BTCanada

I am attaching a study (attached here) that comes closest to addressing concerns based on birth mode.  I do not think it is great research - it is just the best that is out there.  Shortfalls are:

1) it only addresses short term physical and psychological damage (to 3 months).  The damage done from planned vaginal births is often asymptomatic for many years after a PVD.  Aging and menopause are often the 'last straw' before that damage becomes symptomatic.  

2) it  uses multiparous data to arrive at conclusions.  A proper study would differentiate between primiparous and multiparous.  Using multiparous data to look at the consequences of planned cesareans skews results.  There is no way of knowing if the physical or psychological consequences of a planned cesarean are the residual effects of a prior planned vaginal birth when multiparous data is used.

3) data shows that a number of subjects in the planned cesarean group had monitoring during labor.  Clearly not all of the 193 'planned cesarean' group were planned unlabored cesareans.

4) there is nothing about anesthesia types.  I expect that regional anesthesia was used in all or most planned cesareans but it is also possible that some involved general anesthesia - a fact that would increase the risks significantly for planned cesareans.  

5) there is no mention of reconstructive surgery(s) required after vaginal births.  These are required after the vast majority of vaginal births, particularly for primiparous women.   No adequate study comparing birth modes is credible without that information.

6) there is no mention of gestational age or medical indication for the planned cesarean births.  They could just of easily been for serious obstetrical conditions such as placental issues, pre-eclampsia/eclampsia, HELLP, prematurity etc.  These frightening complications are known to cause post traumatic symptoms as well as lingering physical symptoms.

7) there is no indication of the number of non-responders in their survey.  It is my experience that those most terrified by their childbirth experience are also those who want nothing to do with the medical community afterwards.  Doing so is a trigger that many would avoid.  If the non-response rate was high I would infer that that level of physical and psychological damage would actually be much higher than what is reported; particularly for the planned vaginal birth categories (spontaneous vaginal, assisted vaginal and cesarean after trial of labour).




________________________________________________________________________________

Wednesday, February 6, 2008

You'll look back at that and laugh.

And now, nearly 6 months later I can. I think.
One night I had a patient who was a frequent flyer. Not the kind of frequent flyer that has been coming in for the better part of her second and third trimester for labor checks, but one that was actually in early labor and refusing any intervention.
She would come in screaming in pain. She was actually contracting fairly strongly but refused meds, IV, a cervical exam (at first anyway), membrane rupture to help progress the labor etc. So what exactly she wanted from us was a mystery and out the door she went again only to return a few hours later so we could play the same game over again. This went on for days and finally got to the point where I was the only one who hadn't taken care of her so I was up to bat.
At start of shift I figured she would probably be out the door again but at exam she had actually progressed far enough that she needed to stay. She was also screaming bloody murder and not just with her contractions. Constantly.
She said she wanted to get in the tub so I calmed her down long enough to check her again and make sure she wasn't getting ready to deliver. I drew her a warm bath and let her get in. Not two minutes later she is screaming like a banshee again and out she comes. I help her back into bed. The screaming continues.
She is so loud that I can literally hear her down the hallway, in the back of the nurses lounge, in the restroom with the door closed and the water running. The rest of the staff is working hard to reassure everyone else on the floor  (who were all understandably freaked out) that this girl is in fact, going to be OK. I am working hard to calm her down.
When I step out of the room to give her doc a call and an update (which wasn't hard to explain her condition since he could hear her screaming over the phone) the mother steps out and says to me angrily, "I think we need some better labor support in here!"
Um lady, your daughter is a freak.
After hours and hours of constant screaming another cervical exam reveals no change and it would seem her cervix is starting to swell. Miss Priss is still refusing any sort of intervention. Finally, a team of us convince her an epidural would be a good idea and we start an IV so we can get the fluid bolus going.
If you labor nurses out there guessed that she wasn't very patient during this process you are correct. I went ahead and paged anesthesia, extremely worried that she would continue to act a fool and the anesthesiologist would refuse to do the epidural. Luckily for me, while she did continue into her seventh hour of ear piercing screams, I think the doc took pity on me and miraculously placed a beautiful epidural in a moving target.
Silence. At this point, I fully planned to leave her alone for the rest of my shift since I was worn out, was pretty sure she was worn out and most thankfully, she was sleeping soundly. Unfortunately for me, at about 4 AM her doc rolls in and decides we need to check her. Feck.
She is complete but still at a zero station. He wants to rupture her and start pushing. Me, anticipating what kind of a pusher she is going to be, and knowing the baby has looked beautiful all nights suggests we let her labor down some. I lost.
First push: Good. Second push: Good. Third Push: Good. Fourth Push: "Why isn't the baby coming?"
"This takes a little bit of work with first time moms. You are moving the baby well."
She looses her marbles again. We are back to square one screaming bloody murder. The doc comes back in to assess her. She will still push but you can probably figure not very effectively. Her mom starts screaming, "Why can't you push the baby out by pushing on her stomach."
I don't even dignify that with a response. My patient is yelling "Just cut it out, cut it out!!!". The screaming continues. The poor doc is trying to explain her options but she won't stop the damn screaming. She consents to a c-section which has to be done under general anesthesia because she wouldn't quit thrashing and yelling. Mom is pacing outside the OR in tears because her perfect baby is going to have a scar.
The silence in the OR was magical and as I had to push the baby back up this ladies vagina so that it could be extracted from her abdomen I found myself wondering where it all went wrong. Miss "No intervention" inevitably ended up on the operating table.
In a fitting end, as my patient came to, she was still swinging and I got punched square in the jaw. I look at the clock. It is 7:30 AM and in through the door walks my relief. I have never felt so thankful.

