Thursday, December 13, 2007

How much do nurses learn about natural birth?

A week or so ago, I heard from my friend, "Julie". She's a newly trained doula, finishing up her certification and has been attending births since last summer.

Julie had been invited to speak to a nursing class about the role of a doula* in the delivery room, and comfort measures that can help women cope with the pain of labor. I was excited for her and hoped that she would be a part of helping this whole class of nursing students understand and promote natural birth. I was shocked when she emailed with a report of how it had went...

"The nursing speech went well. I was surprised to learn that even though it's a maternity nursing class, the students never see a mom in labor, never do any type of labor support. Their clinicals cover newborn tests and postpartum work - not actual labor work. The professor said that she has to cover IV medications and epidurals because that's what's on the state exam. They don't have time to work on other comfort measures. It was hard to relate my info to the students since they've never seen a labor[and] can't fathom why anyone would do it without pain meds...
When I mentioned that they can really set the tone for a labor and can really influence how a mom feels, there were lots of nervous giggles. When I said something about how moms look to them for reassurance that everything is ok and that many moms feel like the nurse is in an authority position -- they actually looked panic stricken!
It puts the nurses in a slightly different perspective for me. Maybe they aren't anti-natural birth as much as they just really don't know what to do [for a mother attempting a natural birth]. They aren't trained in it at school."

These are RN students, getting a 4 year nursing degree from what is considered a top nursing school in the midwest. This class is the Maternal/Neonate one that everyone is required to take.
Julie learned that their clinicals include coming in as a women is in the final stages of pushing, just in time to do the baby's Apgar scores, weight, etc. They also do the next day post-partum vitals for the mother (blood pressure, temperature, etc).

They are not required to have any hands-on experience with a laboring woman. The actual non-pharmacological labor support, what happens during labor, etc. is one or two class periods. The professor said that she has to focus on pain medications, when to give them, when to wait, who can have what, etc. because that is what they will be tested on during their state exam. When asked about other comfort measures for laboring women, the professor told Julie that the text book does a "nice job of explaining" comfort measures.

Makes me wonder how much birth - natural or medicated or surgical - the average nurse has seen when she finishes her nursing degree and graduates as an RN! Any nurse readers, please chime in with comments and let me know how much birth you had experienced when you finished nursing school!

Maybe I shouldn't have been so shocked a few years ago when I was working as a doula in a small town hospital, and labor quickly picked up for my client. Before we knew it the mother had gone from being 3 cm dilated to 10 cm and pushing in less than 30 minutes - and the OBs had all gone home for the night.
The young labor and delivery nurse who was covering my doula client for the evening started to scream, "Noooooo! Don't push! You have to hold it in for the doctor! I can't catch a baby! I don't know how! Don't do this to me. Nooooo!" She looked positively terrified, and was visibly shaking.
She didn't catch the baby - he landed at the end of the bed, and she still shaking, picked him up and said, "Well, I guess he's okay." Then she looked at me and said, "This is my first birth as a nurse."

I was shocked. Maybe I shouldn't have been.

* A doula is a professional labor support person who stays with the mother through labor to provide physical and emotional support.


Laurel said...

Wow. That is mind opening. Or mind boggling.

Jessica said...

I stumbled across your blog the other day and I must say I find it very interesting. I have been married for 21 years but have never given birth so I appreciate your perspective. Keep up the good work!

joy said...

I'm enjoying reading your blog and I love the pictures!

Quantmlife said...

Hi, I'm a new RN and while I was in school (including a practicum rotation in Labor and Delivery), I saw a total of four births. One vaginal with an epidural, and three emergency c-sections. I also was pregnant during school but managed to have a vaginal birth without any meds even though I delivered in a hospital. I was 3 weeks late by the edd, and I was originally supposed to deliver with a lay midwife at a birth center but due to legalities and my being postdates I had to go to the hospital. I agree it's really crazy that in school RN's are taught so little about natural labor and delivery. On a side note, I did get to share with my class a different perspective on vaccinations -- why some parents/people choose not to have them -- which would have otherwise not have been shared at all. I wish I would have had the opportunity to learn more about natural birth while I was in school. Thanks for sharing your perspective.

mceeh said...

Hi there... stumbled across your blog that was linked on someone else's. I've been a RN for nearly 9 years and I currently work in a "family birth center" in a local community hospital. (And believe me, given my own philosophies, I'm having a REALLY hard time working there in some respects.) I had two maternal rotations in school. In the first, I attended exactly ONE birth - a young 14 year old girl who actually did have an unmedicated delivery. And in my second rotation, I visited with one woman in the very early stages of labor but missed the later stages and the birth. So I guess I attended ONE birth. Otherwise, I cared for postpartum women. I probably had a grand total of about 12 or 14 days on the units, and that includes both rotations. I can tell you that in school, we were never taught ANYTHING about natural labor or pain coping techniques, other than epidurals and other IV drugs. I had never heard of a doula until I became pregnant with my first child, 4-1/2 years later. It's a tragedy that nursing students are not exposed to more of what is "normal". Thanks for your blog!

Anonymous said...

Very interesting perspective. I am a nursing student at a school in the Northeast. I saw my first birth today, actually my first two and I am amazed at the beauty of such an experience. The first delivery was a c-section but the second was a beautiful vaginal unmedicated delivery. i will probably see 3-4 more before my rotation ends and will be taking OB again next year. I think it just depends on the school and where you go. My OB professor is also a midwife and really advocates for medication-free childbirth, so this could also help. I think it really isn't so much the nurses are against things, it's just the way they've been taught and educated.