The BAD Labor and Delivery Nurse, and what to do about it...

Today Facebook is abuzz with the blog post by a personal friend and soon to be student of mine. She was privvy to a VERY inappropriate conversation on Facebook that was also very public between an OBGYN and a nurse working in the same facility. To protect her privacy, I will simply post the text of her post here:

So-called compassion for c-sections from L&D doctors and nurses?

On Facebook, I have one particular friend from grade school who happens to be an OBGYN. Last night, she posts this status update (name removed for obvious reasons):

OBGYN - Waiting on a delivery.... Baby please come soon. I'm getting tired. 10 hours ago via Facebook for iPhone ·
To which her friend, a labor and delivery nurse responds:
NURSE - Ahh just cut her. Fuk it!
10 hours ago

I was infuriated to say the least and sickened to my stomach. I honestly felt like I was going to throw up. I couldn't sit there and let it go:

ME - wow NURSE - that's about the most insensitive thing i've ever heard in my life.
9 hours ago ·
ME - and this is coming from someone who had a doctor cut her baby out of her, never followed up on her care, didn't know her baby was transfered to another hospital in critical condition, left her with a festering infection for two months and could care less that i was stuck to a wound vac for another month after that. so yeah, just "cut her" sounds like really great advice.

8 hours ago · If you think any of that was enough to make you toss your cookies, these are the responses I woke up to this morning:

OBGYN - NURSE is an amazing labor and delivery nurse..., who knows me well and knows that I don't do inappropriate sections. I'm sure she was joking.
8 hours ago

NURSE - Relax MOTHER all that wasn't necessary. I am sorry u had such a bad experience for such a joyful moment. And thank you OBGYN I truely love my job and I know how to relax and joke! Hope the delivery went a bit quicker and MOTHER I hope you found a new doc....try dr ####!!
5 hours ago

ME - Out of curiosity - I wonder what the mother of that delivery would have to say to you if she saw what you wrote...what do you think her reaction would be?
about an hour ago ·

NURSE - im sure she would have a laugh with me instead of being so uptight like certain people on facebook. The problem with patients is they try to control their own deliveres so much for example "birth plans" that they set themselves up for failure. Than they dont actually look into their doctors history they just randomly pick an OB and thats how things go so terribly wrong. Patients need to have a true advocate if they feel they cant do it for themselves. So its always nice to not treat ur nurse like shit and she can be your advocate.
40 minutes ago

I'm still debating what route to take next. With the skyrocketing Cesarean rate in this country, and people finally looking at those numbers - calling it unacceptable - I'm still shocked that two "professionals" would retort in such an ignorant manner. I am 100 percent open for suggestions on this one.

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To begin, this may have been a VERY callous and in poor taste joke between two overworked birth workers. The hospital environment is a hard working and exhaustive one, and I don't think anyone would believe that having a family and being up all night delivering babies is easy. I would like to state for the record, that I do not indulge in 'doctor bashing', or 'nurse bashing', and that I do try very hard in all of my classes and exploits to show consumers what birth looks like from the other side. Each side/perspective of birth has it's own share of pressures, inequalities, and points to consider. I always seek to understand the differences facing each side of a birthing issue, and try to bridge that gap. I spend a lot of time in my classes explaining how birth works for the hospital worker, as well as the added pressures faced by OB professionals and Midwives that people may not be aware of. This awareness creates understanding and sensitivity, and can make all the difference in the feeling and function of the 'team' at a birth.

So all of that out of the way, what this nurse said online is heinous. It's irresponsible, it's insensitive, it's rude, and worst of all, it's ignorant. It's ignorant of what kind of ramifications a surgical birth can have on a mother and family. It's ludicrous that a birth nurse could be so naive to these things, especially with all the news in the last month about cesarean. First, there was the NIH VBAC conference, which called into scrutiny womens' lack of access to VBAC births, and noted that repeat and initial cesarean rates were too high. And just this week the CDC released the 2007 statistics on the American cesarean rate, and it's at an all-time, all-world high. I won't be surprised if this bumps us from 28th in world rankings for maternal and fetal outcomes to dead last, so it's not an insignificant piece of news. A piece of news you would expect a birth worker like her to have heard about.

Clearly, there is a problem in our country, that this nurse doesn't see to understand, but more than that, she seems to be unaware of the massive efforts to change the problem, and even the current events on the subject. Add to this, that she seems UNCARING about the problems our country face, which can only be addressed one birth at a time. This is regrettable, to say the least.

It is repugnant that someone would be so unthinking to post an exchange like this in a public place, and with the attention this is getting, I sincerely hope her administrators are made aware of it and some sensitivity training and cesarean prevention education is put in place for not just her, but her entire workplace, as attitudes like this tend to fester in overworked and overstressed work environments.

