#257 | Labor & Delivery Nurses' Roundtable: How Their Hands are Tied to Doctors' Orders

It's hard and the patients come in generally, with not a whole lot of knowledge about what to expect. And to me, the physician should be educating them at their prenatal appointments. But that doesn't happen. And then you also have to maintain that you're going to be working with that doctor in the future. So you have to walk that line of not making them angry.

It was just a lot of exhaustion, trying to fight for my patients and feeling like there wasn't a whole lot I could do if the doctor said, you need to do this, you had to do it, because that's just the chain of command. And that's what was so hard is that you wanted to spend this time with women really helping them really fighting for them.

But you couldn't. As I was willing my patient back for a stat C section. She's obviously very scared. Lots of process, within earshot doctor that was standing at the nurse's station saying Money, Money Money, while we were rolling back. That's someone's life, that someone's birth story, that someone's body. It was really devastating.

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.

All right, well, Trisha and I are super excited about today's episode, we are so lucky to have three l&d nurses, current and former, who've taken the time out of their busy schedules to come on the show and talk today. So we want to welcome all of you Alex, Kate, and Lindsey, thank you so much for coming together to do this episode with us. The reason that we're so excited about this is that I feel like nurses are just the best people who can possibly tell us what's really going on in hospitals, what women can really do to protect themselves. And it I just feel like, the Insight is going to turn into some really good education and preparation for our listeners.

Yes, so we want all that we want all the nitty gritty, behind the scenes stuff that are, we have plenty of birth stories, and you know, women sharing their anecdotes and their experiences. And we know from our own personal experiences, but you guys are there on the forefront, day in and day out and know exactly the politics behind the scenes and the culture and the policies and the ways that women are treated and mistreated. So thank you for coming on today to talk to us about this.

So let's start with having each of you introduce yourselves. We'll just go in the order for now of Alex, Kate and Lindsey to introduce yourselves, tell us where you work or what part of the country you work in, if you're currently in l&d, or, if you formerly were, and in answering those basics about yourselves. Can we just start off as well by having you answer one question along with those basics? And the question is what pulled you into working as a nurse in l&d and we'll get into later what you've seen and how you feel about it now, but when you were naive, and you hadn't been there yet, what was the longing to work in lnd. So Alex, let's start with you introduce yourself and where you're where you're from.

Thank you so much for having me. My name is Alex and I'm from the central Wisconsin area. I've been in the birth world for about 10 years now. And I'm a former labor and delivery nurse. I was worked in hospital labor and delivery nursing for three years. And what led me to this is all the way back from my childhood. My sisters were born I their triplets. And they were three months premature born at 28 weeks gestation. Now there'll be 29 years old this year, so long time ago, and I was five years old when they were born and they were in the NICU for several months. And I remember wanting to just be in that environment and take care of babies. And I wasn't so much sure if the NICU was something that I wanted to do. It seemed very intense, but started to look more into the labor and delivery side and mothering and nurturing and the whole and that story of my sisters being born so early and prematurely and being in that hospital environment is what led me to want to go into nursing.

All right, thanks, Kate.

Hi, I'm Kate. I was an inpatient pa pediatric nurse for about seven years. And then two and a half years ago I had my son I had an incredible home birth with him. And I had always been pulled to birth work and pregnancy and labor and delivery. But I just got kind of comfortable in pediatrics and never wanted to take the plunge and try something new. But after I had my son it like really deeply ingrained that I wanted to do birth work. So I left the unit that I had been working on for many years and transferred to labor and delivery where I lasted I left a full gestation I stayed for nine months before I realized that labor and delivery nursing is not birth work. And it's not what I envisioned labor and delivery nursing to be. I wanted to be a birth worker and being an l&d nurse is not birth work. So I quickly left and I'm back in pediatrics, where I feel comfortable, and I'm trying to kind of figure out how I can fill that void of working with birthing women.

Lindsay?

