rush into your room because your nurse called for help and is concerned about something. We will keep you informed, so please allow us to do our job and know we are doing our best for you.
2. Labor Is Most Definitely Going to Hurt
Please don't ask if labor is going to hurt. It's called "labor", not "fun and games". Your contractions will feel like 60-90 seconds of your worst period cramps and the tightest corset you could possibly cinch up, with the peak feeling as if your pelvic organs are exiting your body. If your little lovely happens to be facing the wrong direction, you may also expect gnawing lower back pain that doesn't ease up until the baby shifts positions, or you get an epidural. Of course, it's not like this the entire time; it builds as you progress. When you find you can't walk or talk through the contractions, it's about to get real. This is not to scare you, but you need to be mentally prepared so you can practice breathing and relaxation techniques and not be caught off guard.
3. We Cringe When We See a "Birth Plan"
I know that sounds a bit cynical, but our mission is to get your baby out safely and keep you out of danger. When something goes awry, we are going to make sure you take home a baby that isn't going to need lifelong care or worse.
There is a tendency to vilify nurses as unnecessary interventionists, though it's really quite the opposite. We want to honor your wishes; however, we also know that if you have a rigid birth plan, you will probably see the blinding lights of the O.R. shining down on you. If you make a birth plan, my advice is to call it "birth wishes or preferences". I'm being brutally honest when I say that most births do not go according to any "plan". We don't want you to have delusions of grandeur that make you put up a fight when we need to take fast action. It's happened more times than I care to count, and during a labor crisis, every second counts.
That said, we want you to take control of your birthing experience. It's awesome to be motivated, educated, and informed, but also prepare for the unexpected with an open mind. I don't recommend listing things like "IV or internal monitors only if medically necessary". For example, we would never circumcise or vaccinate your baby without your written consent, nor would we use an internal monitor without first explaining. If we feel it's needed, we will make sure you understand why.
Some ideas for your "birth wishes" that are important are:
- you want the lights to remain dimmed whenever they are not needed
- you do not want visitors or only want specific people in the room
- your partner does not want to cut the cord (because it's generally expected that he or she does)
- you will refuse a blood transfusion if it is urgently needed
- you plan to bank your cord blood
- you do not wish to be offered pain medication unless you request it
- you wish to keep your placenta
- you have cultural considerations
If you are up-to-date on the latest and greatest from having attended a birthing class, you will know that we practice delayed cord clamping, put your baby to your chest at delivery, and do everything possible to avoid your baby being separated from you, unless your baby is having any form of distress. We want you to trust us.
4. Don't Ask Us How Long This Is Going to Take
While we do many predictions, we really have no idea. First-time labors can take up to 24 hours and sometimes longer, and so can third labors. The length of your labor is directly proportionate to the size and position of your baby, the readiness of your cervix, the shape of your pelvis, the strength of your contractions, and if your labor is spontaneous or induced. A baby that is malpositioned or a dysfunctional contraction pattern can cause a hang-up and take hours to correct. Please be patient and know we will do everything we can to get your baby delivered in a safe and timely manner.
5. You Are Getting an IV
We need you to have an IV, even if it's just a port for venous access, and it's really not up for debate. Women can and do bleed excessively following birth (and sometimes beforehand if a problem arises, such as placental abruption), and we do not have time to waste trying to get one in when your veins have collapsed during a hemorrhage; and they will. I love giving IVs, but I hate getting them, so I fully appreciate the apprehension and fear that goes along with them. Rest assured, the pain is temporary, and your arm will be mobile. An IV is not the end of the world, and it can help save your life.
6. "I'll See How Bad it Gets" Is Not an Answer When We Ask Your Plans for an Epidural
Research your pain control options ahead of time, and don't be disillusioned because you think you have a high pain tolerance. There is nothing like labor pain and nothing that can prepare you for it, unless you've already experienced it.
If you feel strongly that you want a natural, unmedicated labor, take my advice and prepare for how you plan to handle the pain, whether that be guided meditation, self-hypnosis, massage, aromatherapy, IV medication, or a combination. The more prepared and focused you are on what you want, the more successful you will be. If you change your mind and decide to chuck it all, that's fine with us, and we will support you. Just remember, the point where it gets unbearable is the point at which you are probably nearing the finish line.
7. The Epidural Does Not Slow Down Your Labor
A common misconception and rumor is that once you receive an epidural, labor slows down or stops. Quite the contrary. An epidural actually can help by allowing you to release the tension you are holding during contractions, therefore relaxing the pelvis. This makes it easier for the baby to descend and gives you a much needed rest; particularly if your labor is prolonged by either inadequate contractions or a baby that is large or in an unfavorable position. While most women can handle a natural labor and the choice to receive an epidural personal, an epidural is quite beneficial when maternal exhaustion sets in.