Another point I'd like to make is her commentary on consumerism in birth and birth plans. We've all heard the rumors that nurses 'don't like them'. I have my students write their 'birth preference lists' very carefully, taking care to say things like, 'I trust your judgment, and these are my wishes in the event of an uncomplicated labor/delivery'. This nurse's experience is right in saying that women need to choose their providers more carefully if they want certain things to happen or not happen at their birth. Our biggest assurance for the birth of our choice is the questions we ask and the provider we choose.

However, many people stick with their teenage ob/gyn and don't look into their options, or choices. Women DO need to get educated and make better choices. This is our responsibility for our own health and our own experience. And again, this is something I cover extensively in my classes. HOWEVER.... this nurse seems t o go astray of reality when she starts assuming that women write birth plans as a mechanism to control their births because they do not have a supportive provider. This is where her personal prejudice takes over, and this is unfair to all the women under her care who do their homework.

To make the assumption that anyone with a birth plan is a 'control freak' a 'difficult patient', or 'bound for a cesarean' is a personal prejudice that does exist that I'm not sure what to do about. This nurse talks about parents needing an advocate in the birth process, and I agree. They need a DOULA, someone whose role is nearly the definition of what she is describing. But when this nurse suggests that a woman's advocate should be her nurse, I must say that I thoroughly disagree, and I do so with the utmost respect to nurses.

I have worked with some WONDERFUL women , and not every nurse is guilty of these kind of personal prejudices-- in fact, I think and I hope that most aren't. To rely only on the advocacy of your nurse, who will be working with several other patients and doctors, and whom you will meet only after labor has begun, and whom you know nothing about is not a good idea. A doula, on the other hand, will meet with you and offer support and education from early in pregnancy, and offer a continuity of care and personal attention throughout your labor that a hospital nurse cannot. You can get to know your doula and choose someone who 'click' well with your personality-- but the nurse you get is luck of the draw, so personal prejudices and opinions about birth won't be discovered until labor is in full swing, which is not the time to realize you're lacking support from the only source you planned on.

I also want to address the idea that is expressed by this nurse that women need a 'buffer' between themselves and their care provider. The sentiment here is that it's 'us vs them', which I could not disagree with more sharply. I emphasize choice and consumerism to my clients and students, and together we construct a personalized birth team based upon their wishes, goals, and specific medical concerns. The idea of advocacy in birth is wonderful, as labor does put a woman in a vulnerable place. For the laboring woman and her partner to feel 'safe', having the continuous presence of a doula who acts as an emotional support, an educational resource, and another pair of hands is only natural. But some women don't feel threatened when they are vulnerable, and some partners are well equipped to care for their laboring mothers. Educated consumers will have a provider who is aware of their wishes, and on bo ard with their goals. They will have assembled a birth team that is supportive and loving and of the same mindset, and they won't need to be protected from the 'snipping scizzors' that this nurse perceives to be always at the ready. It's also important to note that the most supportive nurse in the world cannot sway the decision of the medical care provider, or 'protect' the laboring family from intervention if its the opinion of the caregiver that it is needed.

I love nurses, and I really don't want this to be a tirade on nurses, even this particular nurse, who is largely guilty of misinformation and insensitivity. I teach my students and clients to befriend their nurses, and write down their names so they can ask for them with the next birth. I do believe that being nice to your nurse WILL give a better birth, and in many ways, the nurses are the gatekeepers and keyholders to smoother and kinder birthing experiences. But I think it's a real shame that there are nurses out there like this one, whose view point is so skewed that even on her best day, the care she provides will have an undertone of intolerance and impatience for 'that certain type' of patient who writes up a birth plan, even in the most respectful of ways.

I try to foster good relationships with the nurse s I work with so that we will remember one another and have a bond to build from with each birth we work together. We are both birth workers, there for mess and glory of birth. We are both away from out families for nights at a time, and we are both there to support a woman through a challenge that will stretch and shape her into a new kind of woman-- a mother. We should be working together. We are not so different, and this is why I am so upset by what I have read from this nurse's point o f view.

This whole issue is not new, but rather a barometer for an existing problem. This is not a setback, but an opportunity to raise awareness, push for education, and to think about our own prejudices about the birth workers we stand next to when we work. I would like to see some media coverage on this, as well as something done at the administrative level of hospitals to curb this kind of finger pointing an d negativity.

Let us seize this opportunity to ask for change. Let us use this moment to become better, ourselves. Let us turn a very ugly exchange int o a better experience for women to come. Please pass this on, and please consider your own personal prejudice and how it may be devaluing the experiences of the laboring women you serve.