Hi, I'm Lindsay, I'm from southern Ohio, I have worked l high risk, l&d and lower risk LD RP. What drew me into it is I have always thought that pregnancy and birth are really miraculous. And I thought it was such an honor to be invited into that space. So I went to nursing school and I have only ever been in women's health.

Alright, so let's just hear a little bit about how you would each paraphrase and take your time. Feel free to get into a couple of details if you want to. But how would you paraphrase what it is like being an l&d What you witnessed, especially between birthing women and the providers that they've basically entrusted to attend their births, what's what have been your observations, and you feel free to provide examples.

So this is Alex. And I feel like it was just, it was very, it was hard working in labor and delivery. And kind of like you said, Kate, how you lasted, you know, nine months, when I started, I was one of three new nurses. And I was the longest surviving of the three new nurses who lasted, they all laughed. And it felt like, it's just it's a tough, it's a very tough environment. And you wouldn't think that everyone would always say, oh, it's, you're so blessed to be able to work in labor and delivery, because you're with these, you know, you're birthing babies all the time, or you're helping care for babies. And it's, it's not that, like you said, Kate, it's not birth work, your hands are tied. When you work in the system, you have to follow everything that the doctors want you to do all of the rules, all the policies, and while the doctors likely have the patient's best interest in mind, it feels like they are part of a system. And they have to do what the system states and what the hospital policy states. And again, it's, I want to state this Not all doctors are bad, and doctors aren't likely not trying to harm you or harm patients. But they've been trained to act, they've been trained to intervene, they've been trained to seek out pathology. And when they don't find pathology, they become uncomfortable. And they want to intervene even when they don't necessarily need to intervene. So for me, it was just a lot of exhaustion, trying to fight for my patients and feeling like there wasn't a whole lot I could do if the doctor said, you need to do this, you had to do it. Because that's just the chain of command, right? You have to follow safety procedures and guidelines. And while that might not be the safest thing, that's what the doctors are trained to believe is the safest thing. And that's what was so hard is that you wanted to spend this time with women really helping them really fighting for them. But you couldn't. And there are some stories that I hopefully will be able to share about things that happened and why us new nurses who had started at the time aren't there anymore, but I think that's the biggest thing is you want to help women, but your hands are tied. And I don't know if you guys Caitlin Z feel that way. But that's how I felt.

I completely agree. Even when I tried to advocate for my patients I was trampled over. For example, I had a patient who did not have a super set birth plan. She was kind of just going with the flow. And she said the only thing I really care about is I don't want my waters broken artificially. I didn't ask why? Because it doesn't matter. That's her only preference and the doctor came up to me that was taken care of her and said hey, I just was in a birth in another room. So I was just gonna go check room six. First of all, they only call patients by the room number which I think dehumanizes women from the get go. They never use patients names and don't frankly know the patient's names which sent me. It was never by the patient's first name.

That's even going lower than calling them mom.

Yeah, no, it was room numbers. Yeah. Now we've been demoted to room number. Yeah, so I'm gonna go check six, I'm gonna go check seven. And it from from that point on, they're no longer a woman with a history with a story with a history of trauma, there are a number. So she said I'm gonna go check six. And so I walked in with her. And she goes, I'm going to break her water while I'm checking her and I said, Oh, she actually just told me a minute ago, she didn't want her waters broken. So I thought it was understood that she would go in and just check her cervix because I just advocated for her and said she specifically said she didn't want her waters broken. We walked into the room, she opened up an Acme hook, put on her sterile gloves, checked her cervix. And while she was in there, she said, I'm just going to break your water while I'm here to speed up labor. And it was done. She had no time for consent. She had no time to even process what was being told to her. And that trust that I had built with her throughout my shift was broken.

There. It wasn't that there wasn't time for consent, there was no opportunity for consent. The doctor didn't provide consent whatsoever. Correct?

How did you know that trust was broken? Go ahead.

