Behind-the-Scenes Advice You Need to Know From a Labor Nurse
Labor, Birth Education, and Preparation Is Vital for a Positive Birthing Experience
I can't stress enough the importance of prenatal education. Education should include a labor and birth class and a tour of the hospital where you plan to deliver so you're familiar with that specific environment. Nurses are more than happy to educate you and answer questions, but knowing the bare-bones basics beforehand, helps ensure a positive and memorable birthing experience.
With my first pregnancy, in1989 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. I attended Lamaze and Infant Care classes at the hospital where I planned to deliver. My thirst for knowledge and what to expect was insatiable. I couldn't imagine going through labor and birth clueless and unprepared. As a labor nurse, I can't tell you how many women fail to prepare themselves.
If you're skipping the classes and consulting the "University of Google", add the words "evidence-based" or "peer-reviewed" to ensure you're reading the most accurate and reliable data available. There are many books on labor and birth, but this is the one I recommend reading: Natural Labor and Birth: An Evidence-Based Guide to the Natural Birth Plan. It was published in 2018 by a board-certified obstetrician and includes alternate outcomes important every pregnant woman should know.
17 Things Nurses Wish Every Pregnant Woman Knew Before Coming to the Hospital
1. We Have Your Back
Your labor and delivery (L&D), 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. We want you to know a million things, so I hope this candid article helps 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 this field. She knows 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 recognizes concerning changes with your baby's heartbeat and your vital signs in a hot second and will promptly notify your doctor and perform specific interventions to correct them. Nurses are your doctor's lifeline between the two of you because rarely are they present in the hospital during your labor.
We'll fluff your pillows, change your amniotic-soaked under-pads, and bring you toaster-warmed blankets when you're shivering (not because you're cold, but because your body is responding to the stress of labor). We'll bring endless ice chips and popsicles, empty your bladder after your epidural, and put you into laboring positions that'll make you think we've lost our minds.
We'll do all these things without batting an eye. But, we want you to do your part, too. What's that, you ask? We want you to educate yourself, not rely on what your mother told you about her experiences, or how awful your friend's birthing stories are, and trust that we know what's best for your labor.
It’s possible to have a slew of doctors, nurses, and support staff rush in and gather at your bedside to discuss what's best for your delivery when we see something we don't like. We don't want you to panic and hope you'll allow the doctors and staff to inform you of their decisions and suggestions with an open mind. We're working together as a team to do what's best for you and your baby.
2. Labor Is Most Definitely Going to Hurt
Please don't ask if labor's 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 cinch on your body. The peak feels like your pelvic organs are falling out of your vagina. If your baby is facing funky, you may feel 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 can't walk or talk through the contractions, it's about to get real. This isn't to scare you, but you need to be mentally prepared to practice breathing and relaxation techniques and not be caught off guard.
3. We Cringe When We See a "Birth Plan"
I know that sounds cynical and like we don't respect your wishes to write out your wishes, but our mission is to get your baby out safely and keep you out of danger.
There's a tendency for some to vilify nurses and doctors as unnecessary interventionists, though it's quite the opposite. We want to honor your wishes; however, we also know if you have a rigid birth plan, you'll see the blinding lights of the operating room shining down on you and not be the least bit prepared for it.
If you feel strongly about making a birth plan, my advice is to call it "a birth wishes or birth preferences list." I'm being brutally honest when I say most births don't go according to "plan." We don't want you arriving to your labor with delusions of grandeur that make you put up a fight when we need to take fast action to save your baby--or you. It's happened more times than I can count, and during a labor crisis, seconds count.
We do want you to take control of your birthing experience. It's fantastic to be motivated, educated, and informed, but prepare for the unexpected with an open mind too. I don't recommend listing things on your list like "IV or internal monitors only if medically necessary." Just like we'd never circumcise or vaccinate your baby without your written consent, we also won't use the internal monitors without first explaining the rationale and getting your blessing. If we feel it's needed, we'll make sure you understand why and your job is to not waste time arguing about it. Like I said, time is of the essence when it comes to labor complications.
