#151 | Labor & Delivery: A Nurse Shares Why She Left Obstetrics

March 9, 2022

"I don't have time for this today. My son has a soccer game. I am going to say that her baby's heart rate is decelerating and we need to do a c-section."  This is just one of the many things Shelby, a nurse in Arizona, heard from doctors in labor & delivery when she worked on the maternity ward.  This episode brings to light the very real fact that providers don't always have the laboring woman's best interest in mind. Instead, profits, time, and liability concerns drive many of the decisions leading to unnecessary birth interventions. Shelby joins us today to share what she witnessed in her years as a nurse and why she left obstetrics.

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View Episode Transcript

I actually got so tired of it that I left OB, I loved OB so much. But I got to the point to where I couldn't stand what we were doing and how we're caring for the moms anymore.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

My name is Shelby. And I worked as a postpartum nurse for almost three years and spent a lot of time in maternity, just in general, with the nursery that we had downstairs and labor. My area of expertise is arguably more so postpartum. But I have a lot of insight as to what goes on down in labor land. Cynthia and I had a little chat a couple of weeks ago, almost a month ago at this point, about my experiences and things that I was taught things that I noticed surrounding childbirth and postpartum and life in the hospital, once you give birth and going through that process.

So Shelby, after HypnoBirthing class, you stayed on the line chatting with me and some other couples for a while. And you were saying, This is how we were trained in the hospital. These are some of the things I was told. And I said, we just have to get you on the podcast to talk about this because I always figured that in a hospital setting that you know, in in the most extreme sort of hospital setting where there isn't support for visit for a physiological birth, where there's a lot of rhetoric those where there's a lot of manipulation of the laboring mother, I figured these things were sort of a culture of the hospital, which I'm sure they are, and you'll talk about, I always figured these things were sort of like a wink wink or just an understood, covert sort of vibe. But you were saying they were more overt, where there was more language around how to train the hospital staff to I guess I got the impression deal with or manage the laboring women, can you start to talk about some of those things that you were sharing with me?

Yeah, it just, it was such an interesting learning environment. I started out in postpartum as a new grad right out of nursing school, and then spent those three years at the same hospital. So it was very, very interesting learning there from all of these nurses and doctors who have spent a majority of their career dealing with and managing these women. It's wild some of the things that those doctors have said, I've sat there at the Labor desk and listened to a physician who had a woman attempting a VBAC. Say, I have the time to deal with this today. And my son has a soccer game tonight and I need to be there. I think I'm gonna go tell her that her baby is D selling and we just need to do a C section. And that poor woman believed the doctor and she went back and thought her body had failed her her VBAC failed. Her baby was a stress when that wasn't the case. And she had a C section and thought it was necessary.

How did people around you act in that moment? Any other nurses? Did anybody speak up? Did he just did he even feel an ounce of guilt or shame and saying the crazy

thing to me is it was actually one of our women doctors, she We hear this all the time. Oh, my gosh, you know, she isn't but I did

it for a man I did picture.

We probably shouldn't put this part in. But we have a physician who we jokingly say he has or we have dinner with his C sections happen at four o'clock. The baby is in distress. He pulls core gases after the delivery to prove the baby was in distress.

What does that mean? Can you explain that? Six plain ol belly fat his name, if you want me to, but please explain what you're saying. He you put in quotes that he maybe has D sales at four o'clock. It gives C sections because he wants to head home. But can you explain the next thing you

said? Yeah. So a lot of the times these doctors will do what's called cord gasses. So they draw blood from you'll have to forgive me because I'm not sure if it's the umbilical artery or vein. But it's the blood supply to the baby and essentially they look at

it basically it tells you whether the baby was act Sleeping compromised or not? So it's helpful to have this data in case you go to lawsuit to say, Oh, yes, the cord the blood oxygen level, the the pH of the cord blood was in a dangerous level. So therefore, the C section was justified. Or alternatively, if you didn't do a C section and you drop cord gases, you can safely say this baby was not calm distract later later down the line, they have cerebral palsy or something. How did he manipulate

that? How did he create that evidence?