It was just deeply disturbing. And I, the patient never verbalized to me that she didn't trust me anymore. But I'm the last point of contact between the patient and the provider. And it's my job to protect her and I tried my best and it was just negated. Did

you end up feeling like you betrayed her on some level, even though you had absolutely no role in what happened? Absolutely,

I left my shift sobbing, and I take care of very sick children day in and day out. And when I told my therapist about a lot of the things that I saw on lnd, he said it speaks volumes that you want to go back to seeing trauma with children every day, overworking and labor and delivery. Yeah.

I can go a lot of the sentiment as far as informed consent, I think that that's one of the biggest things that I personally struggle with at my job, I don't feel like any procedure, the patient is accurately informed of the risks and benefits. I feel like providers cherry pick what information benefits, whatever their goal is. Um, I mean, that can be even induction, a ROM, a Pz Artemi, it's time for a C section, please define what a ROM is before you become an artificial rupture of the membranes. When the physician goes in with that human hook and breaks people's water, it's just, it's hard. And the patients come in generally, with not a whole lot of knowledge about what to expect. And to me, the physician should be educating them at their prenatal appointments. But that doesn't happen. So they come in, and they most people love their doctors, they just look at their doctors, like they're the best thing in the world, and they're their best friend. And that's not the case. And it's just hard when your patients hold this person in such high regard. And you try to come in there and contradict what their doctor might have told them. I struggle with that too. And then you also have to maintain that you're going to be working with that doctor in the future. So you have to walk that line of not making them angry.

I cannot even imagine how hard that must be. I think there's a part of the human psyche that makes us feel a connection or affinity to someone. I mean, you see it even with children who are abused, you see it, you just see it where people are totally oppressed by other people, even in some cases. When we are when we feel or believe we're dependent on another person for our life, for a very life, I really believe part of the brain makes us we need connection. And I think the part of the brain makes us feel like we must be connected to them, because that's the person so the story goes in the mind, who will keep me and my baby safe. And you can't have that discord in your mind where it's like, it's very uncomfortable to say that's the person I'm dependent on and I don't trust and that is so much discomfort, that it's easier to let the brain focus on like, oh, they smiled just that they're a nice person, or oh, they told a joke and made me laugh. They're a good person. And I'm not saying whether someone is or isn't. But I really think the brain forces us to try to connect when we believe we're dependent on another person.

We also can't ignore the fact that many mothers first time mothers especially are not ready to take on their own authority over their body and their birth. Many of them just don't want to. They really do want to go into the birth experience being told what to do, because they just haven't stepped into that part of themselves yet and I think birth is actually a lot of that the process of birth and becoming a mother transforms us from that younger self into the more mature woman. And unfortunately, the trauma that many women unexpectedly experience in birth forces them into that role faster. But they don't know going in, they really do believe that their providers in the hospital have their best and highest safety, emotionally and physically in mind. And they want to surrender to that. And of course, what we're going to explore today is how that is not true.

I feel like the takeaway from the first response y'all gave if we had to summarize it is like, if I were writing all this into an article, the top of that paragraph would read hands are tied. I feel like that's the key point you're all making do agree with that? Yes, absolutely. So before we move on to the next question we have do you do you? Have you ever even dared to push back against a doctor? Or have you seen another nurse ever do it? And can you talk about what that's like, or if there were any repercussions?

