I found your blog a few days ago and can’t believe I didn’t know about it earlier! Sounds like you are having a great success with it — you have so many readers — I just wish you would post more often

I had a natural birth and am still breastfeeding my 3 1/2-year-old son. I write a blog about natural birth and breastfeeding and many other subjects called Dagmar’s momsense.

I added you to my blogroll and mention you as a resource on my birth/breastfeeding page now: http://dagmarbleasdale.com/breastfeeding/
I’d love it if you added my blog to your list.

Do you have a Twitter account? Do you drive traffic to your blog via Twitter? If not, I can help you with that. Just let me know

Best,
Dagmar
Dagmar’s momsense
@DagmarBleasdale

Please keep writing!

My insurance covers the services of a midwife under the practice of an ob/gyn’s office, but there are none left in my area that are taking patients at this time. (I’m 26 weeks now, so I guess I”m a little late). The more research I do, the more determined I am to have a natural, intervention-free birth. So far my pregnancy has gone swimmingly and I have no complications or risk factors.

Should I just do my research, write a birth plan, and make sure that those with me can support me instead of trying to find another practice? It sounds like I won’t be able to get one with a midwife, and if that’s the case, then it seems like my options are about all the same.

The c-section rate does bother me, but since there are so many doctors at this practice- 5 or 6- there’s no way to know who will be there for the delivery anyway. Do you have suggestions for me other than writing a birth plan and having clearly in mind my preferences?

Thanks!

My suggestion Tonia is patience, perserverance and leading by example.

An example: at my hospital we always have a back up nurse for the baby at delivery. In addition to their presence in the event that resusitation is required, they typically weigh, measure, apply baby bands and administer “eyes and thighs” before they leave. I am a huge proponent of immediate skin to skin and discuss the benefits of it with every laboring mom before the birth occurs. Most want to be with baby right away, right? So when the back up nurse comes in I brief her on mom’s wishes. As long as the baby doesn’t need resusitation I encourage postponing all the routine admission procedures, even if it means I will have to do them myself later.

Another example is to promote intermittent monitoring whenever possible. When I see a beautiful tracing on the central display I ask the nurse caring for the patient what is going on with them. We have some new nurses who are comforted by keeping their patients on the monitor, and I make it a point to discuss with them why they feel their patient can’t come off the monitor at this point in time (if it looks to me like there is no reason to keep them on).

It is so easy to become burned out when you are passionate about normal birth, but you work in a hosptial. Believe me, I know!!!! Understanding your intentions and giving your best to your patients is your gift to the birthing women. Never doubt that your actions make a difference for the women you work with. Keep plugging ahead. I promise you will turn heads and change minds if you promote physiologic birth with your patients.

Be gentle when challenging the status quo. Try to understand why people believe the things they do, and give them research that supports what you believe. Dont expect to change minds over night, but if your co-workers truely care about maternal/child health, they will come around (I hope!).

I would love to be a part of a community of LD nurses focused on mother-friendly childbirth. Strength in numbers and through supporting each other to change the culture from the inside out. Let me know if you find one!!! Or maybe we could start one if there isn’t already someting out there!!

Alethea

Here’s to promoting healthy physiolgic birth!
Alethea

#1) If your client’s birth attendant was so hell bent on treating her as a “potential cesarean section” instead of a mother planning a vaginal delivery (WAY too many people have this mindset…you know…the “every woman is a ticking time bomb” mentality) then would your client/ her attendant compromise on a saline lock? That way the BA has “emergency access” but the mother is not suceptible to the risks of a routine IV.
#2) Wanting an epidural isn’t an emergency. IF the mother is willing to take that as a “risk”, that is, the staff not being able to get an IV in if she “changes her mind” then I think that is the mother’s right.
#3) Pitocin IM, Methergine IM, Hemabate IM, and Misoprostol per rectally are some of the medications that can be given in the event of a PP hemhorrage that do not require an IV. In fact, in my hospital, if a woman comes ready to have a baby and we dont have time for an IV, we usually give her IM pitocin (if the doctor orders it) after delivery of placenta and that is it….unless she actually hemhorages. Also if this mother is planning on breastfeeding immediately postpartum that will offer some protection against PPH as well.

As far as getting an IV in during an emergency….I personally have had women step off the elevator and within 12 minutes are in the OR having an emergency C/S for say, placental abruption. And guess what, I have never not been able to get an IV in. If I can’t , my charge nurse can. If she can’t, the anesthesiologist can. IVs can most certainly be placed in an emergency. I’ve seen my charge nurse place an IV in a patient once who was coding and seizing. Many nurses just don’t want to have to place one in an emergency. But it is done all the time. Think of ambulance EMTs and Paramedics. How many trauma victims have IVs in their arm when they get into a car accident or fall off their 4-wheeler. Ummmmm… ZERO! Nurses just generally don’t want to have to “worry” about getting an IV in during an emergency. But if your client is planning an unmedicated physiological birth and is planning on breastfeeding, her risk is significantly less for any complications. People don’t think of it that way though. Many L&D nurses certainly don’t. Because in reality the majority of patients in this country are having induced, augmented, instrumental, medicated deliveries. That is all some nurses, residents, and OBs know.

Hope this response helps!