Thursday, January 24, 2008

Thanks for the warning.

A while back I noticed a patient of mine had a cyst on one of the outer lips of her vagina. No big deal. It happens.
Come time for delivery, with the patient up in stir ups and the spotlight on her girl parts I notice the doctor silently but quite attentively inspecting the cyst between contractions. I see her poke at it. Then, with no warning what-so-ever she gives it a firm squeeze and a ridiculous amount of purulent discharge comes squirting out at a speed that I am pretty sure broke the sound barrier. It is heading right at me. I manage to move just enough that it hit me in the shoulder.
I give the doctor a "what the hell was that all about" glare.
She looks at me apologetically.
The whole time the patient remained blissfully unaware.

Monday, December 31, 2007

Last Post of the Year

As I rest here in a fit of laziness, I think of my coworkers who are probably battling the swarm of women determined to have the first baby of 2008 and it makes me thankful that I am safe at home. So, in the spirit of being glad I can enjoy the comforts of my own home, I will encourage all you women that want that are determined to have a home birth to do just that.
A couple of weeks ago a woman came in to L&D with her friend as a labor check. She knew her water had broken but didn't mention it, on purpose. The nurse taking care of her checked her cervix and told her she would check her again in two hours to see if she was making any change. The lady seemed agreeable and reminded the nurse it was her 5th baby and she was a pro. She also voiced that she wanted a low intervention labor and asked to be taken off the monitors. Her doc agreed and that was that.
In the meantime, my coworker checked on her several times and she said she was doing great. As the two hour deadline approached we start to hear grunting coming from the direction of her room. I joke that if someone doesn't go check on her she is going to deliver the baby herself.
The nurse taking care of rolls her eyes and gets up begrudgingly to see what in the hell she happens to be doing in there. The next thing I know the emergency light has been activated and we are all running into the room.

Her "friend" who was also coincidentally a midwife, had managed to turn the bed into a chair-like position that allows for squatting (something that is neither accidental nor figured out without knowing exactly how to do it). She is kneeling between the patients legs delivering her baby. As we run in she frantically asks for an umbilical cord clamp and some warm blankets. In the time it took me to reach into the warmer and grab a couple of blankets the baby has been delivered and is resting on mom's tummy.
At this point we are able to put together that the whole friggin time she had planned on having her friend deliver her. By the time each of us had wasted a cumulative several hours (have to stay after shift to get it done) filling out our respective incident reports I can't say she was in anyone's good graces.

You can probably figure out what the moral of the story is.

Wednesday, December 19, 2007

Happy Holidays

In case I don't return before Christmas, I leave you with this thought. You nurses may have already seen it, if not please share. I can't take credit, it has been circulating the floor.

Twas the night before Christmas
and up on OB
A nurse yelled "Thick mec, I need a delee!"