Something I've noticed, I noticed during my time in labor and delivery was that while there are a lot of like strict policies in place, labor and delivery is very gray. So what one provider sees as an emergency, another one would say, Oh, this is like an okay fetal strip, or like, Mom looks okay. And you're kind of at the mercy of whatever providers on call when you're giving birth, because you might have a more conservative provider that wants to send you to see section right away, for just like a few heart decelerations of the baby, or you'll have one that is more flexible. It's very provider dependent. And it makes being a labor and delivery nurse, a newer one tricky as well, because you work with one provider, and they think the fetal strip looks terrible. And so it makes you concern, but then you work with another one. And it could be the same or very similar fetal strip, and they're not concerned at all. So it's very gray. Let's,

let's talk about that for a minute. Because where does that come from? That comes from their lack of or, or belief in birth, their trust in birth, some providers trust that birth is a normal physiologic process, and they have a wider circle of safety. And other providers have a very narrow circle of safety circle of safety. And they really actually don't trust birth. They really see birth as the accident waiting to happen. They're constantly on high alert for the thing that's going to go wrong for the moment, they can jump in for the intervention that they're just waiting to do.

I couldn't agree more i i had disclose to only a select few co workers that I had a home birth with my first son, because I was afraid of the judgment that I would receive from other labor and delivery nurses. And I ended up telling one who also had a home birth and I felt safe telling her that I did. And I said I actually had a 10 pound over 10 pound baby at home, no tearing, pushing for 20 minutes, like it was the most beautiful experience. She ended up telling a resident like, hey, this new nurse over here, ended up having a home birth, blah, blah, blah. And he she ended up the provider said that if she knew that her baby on a third trimester ultrasound would be over six pounds, she would opt for an elective C section.

No trust,

no trust in the physiologic process, no understanding of the physiologic process. A lot of the providers I worked with did not allow moms to birth in different positions. I was trained not to let patients labor on the toilet

is silly, because it's actually a great place to birth a baby if you're there to catch it. But many obese, most obese have never caught a baby in any position other than a woman on her back with their legs up.

I was working with a new OB, she the OB it herself wasn't new. It was my first time having a patient with this OB and I asked my colleagues Oh, what do we think of her? Like, is she is she nice to work with? And they said oh, she's awesome. She lets her patients worth in whatever position they want, said the word rate low standard. And I liked

by two red flag

term. Yeah. Lindsey, why don't you comment?

I have tried to advocate for patients, especially I've had multiple patients try to refuse postpartum Pitocin which I'll be honest, I feel like a lot of my colleagues don't even tell patients that that is standard protocol for them to receive Pitocin after delivery. I always go over that at the beginning of the shift with a patient that that that will happen. That's

that's very nice to hear. Because you are correct. What you're observing is it's not the norm that women are told that. And we've, it's our understanding, some nurses are trained to administer it through an IV without even telling the mom sometimes. And Alex, you're nodding so and Kate you're nodding to. Alright, so Lindsay could go ahead and tell us well, I

have to say my experience is not so much that we're trained to not tell them, it's just automatic, you just do it. And don't say anything. But it's definitely one of the things I talked about when I go in for the day. But I've had a handful of patients say, You know what, I don't want that. And so I talked to him about the whys. And you know, if they're an induction, I'm kind of encourage them to consider it versus a spontaneous labor because they're more likely to hemorrhage after an induction. That is correct. So, you know, after delivery, the and this has only happened with residents to the resident has told them that they're bleeding too much. And they need Pitocin. When to my eyes, it looks like a normal amount of bleeding. But who am I to say, oh, no, no, doctor. She doesn't want Pitocin. And that looks normal to me. So in my experience,

we should we should just dig into that for a moment because residents have this is this is all about the power differential the the the chain of command the authority, residents have way less experience than you have with birth. Yes, therefore, they're calling many postpartum hemorrhages, hemorrhages that aren't actually hemorrhages, because they really have no idea what a postpartum hemorrhage looks like, because they've probably seen three.

Also, that goes into the fear of birth. And they

don't afraid they don't trust birth, because they've seen very little, whereas you could have a labor and delivery nurse like yourself, or someone else who's been, you know, seen 1000s of births and really understands the difference between a postpartum hemorrhage that needs intervention and a woman who's just bleeding. You know, what looks like a lot but really, she's totally physiologically okay. Yes.