This physician specifically would say things like, we need to save your baby, your baby is in danger. If we don't do this, your baby could potentially die. That's what he would say.

And it was all a lie. He did that religiously at around 4pm to end his shift with the C section each day. Yep.

And basically, if there was any kind of slight trend in the direction that maybe there was a little bit of fetal distress, like showing on those core gases, he would say, oh, yeah, these gases, they just they proved your baby. We got your baby out in time before things got too crazy bad,

right? That would be an hour the way they could justify it by saying, I we birth your baby before your baby was in too much distress.

Why didn't he just let them continue with their births and let another doctor take over?

Because his shift wasn't over? Why didn't he just

let her transition over to a different doctor? Was it so he could get one more C section on his shift

probably didn't end until seven or 8pm. And he wanted to be off work at five because he had plans.

I'm trying to say is this about one? I feel like a lot of stuff in the hospital. So let's talk about let's talk about both.

He gets paid more for doing a C section and he gets home two hours earlier. Yeah. That sounds like

a good deal for him. They can control it. They get to control the entire thing. There's no if he

has no one in labor, he doesn't have to be at the hospital. Yeah.

Would let's talk about revenue. What were you saying? Tell us more.

Oh, I so much in the hospital is geared towards revenue. I can't tell you how many times I heard from upper management on my unit that we didn't make the hospital enough money. Right, you don't meet the quota. Yeah, we didn't meet the quota, or our patient census. Abdun flowed so so much. That's why I spent so much time down on our labor unit. Just because we a lot of the times didn't have enough postpartum patients to fill up our postpartum floor. So they would leave them in their labor rooms and just have the postpartum nurses come downstairs to take care of them on the labor unit. But it which again, was kind of a money saving move. staffing at my hospital was more so focused on meeting budgetary guidelines than safely caring for patients. And I feel like a lot of units are like that in the hospital. It's it's geared towards meeting your budget and not safely cure patients. I can't tell you how many times I was given unsafe patient ratios and attempted to refuse them and was told by my supervisor that I didn't get to say

what you mean. Explain that to the layperson.

So be patient ratios an ER nurse to patient ratios are the amount of patients or and in my unit because I was a couplet care postpartum nurse, how many rooms of moms and babies I would get. So one mom and one baby is considered a couplet. So a safe couplet care assignment would be three to four couplets. Meaning you have three pairs of moms and babies. I want to say in California, California's nursing Union states safe ratio was three.

So 123 couplets. Yes.

And that's that's what would be considered safe according to California standards. And I want to say there was actually something that came out too, not too long ago, where it was like the Nursing Association for America, I cannot remember what it was called, but they had come out with guidelines for safe nurse to patient ratios, and they said this safe ratio for a couplet was also three to one nurse, so I was often given for couplets, which wasn't necessarily a big deal. But there were many, many times where I had five or six couplets, many of which were really really heavy assignments, you know, a mom who had hemorrhaged we had a situation once where the poor lady had an emergency C section, rightfully so the baby's cord had prolapsed and because it was an emergency, they didn't do care. out the laps, they do like a lab count prior to the C section, which are the sponges, so they have the the sponges that they'll believe, just soak up the blood during the surgery. And they have to count them to make sure that nothing gets left behind in the surgery.

And so the count at the start and they got to the end. And then because they didn't do a count they Yeah, they

had to they had to open her back up. And they left a sponge inside her. Yeah, they actually didn't. They thought they did. And they didn't. So they opened her back up for no reason. Oh

my gosh. But that the whole thought of that is so sad and painful that they had to do that to that woman. Exactly. It had to be devastating. And then it was a mistake. Okay, nothing in here. We're fine. Oh, there it is like this. Is this what's going on?

Yeah, essentially, except for There was never a lap inside.

Right? The Oh, like, Oh, no. Oh, there it is. I meant like, oh, there it is across the room on a chair. Pretty much. So basically, this was one of your six women on that assignment.

