Do you want a natural birth? What are you going to do about it?

I came across this article this evening, and thought it was a pretty insightful and helpful take on the reason why so many women don't end up with a natural birth when they said they wanted one. It's a US article, but I'm guessing the circumstances are true in a lot of places.

This is from the Banned From Baby Showers blog, by a guest poster named Shazia.

Hospital Nurses and Natural Birth

A few weeks ago, I was in the emergency room with my son, thinking he had a staph infection. Long story short, he didn't. But it was an eventful night, to say the least. I heard a nurse on the phone with a doctor, panicked, as a baby boy was bleeding profusely from a circumcision-gone-wrong (I don't know what happened - he was still bleeding when we left) and was quite traumatized. I also heard a room full of nurses talking about labor and birth. I posted a few of the things on my BFBS Facebook page I heard (which were quite crazy if you asked me), and one of my former students-turning-Birth-Boot-Camp-Instructor, who happens to be a nurse, asked if she could write a blog post for Banned From Baby Showers about why nurses know so little about birth. How could I refuse? Thank you, Shazia, for helping us understand, not only the situation, but how we can improve the current state of affairs.

I have heard many stories from moms about a nurse being unsupportive and discouraging of natural birth. Perhaps you may have had one of these nurses attend your labor. I am a registered nurse and even I encountered a less than helpful nurse during the birth of my son at a local hospital. Nurses are often very knowledgeable and supportive of evidence-based practices in other specialties. If natural birth is evidenced to be the best option for achieving optimal outcomes for both mom and baby, why are some nurses unsupportive and even discouraging of natural birth? I hope to answer that question from a nurse’s perspective in this post.
A nurse’s knowledge base comes from their education and their experiences. To help me write this post, I polled several other nurses who work in various specialties and attended different nursing schools. I have my BSN from the University of Texas at Arlington. I went through a wonderful nursing program that consisted of 120 course hours. Birth was discussed in one 4 hour course. The course was a general women’s health course that covered pregnancy, birth, and the neonatal period. I was blessed to be taught by a Clinical Nurse Specialist who had homebirthed her own children and a Certified Nurse Midwife.
Not every nurse was so lucky during their nursing education. Some nurses that I polled stated that birth was such a small part of their nursing curriculum that they learned very little about birth. Some nurses said that birth was discussed more in depth, but comparing common maternity practices in the United States and evidence-based maternity practices were not part of the discussion. Not teaching evidence-based practices seems ridiculous to someone outside of nursing, but nursing schools in the United States are preparing nurses to work in healthcare settings in the United States. Labor and delivery nurses attend hospital births. Our hospitals do not routinely practice evidence-based maternity care. Nurses in the United States are expected to assist with planned cesarean sections, elective inductions, epidural anesthesia, and other medical interventions in birth. Unfortunately, that is what hospital birth looks like in our country. Natural birth that is intervention and medication free is rare, and most happen out of the hospital. Many labor and delivery nurses, much like obstetricians, have never observed a natural birth. In order to prepare a nurse for the patients and procedures she would encounter on a labor and delivery unit, the natural birth process is not always a priority for educational institutions.
I also polled a few nurses who work in labor and delivery. Their input was insightful. They verified that natural, intervention free birth was a rare occurrence on their labor and delivery units. They stated many moms came in to the hospital with a birth plan to have no pain medication and limit medical interventions. However, the majority had done NO preparation for their birth, other than typing out a birth plan. They said most of their coworkers view the birth plan as a joke, because most of the moms who write them end up asking for everything they wrote they did not want. One of my professors in nursing school said that you can plan all pregnancy long, but it means nothing if you don’t prepare. If you don’t take the time to prepare, you might as well forget the planning too. It’s like writing down that you are going to make an A on the test, but never actually studying for it.
When a mother is not prepared for birth, but seeks a natural birth, the demands of their nurse are drastically increased. Nursing units are often understaffed and nurses are overworked. There is a tremendous demand on a nurse when a mother is not prepared for birth, a father is not prepared to be a birth coach, and a doula isn’t present to assist mom throughout the birth process. This can create animosity towards the patients that seek a natural birth, but due to lack of preparation rely on their nurse for all of their needs during labor. Even though more women are asking for a natural birth in the hospital, many still end up with unnecessary medical intervention due to their lack of being informed and prepared. Unfortunately, this means that even labor and delivery nurses lack experience in the natural birth process, because the majority of patients are not giving birth naturally. They also doubt the ability for women to birth naturally, because they see many unsuccessful attempts. When a well-prepared and well-informed mom comes in to the hospital, they are often faced with judgment and animosity because they are categorized with the moms who aren’t prepared and informed. They assume that they will be unsuccessful also.
What can we do about this and how can we ensure that women having a hospital birth have supportive nursing staff? We can demand evidence-based practices. We can choose doctors and hospitals that have practices in place to support the natural birth process. If we demand better care during our birth and evidence-based practices, we can work towards a society where medical staff at hospitals have seen natural birth and are experienced assisting moms who wish to avoid medical interventions and are well-prepared to do so. If we continue to blindly follow bad medical advice and fail to advocate for ourselves, hospitals will continue to utilize their policies that inhibit mothers from achieving the type of birth they want. The more we demand for better births, the more experience nurses and other hospital staff will have with natural birth.
If we can change the way women choose to birth and prepare them well, we can change the way our hospitals handle birthing women. If more moms educate themselves and prepare for an intervention free birth, we can ensure that our labor and delivery nurses gain experience with the natural birth process. If we change the norm of birth in our society, the nursing schools in our area will also have to change their way of teaching to prepare nurses who want to go into labor and delivery to effectively provide care to a birthing mom.
~Shazia from Above & Beyond Birth blog can also be found on Facebook.