So I've never had a patient successfully avoid postpartum Pitocin because the physicians act like they're hemorrhaging as soon as the baby comes out.

Residents are like first year obstetricians, is that right?

First to third generally, they're full on doctors. They're working on the obstetricians opposite obstetrician, and gynecologic specialty. And

unfortunately, a reality of being a first year is that one thing they must get, the hospital wants them to get, and they themselves want, they must get experience doing stuff, they must get experience suturing a woman who has had an episiotomy, so they give a PCR dummies, they must learn how to do Amjad dummies. So I just warned my class about this on Sunday when I was teaching HypnoBirthing. And I happen to have four nurses in that class. By by coincidence, I was just saying, You've got to be aware of who is attending your birth because some of them unfortunately have the intention. Kate, you want to jump in here I can see that I have the have the the intention to get experience on you. And that's not what you're there for Kate.

I was talking to a senior labor and delivery nurse who had been doing it for a million years. And I'm just talking to her about her experience when I was working with her. And she said, Just wait until July. If you want C section practice, because Because July is when the new residents start, and they're going to want to cut - you know what the motto is? Right? See one do one teach one. Do One, Teach One?

Yeah, she says wait till July if you want C section practice because we'll be doing all the C sections so they call C sections and lower the threshold for doing C sections when new residents come into town.

So your resident could be performing a procedure after they have seen one procedure done. They could be doing their first Peasy automate after seeing one Uffizi automate done on scene, a C

section is a major surgery are you telling me literally they can see one and be responsible for doing one?

I imagine that for Syrians they hold a higher bar, I hope. I mean, there's always a team in there for a C section. So it's not like it's the only person but something smaller, like in amnion me a Pz Atomy placing everything that was saying, you know, fetal scalp electrodes something like that, you know, one time,

let me ask you all a quick question before I have a more effort before I have a deeper one. Lindsey, did you finish your point that you wanted to make or was there a little more you want to add first?

Oh, that was I mean, that was mostly it. As far as advocating for patients. I also feel like I have had nurses who I don't wanna say disrespect but don't agree with what I how I'm treating my patient and want to go the route of more interference.

No, no surprise. It's the system that's in place. So it's not just the doctors it's other nurses as well. Yeah, well, it's it's it's the SIS Dum, it's the culture. And you know, Trisha, and I never say, well, all they want to do is this and doctors like we never generalize, but it is the system. And it's not only the system, it's who is attracted to the system. I've shared that Mount Sinai had on their Instagram page a couple of years ago, they had their new graduates becoming obstetricians. And they did this post where they were trying to make each of their new graduates be appealing, I think every I think every one except one was female. And they said, like, tell us about yourself. And they had to answer their favorite hobbies, and this and that. And the last question was, what made you want to become an obstetrician? And they publicly said they chose to put this answer down in every case, I think except one, their answer was surgery, I've always wanted to be a surgeon, and a couple put an exclamation point after the word surgery like it's actually now attracting, like, whoever went into obstetrics in the 60s was not saying that when they went to medical school, so it is actually attracting a different population of people now, and more women than men are becoming obstetricians, and they're sorry, they're a part of the same patriarchy that got us all into the system we're in now, in the first place. It's all sort of the same thing that they're doing. It

is true that obstetricians do do surgery and that is what their profession is like, that is part of their profession. That is what their type but

it said, but but but it said, Why did you become one that's a completely different? Yes, conversation fine

if they want to be, but then limit your scope of practice to the 10 to 15% of bursts made you know, go

go go become a heart surgeon if you want to do surgery. That's what I say.