Some good ideas for your "birth wishes" that nurses welcome are:
- keeping he lights dimmed whenever they're not needed
- limiting visitors to your room
- not asking your partner to cut the umbilical cord (it's generally expected he or she will)
- refusing a blood transfusion if urgently needed (we need to know this)
- planning to bank your cord blood for the future (telling us after your delivery is too late)
- wishing to not be offered pain medication, unless you request it
- planning to keep your placenta for encapsulating, making soup or planting a tree
- any cultural considerations we may not be familiar with
If you're up-to-date on the latest and greatest from having attended a birthing class, you'll know 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 distress. We want you to trust our judgments as we have a great amount of experience and training.
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's malpositioned or a uterus with a dysfunctional contraction pattern can cause a hang-up and take hours to correct. Please be patient and know we'll do everything we can to get your baby delivered in a safe and timely manner.
5. You're Getting an IV
We need you to have an IV, even if it's just a port for venous access, and it's not up for debate. Women can and do bleed excessively following birth (and sometimes beforehand if a problem arises, such as placental abruption). We don't 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 of them. Rest assured, the pain is temporary, and your arm will be mobile. An IV isn't 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's nothing like labor pain and nothing prepares you for it unless you've already experienced it.
If you feel strongly you want natural, unmedicated labor, take my advice and prepare for how you'll handle the pain. Your options include: Guided meditation, self-hypnosis, massage, aromatherapy, IV medication, or a combination of several of these methods. The more prepared and focused you are on what you want, the more successful you'll be. If you change your mind and decide to chuck it all, that's fine with us, and we'll support you. Just remember, the point where it gets unbearable is the point at which you're 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 can help your labor by allowing you to release the tension you're 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 inadequate contractions or a baby that's large or in an unfavorable position. While most women can handle natural labor, the choice to receive an epidural is a personal choice. An epidural is quite beneficial when maternal exhaustion sets in.
8. Pitocin Does Not Make Contractions More Painful
Another misconception touted by women who've 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 to make contractions faster and harder, with less time compared to spontaneous contractions which naturally adapt your body for delivery, which can wax and wane for hours and even days.
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's 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, Despite What Some Sources Say
Every intervention we perform means more work for us—more monitoring, more equipment, and more charting. We don't want more work and charting and we don't want more intervention for you either. We also don't want you to have a C-section because that's riskier for you and more work for us as well. When your doctor thinks you've labored enough and it's time for operative delivery, we're usually asking for one more hour for you to do it on your own. We've probably told a little white lie about what you're really dilated, so you can have more time—we're passionate about that. Again, we always have your back!
11. We May Need to Attach a Fetal Monitor to Your Baby's Scalp
You've probably heard horror stories from other mothers on this topic. Rest assured, the fetal scalp electrode isn't a torture device. The tiny spiral electrode is the equivalent to getting a small splinter in your finger and is relatively painless, despite how it looks (I've applied one to my own finger to confirm this). We don't routinely apply one, but sometimes they're 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're pooping, you're 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 don't 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 isn't going to solve anything, nor is posting about it on social media, or waiting for the hospital survey to arrive weeks after you're home. Ask us anything, without hesitation at the time you're concerned or upset.
Please remember you're in a hospital, not a hotel. While we try our hardest to 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're human. Babies will be crying and we'll 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're 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 think twice about it. We 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're 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's likely making your nurse feel the same. Just say the word and we'll 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's not your desire, and we'll guide you through this. 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 operative delivery.
4. Your placenta may have issues as in prematurely separating (abruption) or isn't providing insufficient perfusion to the baby.
5. You have multiple babies who aren't 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, don't ask for a bottle because the baby is crying or not latching on and you think they're "not getting any milk". You're right, the baby isn't getting milk because it takes up to 72 hours for milk to develop. What your baby IS getting, are microdroplets 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'll 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're beyond sick of your oversized clothing and can't wait to don your skinny jeans again. But trust me, you'll not want anything tight or form-fitting against your lady bits or C-section incision; not to mention, you'll not be skinny that fast. It takes a good six weeks to return to your pre-pregnant weight and even longer if you're breastfeeding, as your body stores a little additional fat for milk production. The only thing you'll want tight as a bug in a rug, is your bra because when that milk does come in, it 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.
© 2019 Debra Roberts