Friday, May 23, 2008

Support at Labor & Birth

Being a nurse as well as a doula, allows me to do alot of observing while my client is in labor. I recently did a birth at a large city hospital. My client's birth plan was to have minimal interventions plus do alot of moving to assist the baby through the cardinal movements ~ thus making labor shorter and easier on everyone. She had discussed this at length with her care provider and he had signed off on each one of her requests.

To make a long story short, upon arriving at the hospital my client was immediately "put to bed" with continuous fetal heart monitoring inspite of what the physician had ok'd and with no medical intervention. When asked by my client why this was necessary, the nurse said that she felt that it is always safer to watch the mother and the baby as a couplet and the only way to do this is with the EFM in place. Then the nurse left the room.

Had my client been high risk or had the baby shown signs of trouble, I would have been in 100% agreement with the nurse. However, when I went out to go to the bathroom and walked by the nurses desk, my client's nurse was sitting at the computer charting and talking with the other nurses.

As a nurse, I am the first one to admit that today's litigious society causes many of our maternity policies and procedures to become less mother centered. However, how will this ever stop? AWHONN, the Association of Women's Health, Obstetric and Neonatal Nursing stated in their 2000 Position Paper on Nursing Support of Laboring Women: "AWHONN veiws labor care and labor support as powerful nursing functions and believes it is incumbent on health care facilities to provide an environment that encourages the unique patient-nurse relationship during childbirth".

If the largest nursing organization believes this, and we know this to be true from the research, then WHY do most women NOT receive this type of supported care?

If the hospitals cannot "provide an environment that encourages" this type of patient support, and nurses know why they cannot provide this type of support, then why do they often make doulas (trained women who DO provide this support), feel uncomfortable?

The bottom line is that women in labor need emotional and physical support. Nearly 30 years of research demonstrates this to be true. It does not matter who provides it. It simply has to occur.
Perhaps if we stop being so territorial about WHO provides this support and focus more on providing care that is mother-friendly and mother-centered, then we will transform maternity care in the United States into something other countries will want to imitate.

And just perhaps, our maternal/fetal statistics will improve and we will no longer be 27th or 28th in the world.

Tough observations with relatively simple answers....

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