17 different women, 36 crazy children, 0 babies in utero
Adventures, Advice and Questions from a group of Mormon women who met in Queens, NY and have now scattered all over the place.

Thursday, October 04, 2007

Your L&D Nurse: Your Best Friend

I interviewed my sister, Katie, recently on a family vacation. Katie is a labor and delivery nurse for a large hospital in Portland, Oregon and has a lot of good advice for expecting moms to make the most of their birthing experience.

Q: What should you bring (and not bring) to the hospital in terms of helping with the delivery?
A: This depends on the hospital. Check beforehand to see if your hospital has CD players and DVD players available in their birthing rooms. Especially if you are having an induction and it might be a long labor, you might want some distractions along the lines of movies and music. Don't bring anything valuable (you shouldn't even need your wallet). Bring something to eat for after the delivery. You will probably be hungry and not all hospitals have a great selection of foods between meals.

Q: What should your expectations of your L&D nurse be? (What is realistic and what isn't?)

A: Availability of your nurse will depend a lot on how busy the day is for the nurse. Don't hesitate to call a nurse if you have questions, need to use the restroom, are hungry or have another important need. At the same time, try and be organized about your requests and fill multiple needs/ask questions in the same visit. Your guests should never make demands of your nurse (meaning they are not waitresses or gophers there to serve your family and friends. Oh... the stories Katie has told me about obnoxious guests!)

A good nurse should be on top of your pain management, and support you physically and emotionally during the last stages of labor. Nurses should never tell you what to do, but help you make an informed decision concerning the birth of your baby by presenting options and potential scenarios. Finally, they should respect your decisions.

Q: How can making a birthplan be helpful?

A: Birthplans are helpful in communicating your desired birthing experience to your doctor beforehand. However, many women get too set in their birthplan and resist alterations to it that will ultimately be better for her and the baby. It is not uncommon for women with stringent birthplans to end up having emergency c-sections when they won't adjust their plan and suddenly the baby is distressed. One common example is when women refuse petocin when they have been ruptured for a long time, which can cause infection and results in the doctor performing an emergency c-section to protect the baby. Katie suggests that if you have a birthplan and the doctor suggests straying from the birthplan, to talk out each decision and assess if it will ultimately help you achieve a better birth.

Katie's opinion on....

episiotomies... sometimes they are necessary to get the baby out quickly (such as the instance when the baby's heart rate drops) in order to avoid an emergency c-section. However, episiotomies performed to prevent tears are not very effective. The episiotomy usually takes longer to heal than the tear would have. Episiotomies are essentially SURGERIES...so your doctor should ask for consent beforehand, but in Katie's experience, that doesn't usually happen. Katie suggests discussing your preferences beforehand with your doctor, but that doesn't guarantee you won't end up with one....especially if your baby goes into distress

going to the bathroom (or passing gas) during labor...Katie says it's nothing to worry about for many reasons. First of all, there is a good chance you will and you won't have any physical awareness of it. Second, if you are consciously trying not to poop or pee, you probably won't be able to push the baby out very effectively. Finally, doctors and nurses see it every day and think NOTHING of it. So basically, you should never worry that the hospital staff will be snickering behind your back if it happens.

having a doula....Katie thinks there are a lot of advantages to having a doula during labor, especially if you want to have a natural birth. A doula will be well-trained in coping techniques and will be able to help you with effective pushing and positioning. A doula will be by your side the entire labor, whereas your nurse will likely be responsible for multiple patients. Studies have shown that doulas decrease rate of c-sections and increase the overall satisfaction of the birth experience. If you don't want to pay for a doula's services, you can always check with your hospital for a list of volunteer doulas. Often, there are doulas-in-training who need to fill clinical hours.

Final note from me: Yeah for L&D nurses!!! I was lucky to have amazing nurses for the births of my boys and it made such a difference in my overall birthing experience. Much more than my doctors, my L&D nurses were great advisors and cheerleaders along the way. I still remember after Asher's birth when my nurse showed me my delivered placenta and complimented me on how healthy it looked. "Gee, thanks!" I think I said, not exactly sure what the appropriate response should be when you are complimented on your placenta...


  • I must say that I was so lucky to have 2 fabulous nurses for the deliveries of both my kids. For ds's birth I had a male nurse, he was so great. He really helped my husband be more comfortable with all the things that were happening. And he was so calm and comforting to me when I was wanting to freak out. The nurse that I had during my dd's very quick delivery was also wonderful. She didn't leave me once, it was very scary to me how quick things were going and she was there to help me through all of it. And after when dd was having a little trouble breathing she stayed by my side and kept me informed of what was going on.
    I think that L&D nurses have a really cool (but tough) job.
    posted by Blogger Moddy at 10/04/2007 11:56:00 AM  

  • Thanks, Moddy. Honestly, I had never heard of a male L&D nurse. So awesome! I never thought what an advantage that would be from a husband's point of view.
    posted by Blogger Jen at 10/04/2007 12:04:00 PM  

  • I appreciate the perspective that your nurse should be on top of your pain management, etc. I went through several shift changes and the nurse I had when I got my epidural didn't believe me that it wasn't working-she kept trying to change my position and kept telling me it was "pressure" :) and I was in pain for four hours before the next nurse checked out my epidural and found out it wasn't working!