I agree with this article in that women do need to prepare for a natural birth by making sure they are informed by reading as much as they can and also by having a good birth partner who they trust and can voice their needs and wants when the woman is unable to.

But i also do believe that care providers need to play a vital role in achieving a natural birth as well if that is what the mother desires. Not once has the labour and birth of my child been discussed with my midwife. I really think this is something that needs to change.

I was fortunate with my first birth that I had fantastic midwives and my husband who had absolute confidence that I could labour and birth without intervention, even when I was asking for an epidural and to just suck the baby out of me NOW! I definitely did not want those things but in. The heat of the moment said that I did. I am sure this happens to many women during childbirth and labour.

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But i also do believe that care providers need to play a vital role in achieving a natural birth as well if that is what the mother desires. Not once has the labour and birth of my child been discussed with my midwife. I really think this is something that needs to change.
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I agree with you, that the nurses/midwives/ob's should be prepared and able to help a woman have a natural birth, but I guess what the article is saying is that the reality right now is that they aren't. So you've got to line up your own resources (doula, birth classes, etc.) if you really want to succeed. When I had my first, our local hospital did not do epidurals. Those nurses knew how to support a labouring mother! They helped me make it through. But, now that epidurals are available, I think it's going to be easier and easier to just say "here, have the drugs, we'll check on you again in a few hours" and go back to whatever they were doing.
And, in a busy hospital, there simply might not be enough staff to give proper support to all the women in labour!
So while things should change, and we should advocate for change, if you want to succeed NOW, you'll have to prepare yourself well.

Unfortunately, preparation can only get you so far. Unsupportive carers are like a brickwall and sometimes it doesn't matter how well informed you are, or how well you advocate for yourself.

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Unfortunately, preparation can only get you so far. Unsupportive carers are like a brickwall and sometimes it doesn't matter how well informed you are, or how well you advocate for yourself.

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Agree with that 100%

True, sadly enough. But it still remains that if you have a good doula, and really know what birth is about, and have some alternative pain management techniques at your disposal, and have researched enough to decline interventions you don't need, you are likely to get farther than if you just go in unprepared, hoping for a natural birth.

Wow! This is referring to the american system of using nurses in maternity wards. Thank goodness australia uses midwives at least! I can't believe they have no birth training!

Any registered nurse can be hired on a birthing unit. However, when I was in school to become an RN, it was obvious that it was a floor that a lot of the nurses wanted to work on, and competition for jobs there was pretty tight. So if you had extra training, with special courses you took yourself relating to labour, delivery, and neonatal care, you'd have a real advantage, but of course, as with most things, if you know the right people, you could be hired to that floor without special training. Also, ongoing professional development is a requirement to maintain your license to practice. There are people who get by with the bare minimum, and people who are truly passionate about their job and want to learn to do it better.
Is a US/Canadian midwife the same as an Aus midwife? In Canada, a midwife practices independently, like an ob, but with low-risk clients. Our local practice, for instance, has 4 or 5 midwives who work in the office together. Each client is assigned a primary and secondary care midwife, who do all the prenatal care, and both will attend the delivery, whether at home or in hospital. If you deliver in hospital, the labour and delivery nurses will not be part of your care - just your midwives. Whether you choose an ob or a midwife, a home or a hospital birth, your care is totally covered by the provincial health care plan. It's pretty nice in that way!

