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....

Thursday, May 15, 2008

Part 2

This is the Part 2 to my slight rant of earlier.

1. Solutions to a woman's fears: let's address the fear of pain and the fear of the unknown from an educational point of view. We also need to address the fact that the pain in childbirth is not like other types of pain, it is intermittant (with rest periods that allow the mother to work with her support team) and the pain also tells the mother where she is in labor (contrasting the duration and frequency of the contractions) AND that the pain in labor is also a signal that she needs to move to help the baby complete the cardinal movements. We, as health care professionals, need to write books - there are precious few new books written by childbirth educators, nurses, or doulas.

2. Freedom from pain: see #1 above PLUS we need to talk about our society's love affair with pain relief and pain medications. On any given night, count how many commercials have to do with this topic.

3. The Lure & The Guarantee: we are confronted with a society of women who really don't understand that the pain medications for labor DO affect the labor and DO affect the baby. The placenta is not selective and they are cause their babies harm. However, those who produce or administer these medications DON'T want the mothers to hear about that (re: the Cytotec controversy). Additionally, with the nursing shortage, it is easier for the overworked/underpaid L&D nurse to watch her 4 patients who are quiet with their epidurals on the monitors rather than scamper back and forth between rooms.

4. Consistency: the marketing campaign for natural childbirth and the impact of medications and interventions on the newborn must be consistent, frequent, branded, recognizable and in many different places at the same time.

5. Access to the media: obviously, there needs to be a core group of people devoted to organizing a media campaign that runs consistently and for a long duration.

6. Professionalism in marketing materials: 'nuff said.

7. Selectivity in research: a core group of research obtained from NIH or Cochrane Review would give the marketing team the "ammunition" it would need to mount a sizable and convincing campaign.

8. Multi-marketing: see #4, #5 and #6. And keep it circulating.

9. Follow-up: we also need to watch the statisticians such as the CDC and the Listening To Mothers Survey so we can determine if the marketing campaign is reaching the pretermined goals. And we need to have these mothers who have sampled natural childbirth speak out as testimonials ~ very much like the "Business of Being Born" and "Orgasmic Birth" movies.

10. Infighting: all too often women in the decision-making seats of major childbirth organizations lose site of the real passion, the real reason why they volunteered for the position. They need to rediscover the energy that got them into the position and put it into the work of helping women have a ligitimate choice of options. Become the 'sagefemmes' that you can be, and ignore the lure of power. Use the power...don't let it abuse you.

Monday, May 12, 2008

Part 1: Stop Whining and Start Acting

Ok, I admit this blog entry will be a little harsh.

For the past 28 years I have watched my colleagues make the same mistakes. We believe, due to research outcomes, in mother-centered care, family centered maternity care and the type of care that minimizes risks to both mother and baby ~ normal birth.

Why, then, is NORMAL birth not the standard way?
Why are we almost apologetic when we talk about natural or normal birth?

The answer is quite simple ~ marketing. Those with differing opinions than us are much better, albeit savvy, than we are at marketing. This is what they do and we don't do well:

1. Solutions to a woman's fears ~ "Don't worry, I can take care of everything" says her care giver. This enables the woman to forfeit her feelings and control.

2. Freedom from pain ~ an easy fix with medications such as an epidural. Our society is not one that readily accepts hard work OR looking at the cause of pain...we just want it easy and the pain quickly eliminated.

3. The lure and the guarantee ~ you can have everything you want: painfree childbirth and your baby without working for it. Now, who wouldn't want that?

4. Consistency ~ they all say the same lines...frequently. A "blah" marketing campaign with consistency is preferred over a fabulous & glitzy marketing campaign that is nothing more than a flash in the pan.

5. Access to the media ~ press releases, experts interviewed on a regular and frequent basis (see #4).

6. Professionalism in marketing materials and LOTS of those materials.

7. Selectivity in the research that is in the limelight ~ focusing on the research that benefits only their opinion.

8. Multi-marketing techniques are a basic fundamental of success. Combinations that are constantly flowing by the client - websites AND brochures AND commercials AND emails AND newsletters AND press releases.

9. Follow-up: 68% of general sales are lost due to customers being ignored after the sale. This applies to birthing professionals because we do not refer back and forth enough to show our client base that there is a network of like-minded individuals.

10. Infighting: there is little of this in the predominately patriarchal microsociety. Since OUR community is made up of mostly women, there is alot of infighting.

So we have our work cut out for us. In my next blog entry, I will be looking at solutions to these 10 problems.

Thursday, May 01, 2008

Great Things for May!

May is going to be a great month ~ it ushers in a whole summer of excitement for expectant parents and birth professionals!

First, here in Dayton Ohio on May 3, is the 4th Annual Bright Beginnings Pregnancy Fair. Sponsored by Dayton Area Labor Support Inc (the local doula group), the Fair generates funds that will be used to provide doula care for underserved expectant mothers.

Second is the Waterbirth Credentialing Workshop for Legacy Emmanual Hospital in Portland Oregon....followed by the Workshop coming to Dayton on June 20! The day after, June 21, Barbara Harper will be hosting the new film "Orgasmic Birth" in Dayton and on June 22, she will be hosting it in Indianapolis! Both parents and professionals alike will be interested in this film that celebrates the JOY surrounding birth rather than the fear that many birth-related television shows portray.

Third, during the summer, will be a place to order the "Birth Pool In A Box"! One of the only inflatable Birth Pools made without phthalates, it is better for the environment, better for mom and baby. Keep watching for more details!

The Summer of '08 will certainly be one to remember...and this is just the beginning!