Exactly. i It was a day where I had I had a woman who had a postpartum hemorrhage I had this poor woman who had to be opened up twice for no reason. Other than staff mistake, sloppiness, and then sloppiness. Yeah. And then, you know, I had a mom whose baby had to be flown out to a different hospital. Oh my gosh, because it was in our NICU and needed to be transferred to a higher level of care. And then I had, you know, to normal,

as a nurse, what's your responsibility? Is it to make sure they're physically in check, or that you're emotionally supportive to them?

In my opinion, I feel

like emotional is in your opinion, but in the hospitals, hospitals, it's it's purely about making sure you, no one's dying, you take their vitals and you do the physical things and you document adequately in the chart, they don't care if you have any emotional availability. While and

that's that's, you know, one of the biggest things that I noticed is there's no importance really placed on the emotional well being of the moms, it's you chart and you cover your booty, in case they ever decide to come after you on court. That's really what our care was geared towards is covering ourselves. If Did you chart adequately, adequately? Did you cover all your bases? Okay, then we don't really care what else happens during your shift?

And and did you do enough that we're going to meet our bottom line, I mean, everything you're describing, so far, comes back to the hospital is a business. And they care more about their bottom line and covering their ass than they do about the patient experience.

Exactly. And it's, it's so sad, I kind of became the queen of encouraging patients to fire the nurses that they didn't like. Because so many of the nurses at our hospital just didn't care I, you know, we're getting so far away from actually caring for the person and only looking for abnormalities or issues within their body. And if there's nothing wrong than we don't care, and we're just going to leave them alone.

I have a question for you about their practice of keeping records. In the event of litigation. Do the records show that let's say this patient had a nurse who was stretched to six couplets at this time? Does that go on the patient's record? It's in a very significant part of the treatment or the absence of treatment? Does it go on?

Yeah, to my knowledge, there's like an assignment book where they write in the nurses and how many patients they had, I don't know how those records are kept or how long they're kept for,

but the hospital also has ways of justifying their lower coverage at the time, you know, they will have I'm sure they they they're not blatantly violating policies that they would get in trouble for I'm sure they have ways of justifying why exactly,

they get away with it. Right Do away with it. You had told me some specific examples that took place in the maternity ward that I found really interesting. And it was after I taught a class. I think it was the class where I teach positions and breathing techniques because your jaw was kind of dropped at the end because you were merging. I mean, you already started very informed in the natural field. But you were still saying oh my gosh, like you were almost like Cynthia, if all of you knew how these conversations are happening. And you said something to me, correct me. It was something like we are trained to discourage mobility.

When a laboring woman walks through the door, one of the very first questions that they're asked is do you want an epidural? And I had noticed so many nurses who didn't like caring for patients who are going natural because it kind of job more difficult. It Yeah, it's a lot more work. If you have a patient with an epidural. while they're in bed, they're on a monitor, you don't really have to worry about going in and adjusting the monitor consistently, because they're stuck in one spot, they can't really move and flop and flip back and forth. So you can sit out at the Labor desk, and you can eat your snacks and drink your drinks and chat with your friends and stare at your monitor. And you don't have to be in the room with the patient. But if you have a woman who doesn't want an epidural and she wants to be in shower, or she wants to be on a ball, or she wants to walk around the unit, there's a lot more that goes into caring for her in the hospital, especially with the charting that's required. And the documentation that's required. I'm assuming it's Trisha, you could correct me if I'm wrong, but arguably much more different than if you were to give birth in a birthing center or something like that.

You mean the level of documentation?

Yeah, yeah. Yes. Probably yes. Because I it's the way our documentation is geared as it's geared towards a, an intervention filled birth. So there's a lot of boxes that essentially have to be checked and marked off. And you can't do that as easily if your patient is up and moving and walking around. And you're constantly having to put your patient on the monitor taking them off when they want to move back on. So it's just a lot more work. And if your patient is immobilized, and laying in bed, you're going to have an easy shift. And I say easy with quotes.

Did you ever hear medical staff doctors talking behind a patient's back in a disrespectful way?