This makes me angry.

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When a mother is not prepared for birth, but seeks a natural birth, the demands of their nurse are drastically increased. Nursing units are often understaffed and nurses are overworked. There is a tremendous demand on a nurse when a mother is not prepared for birth, a father is not prepared to be a birth coach, and a doula isn’t present to assist mom throughout the birth process. This can create animosity towards the patients that seek a natural birth, but due to lack of preparation rely on their nurse for all of their needs during labor. Even though more women are asking for a natural birth in the hospital, many still end up with unnecessary medical intervention due to their lack of being informed and prepared. Unfortunately, this means that even labor and delivery nurses lack experience in the natural birth process, because the majority of patients are not giving birth naturally. They also doubt the ability for women to birth naturally, because they see many unsuccessful attempts. When a well-prepared and well-informed mom comes in to the hospital, they are often faced with judgment and animosity because they are categorized with the moms who aren’t prepared and informed. They assume that they will be unsuccessful also.

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"You come in and we laugh at your birth plan: you have a vague idea but haven't prepared, so when we push drugs and interventions you just accept them, cos you're more work if you don't just let us yank the baby out when we want. You need to bring an advocate (doula) in with you because we won't listen. And we use words like unsuccessful to describe your birth and further destroy your self-esteem when you had prepared and we just pooh-poohed you."

Pretty much sums it up.

Demand all you want - you still won't get to give birth if you approach a medical person about it.

Ive been 'lucky' to have great careproviders and a fantastic support person, who knows what I need to hear while birthing.

Er... I nurse with 120 course hours?? 4 of those focussed on obstetrics? An RN in Australia currently studies for 3 years and has a degree at the end of it. A midwife studies for 3 years or 4 if doing a combined degree. I don't really understand the US system, but regardless of which birth model I choose, I would hope that my primary caregiver has more than 120 hours total education under their belt.

Yeah the whole nurse/midwife thing intrigues me.....are they saying that all staff working in l&d wards are nurses with the standard nursing training or is it a name thing where they call the staff a nurse but their training is in line with what we call a midwife. Or are there nurses and midwives on the wards and the article only talking about the nurse component of the staff? If it literally nurses with standard nursing training and obs, that does seem to present a huge gap in the knowledge and skills in the delivery room?

But I can understand the gist of the article, if you want something to happen you need to furnish yourself with knowledge, strategies and support, but you also need a healthy dose of good luck in positioning, cord, placenta and cervix condition, etc etc.

Is it kind of a symptom of the quick fix culture we have, you know we want to loose weight without the effort and time and patience, we want to pay some one to fix our problems instead of learning how to do it ourselves.......does that equate to we want a natural birth and we are going to rock up on the day, lay on our backs, not take the many coping strategies available out there into consideration or take them seriously? I guess I don't know if that is how it happens in American hospitals on the whole, what I've seen on OBEM US version could be described as that.........

im not 100% sure but do know a l&d nurse is different to a midwife. and i think a majority of staff in the hospital are l&d nurses.

Just like to point out that they're not all bad, I went into a public hospital with little knowledge and no doula and my midwife, nurse and dr (yes, I said DR!) we're incredibly helpful and encouraging of a natural birth in every way. The fact that it was 9pm new yrs eve and very busy in the hospital when I arrived and I was still labouring by midday new yrs day didn't change the flawless care I was given.
Drs and nurses in aus wouldn't go through the yrs of study and training with little to no income if they weren't actually there to help...

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Drs and nurses in aus wouldn't go through the yrs of study and training with little to no income if they weren't actually there to help...

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stranger things have happened.

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Just like to point out that they're not all bad, I went into a public hospital with little knowledge and no doula and my midwife, nurse and dr (yes, I said DR!) we're incredibly helpful and encouraging of a natural birth in every way. The fact that it was 9pm new yrs eve and very busy in the hospital when I arrived and I was still labouring by midday new yrs day didn't change the flawless care I was given.
Drs and nurses in aus wouldn't go through the yrs of study and training with little to no income if they weren't actually there to help...

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That's awesome to hear a positive story :)