IV's with Pitocin
Were all hung with care
In hopes they'll deliver
And stop pulling their hair

The patients were screaming
In their labor beds
While visions of epidurals
Danced in their heads

The staffing is short
With no one on call
Every warmer is dirty
And sits in the hall

Just when I thought
There's an end to this hell
A patient in triage
Has a major decel

So we rush with a gurney
And race to the back
The O.R. is dirty
Not one section pack

I dropped to my knees
And started to cry
When I heard the bells jingle
And looked toward the sky

There was St. Nick
On his sleigh in the rear
He had six smiling nurses
The day shift is here!

 

Sunday, December 9, 2007

In the spirit of repeat customers.

We have another frequent flyer who is still many weeks to her due date (think next year) and shows up 2-3 times a week for a labor check. Each time she shows up she acts increasingly painful as she moans that she is there for "contractions again". I honestly don't want to have to take care of her once those real contractions hit but that will be a story for after she delivers.
Anyway, she is also quite young, and while I do give her credit for showing up without her mother in tow I suspect this has more to do with her mother having an epiphany about how she no longer has to put up with her bratty daughter now that there is a father-of-the-baby/fiance to do the job. The most annoying thing about her damn visits are her dumb fiance. He gets her settled into the room and then comes to hang out at the nurses station like it's a freaking social hour where our primary job is to entertain. It clearly says, "Yeah, I don't really believe that she is in labor either so I am going to come hang out with you guys because I can't stand the freaking whining."
Last week, mid chat I think his real motive came out. He must believe that if he is nice enough and we like him then he can start asking for favors. It went something like this:
"So, I have heard that having a baby can cause you to tear. <blank stare> You know, down there. And they sew you up right? <What is this guy getting at?> So if that happens and they are sewing down there anyway is it possible that the doctor can go ahead and sew up and little extra?"
And here I thought he was just friendly.

Tuesday, November 13, 2007

Token weird person of the night.

By 4 am I had gotten my patient delivered and out to the post partum unit. While usually this is a bad set up for getting to take care of the next weirdo that walks through the door I was too far into my fantasy about my upcoming breakfast of Eggo's and Ambien to care.
My fantasy was disturbed by a girl being brought through the door in a wheelchair by the ER staff (gotta love them). She doesn't look pregnant at all.
"Ma'am, how many weeks pregnant are you?"
"20"
"And what brought you to the hospital tonight?"
"My baby is having a seizure inside of me."
Congratulations. That's called fetal movement. I have a Benadryl that can fix that though.

Monday, November 5, 2007

Weekly Schedule

It is amazing how a simple trip to the hospital can halt labor. I think any L&D nurse out there would agree that it is amazing how many women that are having contractions that are 2-3 minutes apart at home and in the car suddenly slow down to every 10-15 minutes or stop contracting all together once they get to the hospital. I have noticed that once we get a story out of them, the reason for the "labor check" seems to run on the following schedule:
Sunday- Their significant other has been watching football (or another sport) all weekend and they are severely lacking attention. A trip to the hospital can fix this.
Monday- Isn't it obvious? Someone had already resigned to the fact that she couldn't face another work week.
Tuesday- Leftovers from Monday who made it in that one day and couldn't go on.
Wednesday- These are the girls that were checked in the office Monday or Tuesday. Even though they were told some spotting is normal after a cervical exam they are pretty sure the world is coming to an end.
Thursday- It's poker night. Enough said.
Friday- Similar to Thursday. The significant other is on their way out of town for their last weekend out with the guys and she needs to find a way to get him to stay home. These girls are usually not even term but they will give it a good shot anyway.
Saturday- The whole family came into town because she was due that week and they need to see a baby before they leave damn it.
Scattered in this are the women who have previously delivered a pre-term baby. Once they reach that magic number of weeks they delivered at before they decide they are done being pregnant and start showing up frequently thinking they are in labor.

Saturday, November 3, 2007

Oldies but goodies.

