5 Things Your L&D Nurse Wishes You Knew

  

When it comes to labor and birth, sometimes you get more when you know what to ask for.

As an L&D nurse, it is my job to ensure that a woman is informed, empowered and autonomous throughout her labor and birth process. It is my role to help HER (and her partner) make the best decisions about her care. 

I can’t make decisions for her, but I can help inform her so that she can make the best decisions for herself. 

Here is the wisdom and research behind 5 birth practices that every expecting family should consider:

1) Patience is a Virtue 

Induction of Labor. Cytotec, cervidil, pitocin. I meet women every single week who are at the end of pregnancy and literally pleading with me to get their babies out. I so often teach them about ways to cope with early labor and the benefits of waiting for labor to start, I’ve practically developed a script.

Many providers recommend induction of labor at 39 weeks and beyond without medical need for the simple reason it enables them to schedule a baby’s birth. Many physicians are in group practices, and inducing labor is the only way they can ensure that they will be present for their own patient’s birth. 

The possibility of scheduling their baby’s birthday is incredibly seductive for a huge, pregnant woman who is aching, uncomfortable and anxious about the entire process.

But is induction the best option for you and your baby?

From my experience as a nurse, labor is just what it’s called …LABOR. Induction doesn’t make the process of labor easier … it just means that a woman labors from start to finish in the hospital instead of in the comfort of her own home. As I have written before, there are so many lovely benefits of waiting for labor to naturally start, spending the early part of labor at home and tuning in to your body’s signals.

MUST-KNOW:

  • For a first time mom, induction of labor regularly takes 24-48 hours.
  • Since you will receive medications that increase contractions, your baby will have to be continuously monitored throughout the process, which inhibits your freedom of movement. 
  • Many moms require more frequent pain medication / earlier need for epidural anesthesia due to the increased intensity of the contractions.
  • If your cervix is not yet ripe — ready for labor — then labor induction can increase your risk of having a C-Section. 

ACOG, the American organization of women’s health care physicians advocating highest standards of practice, recommends that women let labor start on its own before 41 weeks unless there is a medical need for induction.

Photo: Paul Go Images

2) The Best Drug For a Human Being is Another Human Being

Doulas are not just “hippie-style birth coaches.” Professional labor support is an evidenced-based practice shown to reduce the need for pain medication and risk of C-Section. This kind of support has also been shown to improve birth outcomes, raising newborn apgar scores and helping achieve a more satisfying birth. 

As a nurse I am such a huge fan of doulas that I recommend doula support to every pregnant women I know, and even teach my fellow nurses the benefits of working with doulas. The research findings are truly astonishing … there is no other intervention during labor and birth that has such an incredible impact with no added risk to mother and baby. 

Photo: Paul Go Images

3) Sometimes Low-Tech is Best 

The worst part of my job, other than charting, is chasing babies with the continuous electronic fetal monitor. Women always ask me, “It’s 2016. Haven’t they come up with better technology for this?” True, there is such a thing as wireless electronic fetal monitoring, though very few hospitals offer this as an option.

The many things I hate about continuous fetal monitoring:

  • Whenever mom changes position, the monitors need to be adjusted.
  • When mom is continuously monitored, her range of motion is limited to a circle with a ten-foot radius.
  • Nurses and doctors often enter the room and look straight at the monitor instead of asking the mother how she is feeling.
  • Whenever the mom moves and the baby comes off the monitor, the monitor alarms. This often scares moms into thinking that there’s something wrong with the baby!

Most importantly, for low-risk moms in spontaneous labor, research shows that continuous fetal monitoring does nothing to improve birth outcomes.

Both ACOG and AWHONN, the professional organizations for obstetricians and intrapartum nurses respectively, have established protocols for intermittent monitoring for low-risk women in labor: auscultation using a Doppler or external monitor once every 15-30 minutes in active labor, and every five minutes while pushing. 

Note: Once a mom chooses an epidural, receiving anesthesia places her into a higher-risk category and her baby requires continuous monitoring. Same for a mom receiving labor-inducing medications.

Even if a mother is planning an epidural once active labor starts, intermittent monitoring during early labor is a great option!

Intermittent monitoring can allow a woman to move freely, thereby reducing discomfort and enhancing labor progress.

4) We Like Big Balls and We Cannot Lie

If there were one invention I could name that completely transformed my nursing practice, it would be the peanut ball. Research shows that use of a peanut ball during labor with an epidural can shorten the length of labor and drop the risk of needing a C-Section. 

The peanut ball has become my must-have labor tool … especially for first-time moms, moms who break their water before contractions start, and moms attempting a VBAC (vaginal birth after C-Section).

5) Cord Blood is Baby’s Blood

Delayed cord clamping (also known as “physiologic cord clamping”) has long been normal practice for out-of-hospital birth and the midwifery model of care. Thankfully, more and more research is revealing the benefit of waiting to clamp the newborn’s cord. Think of it this way … newborn cord blood cells are actually stem cells, cells that are capable of regenerating healthy blood and tissue. When the cord continues to pulsate after birth, the newborn is transfused with these wonderful cells. The evidence of benefit is so convincing that many families pay thousands of dollars to have companies store their baby’s cord blood for future use. But the term “cord blood” is deceptive … the blood in the cord that remains after birth actually belongs to the baby. Studies show that delayed cord clamping reduces the risk of anemia several months after birth … and benefits of DCC continue to have a positive impact years later.

 

Photo: Paul Go Images

 
In the end, my take home message is this: every option regarding your labor and birth is ultimately yours to choose. Learn everything that you can, trust yourself, and make the decisions that feel right. Find peace in knowing you’re doing the best you can with the wisdom you have. At the end of the day, it’s your body, your baby, and your right to decide.   

Kate Novotny is an experienced L&D nurse, mom and postpartum doula with North Dallas Doula Associates. Her life motto is “Peace on earth begins with birth.”

All featured photography courtesy of Paul Go Images / on Instagram @Paulgoimages

   

 

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