Dear Labor and Delivery Nurse,
This letter could also be addressed to doctors and midwives, but it is you, nurse, whom most expectant mothers interact with throughout their labors. I understand that you were called to this profession for a very personal reason. You have chosen to be invited to one of life’s most sacred events, and you arrive with the best of intentions and the knowledge your training and experience have provided. Nursing can be both incredibly grueling and extremely rewarding as you navigate the physical, emotional and spiritual challenges that accompany a profession of service.
Despite the amount of love and skill you bring to a birth, a gap—a disconnect— can exist between you and the mother-baby pair. I write this letter in hopes of contributing to the closure of this gap through open communication and genuine collaboration between birth professionals and expectant families.
Please know that:
I will be an active and equal partner throughout this birth.
I make decisions based on accurate information and knowledge of my unique body.
I take measures to decrease the likelihood of needing medical interventions because they can contribute to complications and further interventions. For example, instead of accepting doses of Pitocin to expedite my labor, I will walk, squat, kneel, remain upright, dim the room’s lights, keep conversation to a minimum, appreciate quiet, and ask for privacy.
I utilize non-pharmaceutical methods of pain management (e.g., vocalization, massage, position changes, acupressure, visualization, hydrotherapy, hot and/ or cold compresses, aromatherapy) before considering pharmaceutical options because epidural usage, in addition to several other dangerous side effects, leads to an increased risk of C-sections.
I know that C-sections can save lives. However, with the current, national C-section rate at 33 percent, millions of women and babies are put in danger unnecessarily. The World Health Organization recommends C-section rates not exceed 15 percent to ensure optimum outcomes. In light of these statistics, I have gathered information about evidence-based obstetric practices and will utilize this information as decision points arise.
I understand that your training and experience have prepared you for highly medical births and may have included a very limited amount of information and experience with how to facilitate unmedicated, physiological labor and birth. This is why I have asked a doula to accompany me.
While my husband may love our baby and me, he has never given birth and never will give birth. My doula has been chosen for her expertise in physiological birth and the rapport we have established over the course of our relationship. When doulas support women during labor, women experience less complications, need less medical intervention, experience shorter labors, and have fewer babies admitted to the NICU.
When I choose to eat and drink during labor I am maintaining my energy and hydration, which is key in facilitating this very physical endeavor. Consuming food and liquids during labor is safe for my baby and me.
I am able to push more effectively in the position of my choosing and when I feel the natural urge to push. Assuming an upright position during the pushing phase of labor decreases the likelihood of an assisted delivery with forceps or vacuum; of needing a surgical cut to my vaginal opening; and of my baby exhibiting abnormal heart-rate patterns. Pushing only when feeling the urge to push decreases negative effects on my baby’s heart rate and decreases negative effects on my baby’s ability to receive oxygen.
While I do not need a VBAC (vaginal birth after cesarean), I would like to acknowledge the many women who are interested in exploring this option but are not supported in making an informed decision. Although 60–80 percent of women who plan VBACs have successful vaginal births, the national VBAC rate is only 8 percent. Uterine ruptures are commonly cited as a reason to discourage women from attempting to birth vaginally after a cesarean; however, the risk of such an event occurring is less than 1 percent.
I am here as my baby’s advocate and as a partner in this birth process, not as a passenger. While the practices within your department may be commonplace to you and often unquestioned by other clients, I may want to deviate from your staff’s protocols in an effort to increase the safety of this experience. If my opinions differ from yours, please respect them because energy cannot be hidden; beyond words and body language, I can feel your energy.
When we step away from this labor and delivery room, let us part with compassion and open hearts and minds. We both want what is most healthful for mothers and for babies. Let us look at the practices that contribute to the best outcomes and collaborate in improving the health of families for generations to come.
This article appeared in Pathways to Family Wellness magazine, Issue #43.
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