Way back in the day, when I was a mere volunteer in a city far, far a way there was a 5 foot tall, 500 pound woman that the doctors referred to as "old half ton" upstairs. Don't shoot the messenger.
Anyway, this lady was being kept in the hospital on bed rest for reason that I can only imagine now were complications that were somehow related to her being so large. One fine day, it comes time for her to deliver by C-section and due to my "awesome" connections, I had the pleasure of watching.
After a long prep of taping this woman's fat folds up to the top of the table, to expose the proper area and hunting down stools for the doctors to stand on so that they could actually see what they were doing the surgery began.
There were all sorts of people with their hands in there retracting skin in attempts to be helpful and and yet it was apparently not enough because shortly after the start of the proceedure we all heard.
"Ouch! Oh shit!"
The doctor with the scaple still couldn't see well enough thorugh all the fat everywhere and he cut one of the other doctors helping. To everyone's horror, the next words out of his mouth were:
"Oh hell no! If this fat bitch has any diseases I swear I am going to kill someone."
Um doc, she only has a spinal, she's not unconscious.

The lesson: choose your doctor wisely.
More to come on consequences of choosing the wrong doc later.

Friday, October 19, 2007

I think you are on crack.

If you have a baby, and test positive for drugs while you are at the hospital having it, I can guarantee it will get taken away. We don't test everyone for drugs but from experience here are some ways you can assure yourself a "random" drug screen.
1) You show up with track marks up and down your arms. Don't try calling it a rash either.
2) Showing up for your routine hit of IV pain meds every other day during your pregnancy for various aches and pains.
3) Showing the person starting your IV what vein you usually use.
4) Offering to help.
5) You're 9 months pregnant and didn't know it. (See below)
6) Your baby is high.
7) Having your clearly drugged out friends bring you the "special brownies" from home.
8) Trying to blame the haze and smell coming from your bathroom on your bowel habbits.
And finally...
9) Flinging poop at the walls. Yes, poop.

Wednesday, September 26, 2007

Not all emergencies end up in the ER.

While we all like to think that having a baby will go smoothly each time, on occasion there are true emergencies. Last week, Carol and her husband show up to labor and delivery because she thought her water broke. Now, just showing up without calling anyone, your doc included, and people that think their water broke are both subjects for another day. Either way, no matter how annoying you are, or how big of a pain in the ass we can tell your family is going to be, you still get treated like everyone else.
Anyway, Carol appeared without calling and there was only one empty bed (lucky for her there was one) but the patient had just been transferred to her new room so it hadn't been cleaned yet. We let both her and her husband know that the room was in the process of being cleaned and we would come and get them from the waiting room as soon as it was ready. Dude takes his wife to the waiting room and then comes back to throw a cussing fit that his wife is having a baby and it is unacceptable to make her wait.
At this point we are all thinking, "OK jerk, everyone up here is having a baby and they are working as fast as they can to clean the room so your wife doesn't have to lay in a dirty bed or deal with a puddle of blood on the floor." Amazingly, everyone held their tongue and we escorted them to their new room ASAP.
One of the other nurses on the floor, Kelly, gathers her paperwork and heads back to her room to get her admitted while someone else makes to call to her doctor to let him know that we have one of their patients there (don't do this, call your doc first). While being admitted, Carol starts screaming that she feels like she has to poop, usually a sure sign that the baby will be there. Kelly yells down the hall for one or all of the midwives and then proceeds to check her cervix. Instead of finding a fully dilated cervix, she finds a prolapsed umbilical cord. This is the point where it hits the roof.
Kelly flips the woman over to the following position to try and relive pressure on the cord but the baby's heart rate is still slow so she crawls into bed and sticks her arm up the woman's vagina to support the baby's head and keep it from putting pressure on the cord, which was cutting of circulation completely.
The rest of us, literally every person on the floor, are frantically prepping the OR, getting anesthesia up there, finding any doc that is qualified to do a c-section, and getting Carol ready. In a matter of minutes, we are rolling her back to the operating room, on all fours in her bed with Kelly on all fours in her bed behind her, arm in her vagina, supporting the baby. Carol is prepped and draped. The drape thrown over Kelly as well, who is now under the sterile field still holding the baby. In less than 10 minutes from the cord being discovered the baby is out.

Now, back to the husband. The entire time is is standing outside of the operating room screaming that we haven't taken good care of his wife and that we didn't really need to do a c-section and how he is going to sue every one of us. Yeah a-hole, we had our hands up your wife's vagina, saving your baby's life and got her back to the OR in under 10 minutes because it wasn't necessary.

