interventions, nurses, and sibley

[Anonymous]

I'm all for natural birth. Had my first induced and then an epidural and decided that I didn't want the same experience the second time. I have had a natural birth in a hospital since and can honestly say it was far better.

We (as a culture) have medicalized birth. The nurses don't want to listen to your opinion on their L&D protocol anymore than they want to listen to your opinion on the best way to perform a kidney surgery. They are just there to do their job, part of which is doing their best to enforce hospital policies and doctor's orders.

The best way to avoid issues with the hospital is to not spend very much time there. You could get a doula and stay home until you are further along in labor.

[Anonymous]

I understand the combativeness and the OP's perspective. Doctors and nurses do know what they are doing for a medicalized birth but are not necessarily trained or inclined for a natural birth so the perspective that the staff always knows best only works if you are up for the interventions.

One piece of advice though don't threaten the lawsuits to the staff while you are in the hospital! Seriously, the interventions done for non medical reasons (and yes this is common) are often done to avoid litigation or staff convenience. If you go threatening a suit, you will probably get every intervention because it will be on their minds that if something unepexcted happens or go wrongs you are filing suit. Some people can be petty and spiteful, they are more likely to go more by the book for you.

You really do have to pick the right ob/gyn and go to a birth center or know enough about the hospital. The first ob/gyn I saw thought anything natural was stopping shirt of scheduling your c-section earlier enough to avoid disrupting weekend or holiday plans. I didn't find out until a few weeks in as I wasn't expecting this. It really opened my eyes about the variance in practice and I'm not someone who is wed to natural birth!

It will take another 5 years or so of studies on evidence based care, pressure from insurance companies, and consumer advocacy to reverse the trend but I suspect it will happen. Remember 20 years ago, everyone laid flat on their back, was given versed to forget the experience, encouraged not to BF, and had a episiotomy as routine. Oh and don't forget shaving now that was a lovely useful procedure that is finally gone.

[Anonymous]

The OP needs to realize that every person has a different birth experience and that while it is wise to do some research and try to make plans, there's no way to predict what will happen -- who will be on staff at that moment -- whether your doctor will be around when decisions need to be made -- whether interventions will be necessary. The PP who had monitoring forced on her -- 24 hours after her water broke and she hadn't made any progress: fetal monitoring sounds like a no-brainer at this point. As someone else pointed out, her friend with an uneventful labor and delivery was able to bounce on her labor ball until she delivered -- without any intervention. These are two starkly different situations.

One thing that expectant moms need to realize is that you have only experienced your pregnancy and have yet to experience labor and delivery -- you are not an expert. The doctors and nurses -- regardless of what you might think -- have your best interest and that of your child as their number one priority. It's okay to ask questions -- but you should trust the experienced professionals to do the right thing.

FWIW, I couldn't wait for the fetal monitoring -- it reassured me that my baby was doing well. And FWIW, fetal monitoring can save your child's life -- when things aren't going well, it's what prompts the nurses to call the doctor to get his/her attention.

[Anonymous]

Anonymous wrote:
One final comment: there seem to be a lot of posts on DCUM from first-time pregnant women who prefer natural childbirth and appear to be incredibly hostile toward medical professionals and hospitals (as well as toward those of us who deign to offer advice or feedback.) Maybe it's all the same poster (?) or maybe it's just symptomatic of an unfortunate distrust that exists more widely. I don't know and obviously I've admitted my preferences are very different, so probably I'll just get flamed for even mentioning this. But I still think it's worth pointing out that it is not necessary, nor is it optimally effective, to go into this whole process with such combativeness (and yes, threatening lawsuits before you're anywhere near a delivery room qualifies as combative). There are good and bad in every profession, and you can find and focus on the unhappy stories if you so choose - but if you're going to have any contact with doctors/nurses/LCs/etc over the course of your pregnancy and parenting you might consider adopting a slightly more open-minded attitude about both the expertise and ethical standards of most medical professionals.

