Thursday, December 17, 2009

Empowering Nurses

I had a great meeting today at a hospital I spend a lot of time doing labour support at. I am SO blessed that one of my former holistic doula students is one of the nurse policy makers of obstetrics there. She is a homebirthing mama herself, and is mired in an environment that often makes her weep with frustration. She is stopped by her OB colleagues and asked, "you're an intelligent, educated woman! Why would you take such risks by having your baby at home?!" Obviously, they're not reading the literature! Today she told me the most challenging thing about being an OB nurse was that, having done her doula training, she thought she would be able to help a ton of women who wanted natural births. And then she realized that the vast majority of women coming in to birth at the hospital aren't even remotely interested in birthing naturally. She cried a little telling us that. Still, she works on, slowly, carefully, and with delicate diplomacy changing the policies she can. It is change that occurs in miniscule increments, but has profound effects...like a baby no longer needs to have a weight in its chart in order to transfer to postpartum...no separation from Mom's skin until a couple hours later if that's what Mom wants. If a woman needs an IV for whatever reason, like to administer antibiotics, they are no longer tied to the pole. She taught her staff to do saline locks. I so admire this lady, and the courage it takes to be taking on such a huge system that is extremely reluctant to change and think outside the box.

She, my training partner, and I met at the hospital today in order to create a doula training for nurses. Our goal is to help new nurses learn about the value of natural birth, and how to support it if the patient is open. This hospital is at least interested in lowering its intervention rate. The chief of obstetrics has been very interested in our statistics, and is curious to see what we doulas can do to help them. The challenge in our town is the incredible shortage of nursing staff. It is simply not feasible to take several nurses off the floor at any given time to do a workshop with them. They often have to take care of 4 labouring woman at a time! So we are devising ways of screening what patients would be interested in receiving labour support, and being mentors for nurses who wish to shadow us doing our jobs.

This is extremely exciting for me. What I know about nursing training here, is that during school, a student nurse might witness a birth or two, one of them almost always being a C-section. The other is most likely an epiduraled birth, since the epidural rate for first time mothers in Montreal hospitals is around 98%. So then they come to work in labour and delivery, and are suddenly surrounded by ladies in active labour...who tend to vocalize quite a lot in many cases. Without any training or support whatsoever, they have to deal with these whirling dervish like labouring people, trying to keep them on a monitor to keep their own jobs. Plus, if they've never learned about the value of labour sensations, the way they conduct a beautiful symphony of hormones, and all they perceive is abject misery, OF COURSE they're gonna push drugs! They are taught that labour pain is a nasty side effect of the birthing process, not something that a woman can perceive as intense, but manageable and even amazing given the right preparation and support.

So, our job as doula trainers is to help OB nurses learn about birth. Sounds crazy, doesn't it, that the people who deal most with birthing mothers are in fact in the dark about how labour unfolds and why it is intense, rich in sensation, and often for most women extremely painful at times...but do-able. They don't have time to observe the endorphins or the beautiful oxytocin induced high that makes a lot of women very sexy and loving during labour. They don't pay attention to the profound rest in the spaces, where a woman can gather energy for the next wave. Often, an inexperienced OB nurse's method of helping with labour support is to yell, "BREATHE" in the woman's face, trying to control her, giving her the message that the reason she's feeling pain is because she's "out of control" and not breathing right. I've never done a breathing technique in my life and birthed just fine, thank you very much, and would have been very offended by someone forcing some kind of aggressive technique on me. Not that I think there's no value to breathing techniques...if a woman feels this will work for her, it's a tool she should have...many swear by it, so I respect that. But the "BREATHE" from nurses is usually not calm suggestion, it's just a fear response, a desire to DO SOMETHING to SAVE this poor creature from the devastation of a pain that will somehow do something so horrible to her, we cannot even bear to witness it. This is what many nurses believe, and what many convey. And if a nurse conveys this message to a labouring mom, a nurse being a medical person, thus someone who, according to a patient, knows what they're talking about, then she must be right. And so enters the epidural, and truly, you can just hear the sighs of relief from hospital staff when a woman is talked into "her" epidural.

If any OB nurse is out there feeling offended by this, I deeply apologize...I can only speak about what's going on in my neck of the woods, and it in no way applies to everyone. There are lots of nurses I work with who are master labour supporters...very skilled and loving. There are many who are as frustrated as I am at the lack of training nurses receive in school about how to hold the birth experience skilfully. These nurses, however, are so busy with their jobs given a nursing shortage crisis, they are not in a position to be able to teach the newer nurses. They have asked we doulas to help out. I want to shout out from the rooftops my love for OB nurses, and how I respect their work, and how much I know they shoulder in every way. Many have become friends over the years. I just know with a little guidance, a whole new world would open up to them and to the patients they serve.

A 98% epidural rate could most definitely be reduced if a nurse came into the room during a loud contraction, and she stood calmly smiling, whispering, "you're so great...you're doing it, Hon! You're getting there!" It would be so much more effective than being all tense and scared saying, "you know, this is only going to get worse...I think you'll relax more if you take the epidural...after all, you need your energy to push, right?" (insert image here of Lesley banging her head repeatedly against the wall in a rage of frustration) Oh, the disempowerment! I know it's not intentional and malicious...it's just so...counterproductive. This is our culture.

Instead of wallowing in the quagmire of frustration, however, I will get really positive about the fact that I am allowed to go in there and SHAKE IT UP!!!! I get to change some minds. I get to demonstrate how to be comfortable with expressions of labour, how to be gentle with a labouring mom, how to not force her to be intellectual when she should be allowed to be in primal mode, how to respect her space, and how to provide basic comfort measures if she should so desire them. No, I'm not naive enough to believe a nurse can change the mind of someone Hellbent on wanting an epidural, but I do believe she could help those who might be open to discovering what walking down the road of natural birth has to offer.

So an exciting day in Doula Land!