Oh, 100%. And you know, and I had mentioned this in class, I had said, I felt like nurses nowadays are trained to fear the woman who doesn't want interventions. What are some of those comments? Oh, my gosh. One, specifically, that pops into my head is all these these parents, they they think they know better than the doctors. They're not the ones with the degree. Who are they? They don't know anything. Or one of my favorites is when we get parents who decline the newborn medications, the vitamin K, the hepatitis B, injection and erythromycin. Yeah. The parents who decline those, I can't tell you how many times I've heard those parents are so ignorant. They're so stupid. They don't even know what they're talking about. Do you? Why Why would you ever decline that for your children? And there were a couple of nurses who had made these comments. You know, we we give report at the change of shift to fill our nurses, the oncoming nurses and on how our patients are doing and what's going on with them. Well, part of that and postpartum is this parent declined the meds for their baby or this parent gave Hepatitis B but declined the IOM met or something along the lines of that. One of my favorite comments was, Are you kidding me? Another one of these crunchy moms again, that doesn't know what she's talking about? Oh, I can't believe this twitch. My response was, Well, have you read an insert? And the nurse goes, What's that? Oh, come on, when I was like, you know, the information that comes inside of the box for this medication that tells you all of the risks and side effects. She was like, Well, no, I haven't. I was like, Oh, that's funny. Did you know that this is the side effect? He's like, no, no, what

an insert is.

I know. So I was like, well, let's go look. So I pulled it out. And she was like, Oh, my gosh, and I was like, yeah, so that's why these parents are declining this

maybe because they read and that was their choice.

Yeah. So they described the patients as crunchy. I would say I'm probably a little crunchy too.

What is it like for you being the queen of telling the patients to fire their nurse? How does that influence you as an employee there? What do you feel like when you go to work and how were you treated?

You know, I think in my case, I was pretty lucky a lot of my co workers had gotten to the point where I think they had a lot of respect for me because they realized how hard I worked and the research that I had done. They didn't agree with it. A lot of them didn't. But I kind of felt like I was tiptoeing around and walking on eggshells around a lot of the doctors and nurses you know, I had all these opinions and things that I wanted to speak my mind on. I would mainly, you know, encourage our patients and not so much relay that to the staff just because, you know, you work with these doctors and I arguably some nurses could probably say You know, there's a little bit of fear surrounding the doctors. You don't want to make them mad. You don't want to have a poor relationship with these doctors because you're stuck working with them every day you're there. So It definitely was like walking on eggshells, I actually got so tired of it that I left OB, I loved OB so much. But I got to the point to where I couldn't stand what we were doing and how we're caring for the moms anymore. And right before I left, I was actually offered an opportunity to either train and become a NICU nurse or a labor nurse. And it's kind of crazy looking back on now, because going into nursing school, my ultimate dream was becoming a labor nurse. That's what I wanted to do right out of college. And I was so sad that they made me start in postpartum. And that was all I wanted to do the first year of nursing. Every couple of months. It was when can I go to labor? When can I go to labor? And I turned it down, just because the way that we're trained in the way that we interact with the patients wasn't really what I wanted to do anymore.

How in your experience from what you witnessed working as labor and delivery nurse, how many C sections would you say were done unnecessarily for women? What percentage

at my hospital? Are we are we saying how many like we're not talking about just C section percentage, we're talking about how many C section were unnecessary, correct?

Exactly. Yes. How many C sections do you think we're done prematurely? unnecessarily?

I'm ethically honestly, I'm ethically

Yeah. Honestly, I feel like probably honestly, 80% Maybe. And we had an extremely, extremely high C section rate at my hospital i And again, it comes down to physicians, but from what I've seen, our hospital likely had a way higher C section rate than most of the other hospitals here around us.

What's the most important thing for women to know before they have their hospital birth?

You're in charge? Yeah, you absolutely are in charge. And that's, you know, a lot of nurses and doctors won't tell you that. But you are, we can't touch you without your permission. We can't do anything without your permission. And you know, when a doctor comes into your room and says, Okay, well we're going to do this and you nod your head, it's implied you're consenting, you have every single right to tell them no to stand up for yourself to fire the nurse that you don't like. Or the dancer and really, yeah, you are so much more empowered and have way way more say in your care than most nurses and doctors will make it out to be and if you have that right nurse that it makes it even easier.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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