Hi, OP here. For brevity's sake I am only quoting the end paragraph here. Your comments are helpful. I haven't gone back to reread my original post, but I don't believe I would have said anything to suggest I am anti medical establishment. My post was responding to one person's commentary about her experience at Sibley. She said that a CFM was "forced" on her. To me, that doesn't mean pushed, it means that she was literally compelled to do it against her will. Thus, I asked a question about not only her experience but others. I still don't know that I have the exact answer I'm looking for, which is "do they force you to have a continuous fetal monitor at Sibley or can I successfully ask for intermittent monitoring?"

The thing is, I do have a birth plan. I have to think that an educated first time mom is much better off than a first time mom who has no idea of what to expect. Now, there exists, among this board, a clearly defined chasm between the natural and "go with the flow" childbirth camps. I'm somewhere in the middle. A reread of my original post would tell you all that my plan is to try to have a natural childbirth. If I can't hack it, I won't beat myself up over an epidural. By all means, if my doctor, who I trust implicitly, tells me that CFM (or any intervention) is necessary for a medical reason, I would do it without a peep. I want a healthy baby and healthy me. However, that does not mean that I will not or should not take steps to try my hardest for natural pain management. I am convinced that natural delivery has benefits. Clear baby lungs, fewer incidents of post-partum depression for mom, are just two that interest me most. I also buy into the "cascade of interventions" theory that gets a lot of air time here by proponents of natural childbirth and those who think the phrase is hogwash. What that phrase means to me is that if I end up with an epidural, I can't move around as much, I won't necessarily feel to push so my pushing would be medically guided and not instictive, and so on. But do I think it's the end of the world if I end up with an epidural, and even the works? No. I just don't want to go into it aiming lower than what I think is ideal. Whatever happens, happens, but please don't confuse my desire to have a plan with a general dislike of the medical community.

Now, PP, who I have quoted here, makes an excellent point. I made some rather loud comments -- really I was aiming these comments directly at the other poster -- that clearly made me out to be an anti-nurse, anti-medical community and that is inaccurate. I have numerous great friends in the nursing field. I know that nurses are overworked, understaffed, and, in my opinion, usually wonderful. I've also heard stories from these same friends about the moves that they've seen fellow nurses pull that have made my hair stand on end. And from reviewing these boards, it seems clear that some nurses do have a strong sense of what "should happen" during birth. Anyone who feels passionate about their calling can be a little bit didactic about their beliefs, but that doesn't mean I should comply with something one person thinks is right, especially when the orders aren't coming from my doctor and when the orders run counter to what I have learned about birth positions, etc. I know people will say I'm inventing trouble, but I was responding to one person's specific experience, so that's not true. And I know that some people won't be able to stop themselves from reminding yet another rookie who thinks she's going to captain her ship all the way through labor that it just doesn't happen that way. The thing is, I get it, and I'm not that worried about all of the details. But I am going to prepare for several situations during birth and I am going to go into it knowing how I am, (obviously fairly prickly as you may gather) and then do my best at birth. If interventions are necessary, I'll be okay with that as long as my little one is okay. However, that doesn't mean that I should just accept what a nurse tells me I "must" do, especially if it puts me on my back in bed when I'd feel better moving around. I may not be able to plan it all out, but I sure do want to make sure I've got options.

Anyway, this post is long enough, but I will officially recall the lawsuits and so on comments. There was some humor in those comments that clearly missed the mark. I stand firm, however, that I won't have CFM forced on me -- if Doc says it's necessary, however, I'm all for it. Meantime, if someone would answer directly it would be very helpful. Is it the policy at Sibley to require continuous fetal monitoring or can my OB override this policy?

[Anonymous]

I believe most hospitals insist on CFM, unless your doc okays otherwise. Also, the vast majority of interventions (pain meds, AROM) will also make it necessary.

I just ignored the requests of nurses and doctor to do things like put my feet in the stirrups. I didn't feel like arguing, but also knew I didn't want to deliver on my back. It was very effective and minimally confrontational.