Tuesday, September 25, 2007

I'm scared.

I am not sure I can truly put into words the difference between a woman delivering with an epidural and one delivering without. Today, I delivered two women, both without epidurals and it was actually scary (and, if you were an outsider, a little bit comical).
I don't think I will ever forget the look in my patients eyes, like a wild animal about to be trapped. She grabbed my shirt and emphatically screamed, "I'm freaking out now." I had to stop, take a deep breath and then remind her to breathe as well. In the meantime, she is clamping her legs together, coming off the table and moaning that she can't push anymore.
"Alright sweetie, the baby isn't going to come out with your legs shut and the only way for you to stop hurting is to deliver this baby." Um, doc, can I get some support here?
I don't even know where to start describing the screams and pleas for help. The sense of urgency to get the baby delivered takes on a whole new meaning as you watch someone in more than the worst pain imaginable with only one solution.
All I can say is that I am not that brave.

Sunday, September 23, 2007

Birth Plan

Definition of Birth Plan:
- A written outline of a woman's preferences for her labour and birth.

My Definition of Birth Plan:
- A way to guarantee that you aren't going to get what you want.

I have yet to see a woman come in with a birth plan that ends up laboring according to her wishes. In fact, I have yet to see a woman with a birth plan that doesn't end up having a C-section. If I were going to get a PhD I might research why.
Take Lisa (chill, it's not her real name). She came in for an induction with the most horribly annoying three page birth plan that basically included no intervention at all. She settled herself in her room and then refused an IV, pitocin and having her water broken. At this point it was necessary to stop and determine if she realized what induction of labor was, and if she wanted no part of it, send her home to wait for labor to happen on its own. She decided to stay and for the moment, get an IV.
Over the next four days she caved to each intervention one by one. First it was starting some pitocin to get the contractions going. After she had been there 48 hours and nothing had happened, I am sure she was getting antsy. I wonder if she thought her labor would start just by showing up to the hospital. The next day it was having her water broken. After the contraction got stronger, as they will when you no longer have that cushion, she was begging for an epidural when she previously wanted no medicine for pain at all. A whopping four days after checking into the hospital for "induction of labor" with what she hoped would be no help at all, she was rolling back to the OR for a C-section. Maybe it is karma for people that try and control everything?
More to come on this subject as I develop my theories.

Wednesday, September 19, 2007

You've got mail.

As some of you may know, I took a direct hit of amniotic fluid to the eye last week. I got to spend over 2 hours in the emergency room having labs drawn (but mostly waiting) and the poor lady had to get stuck again for labs as well. I wish I had heard how the scenario was explained to her.
"Excuse me. Congratulations on the baby but we need to check and see if you have HIV since your nurse got your vag juice in her eye."
Luckily, according to my detailed lab results that arrived in the mail today, all is well.

Tuesday, September 18, 2007

I need to put a catheter in your bladder.

With every epidural comes a catheter, due to the new inability to feel the urge to pee. Those of us who are nice (and I am) wait a little while for you to start to go numb before inserting the catheter. Sometimes, a full bladder can keep the epidural from taking full effect and the only way to ensure you a wonderful epidural is to go ahead and get that catheter in in a timely manner.
If this happens to you, it will be OK. Having a baby isn't a cake walk, something I assume most people know from before the time they realize they are expecting their bundle of joy. Having a catheter placed is going to be the least of your problems. To ensure that we don't have to use 2-3 catheters, and to keep the procedure time down to less than an hour it would help if:
1) You do not jump 3 feet every time I touch you. I will tell you what I am about to do. Coming off the bed doesn't help.
2) Please don't scream that I am stabbing you. I'm not, I promise.
3) Please don't have a panic attack. Breaking sterility to get you an inhaler will only delay the inevitable and leave me seriously questioning your ability to get through the rest of your labor.

With these handy tips in mind, you catheter insertion should be smooth, quick and easy.

 

Tales from Labor & Delivery

Warning: If you have no sense of humor or tend to take things way too personally, this blog is not for you. If that isn't clear enough for you, see the disclaimer.