8. Pitocin Does Not Make Contractions More Painful
Another misconception touted by many women who have been induced with Pitocin or had it during a stalled labor, is that labor was terrible because they received Pitocin. The truth is, "a contraction is a contraction", whether spontaneous or induced, the pain of a contraction is hell on wheels. What Pitocin can do is make active faster and harder, with less time for build-up as compared to spontaneous contractions, which can wax and wane for days, preparing and adapting your body.
9. Be Prepared to Move Around
While you may want to spend your labor relaxing in bed on your back, that's not helpful. Your nurse will have you sitting, bouncing, squatting, standing, leaning, bending, twisting, and contorted six ways to Sunday. We know what works to make your baby move into an aligned position for exit. Here is a very comprehensive article depicting the many positions you may find yourself in during your labor.
10. We Do Not Want to Perform Unnecessary Interventions
Every intervention we perform also means more work for us—more monitoring, more equipment, and more charting. We don't want more of that and we don't want that for you either. We also don't want you to have a C-section because that's more risky for you and more work for us as well. When your doctor thinks you've labored enough and it's time for an operative delivery, we are usually asking for one more hour for you to do it on your own. We have probably even told a little white lie about what you are really dilated, so you can have more time—we are passionate about that. Again, we always have your back!
11. We May Need to Attach a Fetal Monitor to Your Baby's Scalp
You have probably heard horror stories from other mothers on this topic. Please rest-assured, these are not torture devices. The tiny spiral electrode is the equivalent to getting a small splinter in your finger and is relatively painless, despite how it may look (I have applied one to my own finger to confirm this). We don't just routinely apply one, but sometimes they are necessary to give us a better picture of your baby's fetal heart rate pattern and changes.
12. We Don't Care If You Poop
Poop happens during birth and we expect it. In fact, we sort of want you to poop. The fact is, if you are pooping, you are pushing properly and with the right muscles to get the job done; especially if you have an epidural and can't feel what you are doing down south. On the flip side, we do not want you to do an enema before you come to the hospital. We want poop when the time comes, not diarrhea!
13. We Want to Know If You Are Upset About Something
Complaining to your family when we leave the room is not going to solve anything, nor is posting about it on social media, or waiting for the hospital survey to arrive weeks after you are home. Ask us any anything, without hesitation.
Please remember you are in a hospital, not a hotel. While we try our hardest not to bother you and allow you to rest, a hospital is a busy, bustling, and noisy environment. Nurses can be loud—we don't mean to be, but we are human. Babies will be crying and we will be in and out of your room a thousand times because we only have a short time to teach and care for you before you go home. Plus, we are caring for two of you, so that makes for even more trips to your room 24 hours, round the clock.
14. We Love Being the Bad Guy
We won't even think twice about it. We usually don't like your 16 visitors going in and out and constant calls from the front desk asking who we can allow in or how many you already have in the room. Visitors can distract from the care we are trying to provide and the focus you need to have on yourself. While this may sound harsh, it's the truth. If your mother-in-law is making you homicidal, she is likely making your nurse feel the same. Just say the word and we will happily do the dirty work.
15. You May Need a C-Section
There are a plethora of reasons why you may end up needing a C-section. We realize that was not your desire, and will guide you through this journey just the same. Some of the reasons you may not have a vaginal delivery include:
1. The baby isn’t positioned properly and our attempts at fetal rotation have failed.
2. Your labor pattern is inadequate or the baby isn’t fitting through the pelvis due to malposition or large size.
3. The baby’s heart rate may indicate he or she is not handling labor well, necessitating an immediate need for an operative delivery.
4. Your placenta may have issues as in prematurely separating (abruption) or is not providing insufficient perfusion to the baby.
5. You have multiple babies who are not in a favorable position for a vaginal birth.
6. You had a C-section prior and your uterine scare puts you at an increased risk of uterine rupture, a life-threatening condition.
16. You Will Not Have Milk Right Away
When you first put your baby to breast, please do no ask for a bottle because the baby is crying or not latching on and you think they are "not getting any milk". You are right, the baby is not getting any milk, because it takes up to 72 hours to develop. What your baby IS getting, are micro droplets of liquid gold called "colostrum". This is one of those times when "a dab will do" is true. Those nearly invisible droplets are loaded with the antibodies and nutrients your baby needs for the first several hours to a few days of life. This is why it's very important for you to nurse your baby every 2-3 hours round the clock during that crucial first few days. The only time we will suggest supplementing with a bottle, is if your baby's blood glucose levels are at a concerning level.
17. You Will Not Be Wearing Your Regular Clothes Home
Even I made this mistake! You are beyond sick of your oversized clothing and can't wait to don your skinny jeans again, but trust me, you will not want anything tight or form-fitting against your lady bits or C-section incision; not to mention, you will not be skinny that fast. It can take a good six weeks to return to your pre-pregnant weight and even longer if your are breastfeeding as your body stores a little additional fat for milk production. The only thing you will want tight as a bug in a rug, is your bra, because when that milk does come in, it's comes with a vengeance and it hurts. Keeping the girls tight and free from bouncing is very important, so be sure you have a good supply of comfy, supportive nursing bras you can also sleep in.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2019 Debra Roberts