    One thing that I found at my hospital was that some L&D nurses were "experts" at different subjects: some were good with neonates, others with laboring positions, delivery, etc. Of course I had a neonate expert during delivery and a delivery expert when my baby wouldn't latch on the next day to nurse! :) They were all good at everything but did have specialities.
    posted by Blogger Liz&Meg at 10/04/2007 04:53:00 PM  

  • What a great post! As a nurse, I was far more critical of my L&D nurses than I should have been. I guess I thought I knew so much. I must have been so annoying.

    I agree with Katie about being organized with your requests. Most nurses have more than one patient at a time and some hospitals also have the L&D nurses running the nursery. I think it's also wise to be informed. Birthing mom's have every right to know what the Dr.'s and nurses are doing and what is happening during each step of labor. If you have no idea, just ASK.

    Also, when I had my last baby I had a terrible nurse, so I kindly asked for the nurse manager and requested a different nurse. If you get a bad vibe or feel that you are put in danger, get a new nurse! This is an experience and a person you WILL remember forever!
    posted by Blogger Krista at 10/04/2007 07:14:00 PM  

  • I think because I had a midwife for the first two babies, I don't even remember my L&D nurse. This time around, it looks like I will be using an OB/GYN so I have seriously thought about employing a doula. Nice to know there might be a list of doulas out there who might help me deliver for free.

    Tell your sister thank you for all her valuable information!
    posted by Blogger TftCarrie at 10/05/2007 08:53:00 AM  

  • Question for all you pros. How can I ensure my nurse(s) will help me stay on top of my pain management?

    Everyone warned me how quick hospitals were to give drugs, but I had to beg, and cry, and curse for anything to happen. The nurse kept telling me I was 'too close' to delivery for an epidural. Yet previously my doctor had told me that the only true 'window' of opportunity for an epidural closes when you start pushing. What do you all think?

    After using some choice words, (since you are all ladies I won't repeat them), the nurse called the anesthesiologist, and he came an hour later, (to be fair he was in the ICU for an emergency surgery on a little one). By then my doctor had arrived, I got my epi., and started pushing 15 minutes later. Even though I didn't go completely numb it really gave me just that little bit of relief I needed to push my kid out.

    I think the trauma of not getting the pain meds I asked for was probably worse than the actual pain.

    Anyway, do I really need to ask super early on? Did I just progress too quickly? I labored for about 6 hours in the hospital, and told them when I checked in I would want an epidural. I completely assumed I would have one when I wanted it.

    I am due in a few months with #2 and don't want to repeat what happened with #1.

    (side note--the hospital I deliver at is quite small and there is usually only one anesth. at a time working)
    posted by Anonymous Tally Girl at 10/05/2007 09:49:00 AM  

  • My L and D nurse was AWFUL. Her accent and the volume of her voice, and her hair color just put me over the edge. AAAAAAAAAAAH...I can't even think about her....
    posted by Blogger Kage at 10/05/2007 10:15:00 AM  

  • I've never had kids but I think I'll just tie my tubes now to avoid freaky looking L&D nurses who refuse to give meds. Hahaha. Oh the joys of womanhood.
    posted by Anonymous Anonymous at 10/05/2007 11:59:00 AM  

  • Jen and Katie - thanks for the info.

    Carrie - was that an announcement? Am I out of the loop and am the only one who didn't know? Congrats if you're pregnant and if not, sorry I'm starting a rumor. :)
    posted by Blogger rebecca at 10/05/2007 12:12:00 PM  

  • Tally Girl - I'm not sure on that one. In my experience it did take a while from the time I said I was ready for the epidural until the moment that the anesthesiologist actually showed up in my room. But it seems to me that if you told them you wanted one when you got to the hospital, you should've been able to get one. Maybe they thought you were handling the pain well and that you had changed your mind or something? Maybe Jen's sister will have some advice.

    I had three different L&D nurses. The one who helped delivery my baby was AMAZING. I loved her. Another one told me that she didn't like my DR. and "why did I choose him?".... WHAT???!!!! Who says something like that to a pregnant woman hours into labor?! The other nurse I had must've had a lot of other patients because she was frazzled, and I had questions about my epidural and she DID NOT want to take the time to answer them. I the midst of my pain I seriously felt like I was about to say some not-so-nice things to her. But oh well, at least the nurse who helped deliver DS was wonderul and I was so grateful for her. Why does it have to be so "luck-of-the-draw" though?
    posted by Blogger Beth at 10/05/2007 01:15:00 PM  