Disclaimer

The stories in this blog are in compliance with HIPAA regulation. Details have been changed to protect patient privacy. I am not talking about you. While I originally said opinions expressed are my own, at the time I wrote whatever you are reading, upon further consideration you may not be reading my opinion at all. This blog is for entertainment. All stories are slanted with the intent to amuse, if you are into that sort of thing. If you are looking for a blog about beautiful birth stories, there are plenty out there, keep moving. This blog is not meant to offer or substitute for medical advice (i.e. call your doctor).

 

http://itsababynotbrainsurgery.blogspot.com/

 

 

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 I’m Cranky, and These Labor Nurses Aren’t Helping

http://womenshealthnews.wordpress.com/2008/01/31/im-cranky-and-these-labor-nurses-arent-helping/

Posted by Rachel on January 31, 2008

Look, I know it can be helpful to members of every workplace or profession to blow off steam about their bosses, their clients, or whichever people make them crazy on a regular basis. However, I tend to think that kind of thing should happen privately, over beers, in person, rather than being posted online where all of your potential clients can see it.

Well-Preserved linked to this Rules of Labor and Delivery piece in the OB Nurses forum on CafeMom. Yes, I know it’s supposed to be funny. Yes, I know you have jobs that can be trying. However, when I see things like this, and then see other L&D nurses commenting on how hysterical and true it is, I hope as hard as I can that I’m never unlucky enough to be one of these folks’ patients. Sure, maybe they’re professional in person. I just don’t appreciate knowing the sentiment is there, underneath.

For example:

11. This day and time, if a patient is between the ages of 37 and 42… she has had approximatley 2-5 partners. If she is between the ages of 28-36, the average is 7. If she is in her early to mid twenties, then her age is how many partners she’s had… If she is a teenager, then “too numerous to count” applies. (and she has had, or currently has chlamydia or trich) 

12. Open your damn legs. If you were a virgin, you wouldn’t be here.

13. Shave that sh*t. If we wanted a trip to the jungle… we’d go there. 

15. You’d better be nice to your nurse. She, not the physician, decides when you get pain medication… There is such a thing as placebo. We can also make you wait the entire 2 hours… adding 45 minutes for our convenience… or we can give it to you 15 minutes early…. it’s all in your attitude.

16. The fewer visitors you have in with you… the better mood your nurse will be in. 

17. Get rid of that one “know it all” visitor before it’s too late. She can ruin the entire experience for you by pissing me off. 

25. If you’re an addict, we already have a preconceived notion about you, and we probably don’t like you. Nothing personal… it’s just the way it is. You chose that life… now live it.

30. Don’t scream. We hate screamers. It get’s on our nerves and we just sit at the desk looking at each other and grinning and making faces. It’s not to your advantage.

In one fell swoop, we have assumptions about sexual history, disregard for drug addicts who may actually need their help, rude comments about women’s bodies, a threat to withhold pain relief, and general threats regarding visitors. If that’s seriously how you look at your patients, get out of the business. It’s not funny.

Update: It looks as though they’ve made the group private overnight so the forum posts cannot be seen. I’d say it’s a little late for that.

11 Responses to “I’m Cranky, and These Labor Nurses Aren’t Helping”

  1. Emily Says:
    January 31, 2008 at 5:48 pm

I have a nagging suspicion that nurses and dr’s believe this stuff when I say something and they have that “blank” nod and semi-smile that really wasn’t anywhere near as comforting as they probably thought it was. That’s around the time I stop co-operating. I feel safer left to haemorage than facing this sort.

  1. Labor Nurse Says:
    January 31, 2008 at 7:16 pm

The sad thing about this is that for some nurses, its true. But I take offense that the person posting this assumes all nurses in labor and delivery feel this way. Here are my responses to the above list:

11. I don’t ever ask my laboring moms how many sexual partners she’s had. All I care about is that she’s going to have a baby, and that she doesn’t have any current infections.

12. While we all know that the only immaculate conception occurred many years ago, there is still such a thing as modesty and just because a woman is pregnant doesn’t mean she is ready to spread her legs to the world. On the other hand, you can’t give birth with your legs crossed, and so we need you to open up for that.

13. Who cares? I know more nurses bothered by a woman who hasn’t cleaned herself like… ever.

15. Wow. This is just unethical, and reportable to the Board of Nursing. I think this nurse has it all wrong… who wants to care for a woman who’s losing her mind because of her pain? I want to give these women the pain medication ASAP if they are asking for it!

