Do you follow –even occasionally — the discussions on nursing bulletin boards?  I don’t, as a rule, but did today.   As a rule I’m impressed with the kindness, flexibility and knowledge that most posters show.   But today I came across some posts that sound like they could have been posted by 90% of the L&D nurses I know in Birmingham, Alabama, the backwater of evidence based maternity care,  I thought I would share this amalgamation of posts with you.

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They are right, though– they do not understand why women go to the HOSPITAL for birth and refuse medical care, like EFM, anesthesia, etc.    Those mothers who want to try normal birth but for whatever reason don’t finish with one are ‘failed,’ which in my estimation is a poor attitude toward those, her clients, she is to advocate for.

I suppose that “natural” appendectomies would be performed as they were in the old days: with six strong Bohemians holding the patient down while a barber cut without anesthetic. I guess the old trepining procedure (cutting a glabelar triangular hole in the skull with a rock to let out evil spirits) is natural, too.
For those who want that “natural” experience, more power to them. But, please, stay at home and have the baby. Why come to the hospital? And if you do, expect the full-court press to protect you and yours. Why? BECAUSE YOU’LL SUE EVERYONE if we don’t.

That’s just it. There’s nothing “natural” about being in a hospital. But, if you go to one, you should expect — and receive — medical care. I am NOT saying that every laboring mom should have an epidural/intrathecal. I AM saying that she should expect (1) fetal heart monitors and vital sign monitoring, (2) remaining NPO in case of an emergent c/s, (3) a c/s if her baby is showing lates or other NRFHT, (4) a spinal anesthetic for a c/s if she doesn’t already have an epidural, (5) a general anesthetic for a true crash and therefore no memory at all of the birth of her baby.  

Don’t give me this garbage about me being biased toward epidurals. Of course I recommend them. But, I can say with absolute certainty that I have NEVER snuck up on a patient and popped in an epidural. I DO tell women in initial interview (for medical hx, know who is on the floor, etc.) that they should NOT tell me ‘absolutely no to any epidural’ because I cannot in good conscience or legal right come back later when she’s in excruitiating pain saying, ‘give me that epidural.’ It’s now under duress.

I’m sure you do have plenty of moms who go “natural” and have “a beautiful birth.” More power to them. It doesn’t always happen that way and you know it. The more common is the scared primip screaming her head off ready to die or kill someone. Get real.

So, keep the bias AGAINST anesthesia to yourself. If you want to root for the mom to go natural, you better make sure she (1) plans to get pregnant, not ‘just happened, (2) goes to every prenatel class or laMaz or whatever for ‘visualization of no pain’, (3) was born with a naturally high pain tolerance and a tough attitude. When you can guarantee all that, then y’all can start being all high-and-mighty about so-called natural childbirth.

And, yes, if a mom is clamping down from the pain and not progressing, there is a small segment who will benefit from the relaxation provided by an epidural. Also, at the low concentrations of local anesthetic now commonly used, there is less numbness than there used to be. We expect them to feel the contraction, not the pain so much. And, we expect them to feel more at the end, through the less-well-covered sacral nerves.

Like I said, for a “normal, low risk pregnancy” mom can come to the hospital and decline an epidural. There is NO forcing them on ANYONE.

So keep your to yourself and get real.

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