  • Tally Girl - I think you're concern about not getting pain medication when you want is very common. It is really unfortunate you had such a bad experience with your first labor. Ideally, you should be able to get an epidural whenever you want. At our hospital, the only time it is too late for an epidural is once the baby is coming. I've even had patients get them after they are complete..as long as they are able to stay still. The fact that you are delivering at a small hospital does make a difference. You have to plan ahead. If you know you want an epidural, and especially if you labors go quickly, find out if they are willing to place an epidural right away and wait to put the medication in. I do not know if all hospitals will do this, but at our hospital, if the anesthisiologist knows they will be busy later and the patients wants an epidural, they will put the catheter in (which is the longest part of the process), then it is very quick for them to come back and hook up the medication. Another thing to remember is that there are other pain control methods that do not involve an anesth. There are IV drugs. It is important to know that with those, they cannot be given too close to the delivery of the baby (often not after 8 cm). There is also something called a pudendal block. This is an injection of medication in the pelvic nerves. It just numbs the lower pelvis area and is done by the OB doc. This can often give a person just enough relief to make it through the end stages of pushing when nothing else can be done. It doesn't last a long time though, so is usually not done until the end. My advice would be to talk with your md/cnm about the pain control options at your hospital and have a plan ready. Hopefully things will go better the next time around.
    posted by Anonymous Jen's sister at 10/06/2007 02:42:00 PM  

  • I had c-sections with both of my kids (long labor with first that ended in c, scheduled c with second). I was nervous about getting an epidural with the first, so my angelic L&D nurse suggested what I think was Demerol? WOW...that's some crazy smack. Made me hallucinate...so we discontinued that and eventually she held my hands while I got an epi. She was so kind while I was a wreck - really great nurse. I delivered at a large hospital in Manhattan - I had zero problems with pain management and getting drugs when I wanted them.

    Second hospital was in San Ramon, CA right outside San Fran. Again, no problems with pain management and great nurses.

    I count it among my many blessings that I had great L&D nurses for both births.
    posted by Blogger Chloe at 10/06/2007 11:31:00 PM  

  • One eye had orange eye shadow the other had pink. I couldn't even look at my L&D nurse without getting dizzy this last time around!
    posted by Blogger colds1 at 10/07/2007 10:03:00 AM  

  • Thanks so much for the advice! Here's one last question regarding drugs. I don't know much about i.v. drugs, but is there one that has less side effects than another? (Especially in the vomiting department)

    I throw up pretty easily, even on Nyquil, and people have mentioned that the i.v. drugs wacked them out. I don't mind the feeling of being loopy, (I love my visits to the dentist with laughing gas), but I'm guessing it probably isn't fun to be vomiting during labor.
    posted by Anonymous Tally Girl at 10/07/2007 12:14:00 PM  

  • Tally girl, moraphine makes me throw up - it's horrible. It also makes my skin crawl - I DO NOT recommend moraphine after giving birth...
    posted by Blogger Chloe at 10/07/2007 02:15:00 PM  

  • Around here, you WILL need your wallet. All the hospitals require both a current insurance card and picture ID upon admission. So don't leave the wallet home.
    ALso, around here, hospitals will not refer to doulas AT ALL, claiming liability concerns.
    Your best bets for finding a free or low cost doula are:
    -visitng www.bellywomen.net
    - Contacting DONA (www.dona.org)for a list of all non-certified members in your area (only the more experienced, certified doulas are listed on their site)
    -Finding out if you have a local doula trainer through DONA or CAPPA www.cappa.net and contacting her for names of brand new doulas.
    Amen to everything else said here!
    A long-time doula
    posted by Anonymous Anonymous at 10/07/2007 07:44:00 PM  

  • Tally Girl, if you get nauseated easily, let the nurses know. They may be able to give you something for that.
    posted by Blogger Sara at 10/08/2007 04:50:00 PM  

  • Tally Girl - It is hard for me to give advice on the IV drugs. It depends on the hospital as to which drug/drugs they offer. The IV drugs given while you are in labor are different then ones you would get after a c-section. They are short acting because they do go to the baby. (so it is important for it to be out of your system before baby is born). If the baby is born while it is still in his system, he can have some trouble breathing. Other than that there are no other effects to the baby. In my experience, the one we use, Fentanyl, does not cause much nausea. It mostly makes people a little dizzy and sleepy. We give ours every hour (if the patients wants) but it does lose its effectiveness the more you get it. IV drugs effect everyone differently, so it is hard to say if one would make you nauseous unless you have tried it. Many women experience nausea and vomiting with labor (not as a side effect to any drug) and it is completely normal. It is true that you can get something for nausea from your nurse. Often these drugs will make you sleepy also. I hope this helps a little.
    posted by Anonymous Jen's sister at 10/09/2007 07:54:00 PM  

  • carrie, i think we live close to each other? close to disney and in la? anyway, i had a phenomenal midwife earlier this year and am a doula myself. are you already settled with a provider?
    posted by Anonymous makakona at 10/11/2007 03:03:00 PM  

  • makakona,

    I have my first appt. next week. E-mail me at talesfromthecrib at gmail dot com if you can. I would love to talk with you.
    posted by Blogger TftCarrie at 10/11/2007 03:09:00 PM  

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