16. & 17. Of any of these, I’d say that many nurses would agree. I say ignore them if it’s that bad.

25. People who believe this don’t belong in healthcare. This is an ignorant attitude. Shame on them! Yes, an addict may have initially chosen to take that drink or do that drug, but they didn’t chose to be addicts. No one does. Addicts are people with incredible emotional pain, and they need our understanding.

Thanks, Rachel, for letting me rant!


  1. January 31, 2008 at 7:19 pm

For 9 years, I worked with nurses on the administrative end of things in both a non-hospital and hospital setting…they can be some of the most kind-hearted people; and yet I have also worked with some of the most non-compassionate, jaded people who didn’t deserve the title RN, as well.

I’m glad somebody got on that thread and called them out for it.


  1. January 31, 2008 at 7:25 pm

Labor Nurse, I knew you’d have something to say about this one. Your responses are quite heartening.

  1. Katherine  Says:
    January 31, 2008 at 9:08 pm

Even though I’ve never had a baby, I’ve been around a LOT of nurses. I’ve actually got a bit of nursephobia, because I think that what Ginger said is spot on.

  1. Rachel Says:
    January 31, 2008 at 9:37 pm

Don’t get me wrong, I’ve had some fantastic nurses - the recovery nurse who was with me when I woke up in pain and afraid after thyroid surgery will always stand out in my mind. Those fantastic nurses, though, were not just technically competent - they were caring, compassionate, and comforting, something the L&D list above clearly does not display.

  1. Katherine Says:
    January 31, 2008 at 10:51 pm

Oh, I’ve had some very wonderful nurses. In fact, my rheumatologist’s nurse is now one of my favourite people. She actually CALLS ME to make sure that I’m doing okay with my medication regimen. And she’ll stay on the phone for 10 minutes to talk me through things. That’s phenomenal.

I’ve also had wonderful nurses in the ER and during various stays in the hospital. I’ll say, though, that for every 5 great nurses I’ve had 1 AWFUL nurse. For some reason the awful ones stay with you…

  1. snikta Says:
    February 1, 2008 at 9:30 am

Rachel,

When you do eventually have children, you need to do it in Morristown. Our L&D nurse, Debbie, is the absolute best nurse in the entire history of medicine, and she will not ever lose that title. Sorry, Labor Nurse.  A good nurse is so important in any medical situation, but I think the need is amplified with birth. Debbie was never far away, but never obtrusive when she was in the room. She was always welcome by us, and welcoming to our visitors. She knew our needs long before we did. She really made the experience (the labor part) wonderfully pleasant. And I know that an incompetent nurse would have made us miserable.  I applaud all nurses. They are the often unsung heroes of the medical profession, and are terribly underpaid. They provide most of your care and doctors would be lost without them. A good nurse is the best thing in the world.

  1. amazonratz Says:
    February 1, 2008 at 10:54 am

As a nurse (practitioner) it makes me really angry to see this kind of disrespectful crap in print. I am certainly guilty, as are most of us, of the random un-PC thought or even a comment, but this list displays a disregard for the patient’s humanity (and a disturbing misogyny) and makes those nurses look very uncaring. Sometimes judgement about what is humorous and what is cruel is not apparent. The “angel of mercy” stereotype of nurses is overblown and cliched–we’re not all selfless angels, but this portrayal is truly unfortunate.
I’m not into religious references as a rule, but I say this nurse ought to, “Judge not, lest ye be judged.” What goes around, comes around.

 

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The Last Taboo

By Kristine Soedal

It would seem that, with the many talk shows talking and talking and talking about everything under the sun, there could be no more taboo subjects in our society. But there is one! If you would like to watch someone become squeamish and try to disappear as soon as possible, ask her if you could tell her about birth trauma. Are you still there? Most women who feel the need to talk about negative or painful aspects of their childbirth are met with impatience and a reply along the lines of, "You should be grateful" or "At least you had a healthy baby." Not wanting to appear ungrateful, and not able to share something so painful with someone who won’t understand, anyway, these responses are effective at shutting us up. What a relief for the listener, to be able to turn off a troublesome topic and focus on the cute baby instead. 