[Anonymous]

OP--the answer to your question is NO--it it NOT Sibley's policy to require that you have CFM, unless you get an epidural, in which case Sibley will require that you lie in bed with an IV and CFM. If you do NOT get an epidural, Sibley's policy is that your labor will be physician-directed, meaning that whatever your doctor's okay with, Sibley's okay with. I have three friends who gave birth at Sibley this year--two chose to have unmedicated births and were able to do so, without CFM. The other one went in knowing she wanted an epidural and was, therefore, required to lie in bed and be monitored, but it was her choice. The nurse who gave my husband and me the tour at Sibley made a point of showing us their shower and the chair they have in there in case moms want to labor in the shower. If they required CFM as a matter of policy they would obviously not have showers, rocking chairs, squatting bars, etc.

[Anonymous]

Anonymous wrote:OP--the answer to your question is NO--it it NOT Sibley's policy to require that you have CFM, unless you get an epidural, in which case Sibley will require that you lie in bed with an IV and CFM. If you do NOT get an epidural, Sibley's policy is that your labor will be physician-directed, meaning that whatever your doctor's okay with, Sibley's okay with. I have three friends who gave birth at Sibley this year--two chose to have unmedicated births and were able to do so, without CFM. The other one went in knowing she wanted an epidural and was, therefore, required to lie in bed and be monitored, but it was her choice. The nurse who gave my husband and me the tour at Sibley made a point of showing us their shower and the chair they have in there in case moms want to labor in the shower. If they required CFM as a matter of policy they would obviously not have showers, rocking chairs, squatting bars, etc.

This is what I was thinking about the showers, chairs, etc. Their website is also all about choice and flexibility. I think that the poster who had the CFM forced on her may have had a very bad experience but I'm just hoping it is not standard practice -- that's exactly what I was trying to find out. Thanks so much for this.

[Anonymous]

I gave birth at Sibley, did not have an epidural and was required to have CFM. My OB knew of my interest in a natural birth. It is all sort of a haze now, but there was no fetal distress so I am not sure why the CFM. It was awhile ago too, so it sounds like things have changed.

FWIW, having done it, I think natural childbirth is overrated. Someone previously mentioned "caving" and having an epidural. You don't get a prize for enduring the most pain. And frankly, having had a subsequent epidural, I'll NEVER go back to natural unless the birth is too quick. For me recovery was easier after the epi, since I was better rested. And, I enjoyed the birth more (since I was spewing expletives, as I am wont to do....) My husband wasn't a huge fan of seeing me in extremis either. Just my two cents.

[Anonymous]

I did a natural birth class with my first preg, got a doula, the whole nine yards, all up in smoke due to breech and I wanted to make a couple of comments.

With respect to the second poster who had a neg exp with Sibley, I am sorry for that. But I was a little surprised to learn that you did not have a doula, who doubtlessly would have advocated for you (and how can you do it for yourself when you were going through so much?) Maybe it was oversight or you thought you could manage it, I don't know. But as long as you are going to go into a hospital, doesn't everyone know that many of the treatments are done more for the staff than the patient (when it comes to birth?)

I also agree with a PP who mentioned who some of these nat. birth classes are REALLY anti-medical. I did not realize how brainwashed I was until I had to have a scheduled C and I was DEVASTATED. And there was not support from all these natural people, just pity. God, it was awful. I really needed someone to tell me it would be okay and I got even MORE judgement about why I wasn't trying to deliver BREECH?!?!?!? Christ!

My experiences were up and down at Sibley, but overall okay. I am not naive enough to think it would have been different anywhere else. Nurses, like teachers, are mostly AMAZING and then you get some REAL DUDS. That is life.

And OP, there is such a thing as a little too much knowledge and I only say that b/c I relate to you. You want to be the best preggers lady and then the best mom. You want to know what the hell is going on. You want to not be surprised or caught not knowing something. But, for me, I have come to learn how little I can control about pregnancy and parenthood and you gotta do the best you can and let it go. I have had all sorts of little things happen to me during preg and birth that have taught me that HEALTHY MOM/HEALTHY BABY are all that matter in the end. I know you know that, everyone knows that. But try to really feel that, b/c you could stress your preg and delivery so much, you could miss the miracle!!!

I wish you the best! Oh and, I brought TONS of gifts for all the nurses donated all my flowers to them and I got STELLAR treatment from most!!!!