Last night I was supporting a client at our local hospital and I got to meet a nurse I haven't worked with before. I've only attended 4 births at this hospital so far, and I'm pleased to report that the nurses there have been (around me, at least) very supportive of doulas, birth plans, informed consent, bonding, etc.
This client was a first-time mama who had a strong desire to go unmedicated. (Our hospital has a 90+% epidural rate.) We had talked at length in our prenatals about it, and she highlighted her feelings on a Pain Medications Preference chart. She rated herself pretty high on the scale for not being confident in her ability to cope (+9), but she rated herself low on the scale for desiring no meds (-5) and potentially feeling disappointed (-7) if she chose meds. She also said she would like meds as soon as she asked for them in labor (-3). She asked her DH and I to avoid the subject, and not talk her out of it, but leave it entirely up to her. I made sure she knew she would have my full support if she chose the epi.
Well, I met mom and dad at the hospital at about 5pm. Mama was 2cm and 90% effaced, and her ctx were 3-4 min apart. It was a busy day in L&D and we got the last available room, all the way down the hall, tucked in the corner. It was quiet and easily forgotten (which has its ups and downs, considering intermittent EFM.) Mama quickly got into a beautiful groove, breathing and moving and barely making a peep. After about 3 hours of labor, she was 5cm and fully effaced. Ctx were about 2min apart. At shift change she got a new nurse who was very happy to read the birth plan, but she proceeded to "sell" the epidural by every conceivable angle. "First time moms should never attempt to go natural / After you try the epidural you'll never want to go natural / Take it from me, I have 4 kids and I'll never go without an epi / Your body hasn't been tested by labor before and you'll wear yourself out / You're only 5cm, you have hours and hours of this still to do / Don't be a martyr / Don't let anyone tell you what to do (!! -- this is when she gave me "the look")," etc. She would always bookend her sales pitch with, "If you really want to go natural, that's great!" but this poor mama was being bombarded with negativity from the nurse. (Despite her epidural pitch, she was a wonderful nurse and very friendly and patient and accomodating. I just found it funny that as soon as she heard I was a doula, she kept giving me "the look" like she didn't trust me.) Dad and I kept silent about the epidural, per our agreement with mom. Things were picking up fast, and each contraction got heavier and more taxing for mama. She started vocalizing a lot and expressing doubts, but I reminded her that we could talk about it "after this contraction is over," (which was our pre-determined code for: "If you really want it, you're going to have to ask for it yourself.") Well, as Dad and I already knew, mom didn't say a word about the epi between her ctx, so we didn't say a word about it either. When nurse asked, mom would say, "I'm okay." You'd think the nurse would have left it at that.
Well, within the space of about 45 minutes of the nurse's "you're going to be suffering like this for hours" speech, mama hit transition. Dad and I were literally holding mom up during her ctx at this point; the nurse would not let it alone! She badgered, waiting for an answer, even gave mom the "are you having a good time? is this how you WANT your labor to be?" ultimatum. Mom was crying and frustrated at this point (she was SO close!), and Dad and I told her that we'd be there for her no matter what. I gave mama my tried-and-true doula lines that I've used for all of my mamas who get to that point of expressing that they can't go on, reinforcing my unconditional support for whatever decision she made. Ultimately, mama decided she wanted the epidural (even though I think the nurse's attitude had a LOT to do with it, mama really was exhausted and beginning to panic, so I was totally cool with it). Nurse called for the anesthesiologist and I asked mom if she'd like to be checked first (@ her last VE, less than an hour prior, she was still 5cm and -1, but I
knew she'd made huge progress since then.) (when you know, you know. right?) She declined the VE, got an immediate dose of Fentanyl and the epi was placed within 15 minutes.
It was a huge relief for this mama, and I'm confident that she has no regrets. As promised, Dad and I stayed right by her side. She had a VE right after the epi took, and she was 10cm and +1! (I knew it!
) She was thrilled, and Dad about burst his buttons with pride over his super-woman DW.
We praised her strength and ability and congratulated her on a job well done. (No more stink-eye from nurse.) Doc came in to AROM now that she was complete, but he no sooner touched her than her waters released pretty much on their own. BP tanked a little post-epi, accompanied by FHR decels, but nothing major. Mama strapped on the O2 and rested happily. OB and RN left for an hour to allow for rest & descent (I still love this hospital). Mom had some heavy ctx and had some lingering sensation on one side, but she got back into her groove very quickly and was able to sleep soundly in between ctx.
By the time OB and RN got back (all very leisurely and lighthearted), mama was ready to push. Baby boy was out in 6-7 ctx. (8.01 lbs, 20.5 inches, Apgars 8&9) It was the easiest epi birth I've ever seen (I have to wonder how long delivery was delayed by the epi, though. I think if she'd been left as-is, the baby might have been born almost 2 hours sooner and wouldn't have been stressed). There had been some moderate meconium staining, so baby didn't get immediate skin-to-skin, but the NICU team did all of their work on babe within 5 feet of mama and she got to love on him pretty soon. She had a 1st degree midline tear and got 3-4 little stitches. Baby was latched on within the hour; mama and dad were totally blissed out.
As I was leaving, I approached the nurse to have her fill out my "dreaded" eval form (I hate that part), and she actually
thanked me for my hard work! She told me she was "so impressed" with me, and that she was glad that I didn't push my "agenda" or my "doula ideals" about a med-free birth onto the mom, "like other doulas do." (I have to wonder what other doulas she's referring to; she told me she hadn't worked with many doulas at this hospital, and I know all
4 other local doulas and there's no way they'd behave inappropriately, but I digress.) She gave me all 5's on my eval! and she wrote a comment that I remained supportive even though the labor didn't go as planned. (I think this was a first for her.) She even said she looked forward to working with me again!
I think I converted a doula-wary nurse into a doula fan!
It sounds like you were a wonderful support - well done!