Unfortunately, it is not as simple as that for the mother. Women who feel traumatized after childbirth (or events during pregnancy or postpartum) share similar symptoms to war veterans or victims of rape or abuse. Their nervous systems have been overwhelmed and overstressed beyond capacity, and now there is damage to live with. Someone can just as well say to an amputee, "Grow back that limb!" as say to a woman suffering from Post-Traumatic Stress Disorder after childbirth, "Just get over it!" The woman can’t just get over it. In fact, she must learn to live with a host of debilitating problems and meet the demands of motherhood at the same time. It is a task worthy of a medal.

Some PTSD is the result of true medical emergencies that occur either during pregnancy, birth, or postpartum. These women, along with the normal symptoms of PTSD, might suffer from intense fears of a baby dying again, or their body malfunctioning again. They may feel anger or rage toward God or life in general. Also, anxiety may be triggered every time something reminds them of the trauma, such as hearing ambulance sirens.

Unfortunately, huge volumes of PTSD are inflicted by health care providers, themselves, and could be prevented. Many, many women who write in to web groups about birth trauma are broken hearted about the way they were treated during childbirth. Penny Simkin, one of the founders of Doulas of North America, found in her research that a women’s "level of satisfaction is strongly associated, not with length of labor, with complications, or whether they had drugs for pain relief, but with the way they were treated by those caring for them." (Rediscovering Childbirth, Sheila Kitzinger, pp 126). Because of this, I am a huge believer in the benefit of doulas.

Sometimes emotions become jumbled, too, such as in the case of a woman who experienced her esteemed health care provider gallantly saving her life during a dangerous uterine rupture, only to find out later that he caused it in the first place by giving her the drug Cytotec. Birth trauma can include a whole range of conflicting emotions and fragmented memories that accumulated over the course of a labor.

Another sufferer of birth trauma and I were talking one day. She said that she felt unjustified in being traumatized when her health care provider, a woman she didn’t know except by a poor reputation, rolled her eyes at her when she asked a question. We agreed that she could probably lay down on a hospital bed today and be treated in exactly the same way and it would be more annoying or pathetic than traumatizing. The whole mixture of being at the end of a pregnancy, full of hormones, in labor, concerned for our babies, afraid of pain, having our "care" turned over to someone we don’t trust, and not knowing what to expect, makes us particularly vulnerable and inflexible. Something that can seem minor to an onlooker can devastate a laboring woman.

I am very concerned for women who become victims of the hospital "birth machine." I know there are many fine and caring doctors and nurses, and many people have good experiences in hospitals. However, there are aspects of hospital birth that sometimes devastate women. Many women feel hurt by medications and procedures that they wouldn’t have agreed to had they understood the risks. Worse, many have had them done to them without their consent. Likewise, they fall prey to the mentality that most women need to be induced and hooked up to machines in order to give birth. Others get the doctor or nurse who is going through a personal crisis or is just not "with it." Or they may get a health care provider who is over-extended, exhausted, burnt out, disgruntled, or inadequately trained. Some women are victims of understaffing, and suffer neglect during a very vulnerable time. There are just so many wild cards in hospital birth.

My personal goal is to see the home-birthing midwives’ commitment to providing supportive and nurturing care permeate hospitals. Midwives seek to protect women’s emotions, instincts, and desires, creating an environment that makes women feel strong, capable, and valuable. The word most used to describe birth in this kind of atmosphere is empowering.

Another vital difference between hospital birth attitudes and home-birth attitudes comes after the birth. A woman wishing to talk over an aspect of her birth with a doctor or other hospital personnel soon finds herself a victim again, of stonewalling. Stonewalling is the particularly American tradition of health care providers refusing to admit mistakes in order to try to avoid lawsuits. A sufferer of PTSD after hospital childbirth is denied any healing balm of understanding or apology. In fact, she may be subjected instead to personal attacks and humiliation. Home-birthing midwives, in general, are willing to own up to their mistakes and give their clients valuable debriefing time.

My conclusion from all of this is that it is vitally important for us to educate ourselves so that we’re prepared to face the challenges of labor and delivery, and the pitfalls, of all our choices. A situation that we are prepared for will not be as traumatizing as one that takes us by surprise.

Homebirth.us

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