Go get organ

transplants you

do surgeons to do? You do need obstetricians to know how to do surgery to drop they need

to learn surgery as a part of their job. It shouldn't be why they want to go into the line of work. And that is the that is the question they were answering. Why did you go into this work, and they are they're so drawn to surgery that they believe the appropriate place for surgery, the end because it has become that now, my

vision, my point is to try to say, let's let midwives and let's let midwives manage 90% of births and keep obstetricians to the 10% of births that ultimately may need surgery. So Fine. If you want to be an obstetrician, because you'd like to do surgery, but maybe stay out of the physiologic birth world then, because we don't have the training and the knowledge. And even as evidenced by this the desire to support physiologic birth. Let

me ask a quick question. Now before I asked a longer one. I you may have different answers to this. And I think it'll be interesting if you do. But please give your gut response even if you all answer around the same time. Feel free to all just jump in with this. When you're at a birth when you're at work. Or when you were in your case, Alex, who are you working for?

mom and her baby patient.

I heard two of you.

Yeah, that's tough. It's tough. I'd like to say the mom and the baby. But I also very much have to take the physician into consideration. I mean, yeah, because I'll tell you one of the hardest, actual aspects of my job is trying to time when to call the physician for delivery because I don't want to call them in too early because then they get annoyed that they have to sit there and wait. So I don't want to call them in too late because then they get annoyed that they missed the delivery. Yes. Wow. And I'll tell you what, unmedicated patients are very tricky to time. And I love my unmedicated patients. i That's my favorite to support, but the doctors very much do not because it is an inconvenience to them to be there earlier. Stop

right there. Stop right there. That's such an important point to reiterate. unmedicated patients are difficult to manage, because they're difficult the time because it, it disrupts everybody's flow, everybody scheduled, nobody knows when the baby's coming. They could be one centimeter and an hour later, they could be giving birth and nobody knows. medicated patients with epidurals and you know, continuous monitoring are a lot easier to manage, because we can control that Pitocin or, you know, we can control the process. We can watch it from the other room, we can predict when to go, Lindsay,

why would they be upset if they miss the birth?

You know, I've never gotten a clear answer for this. I had been told a lot of theories, but I've never gotten a real reason why they are upset. I would like to think it's just because they have bonded with their patients over their prenatal care and want to deliver their babies. The cynical side of me says that's not the case. But I have never gotten a true answer for that.

I mean, that's not feeling like that's likely to be the actual answer when we are coming off of saying that they refer to women as the number of their room. So I think that's you using your own heart and answering the question chin. But why would they be upset? Like, do they build differently if they're not in the room at the time, Lindsay, finish what you were saying.

I have never gotten a true answer to that question. Okay. And I will tell you, the midwives that I've worked with have been always been a lot more considerate over missing deliveries than physicians have.

Okay. So

it feels like, at least for me, when they would miss the birth, they thought for some reason that it wasn't safe. It at least is what I had heard from them, like, Oh, it wasn't safe because I wasn't there. Or what if something went wrong, because I wasn't there. And that that was mentioned a couple of times like safety.

I guess they also have to fear a culture where nurses are purposefully not telling them because that could get out of hand. And that's probably what they're thinking could happen. If it's if they don't make a stink about it and get upset and say, Oh, my anything could have happened, I had to be here. You know, if they really were too nonchalant about it, I guess they're afraid that nurses could be very protective of their patients and evaluate that they don't need to call the doctor and things could get totally out of control.

So I think it's fair to say that at the moment of birth, that is in the in the immediate moments after you now have mother and baby to worry about so to not have a skilled provider there who can assess both quickly, that is also the time of when there's the most risk if if there's risk and birth, it's right then in there, at the moment, the baby is transitioning from inside to the outside world. And so I think it is stressful for a provider, even though in retrospect, they're looking back and saying, Well, everything is fine, it all went well. But it's it is sort of that that fear, I think, Cynthia, that you mentioned that, you know, if we, if we don't act like this is a big deal, this could start to happen all the time, and then we are putting the possibility of something going wrong. Now, if we allow that,

I just think it's interesting, because in envisioning having your jobs, I don't know who I work for either, like your heart wants to just be there taking care of that mom, of course. But you do have to deal with doctors, the fact that not only their egos and their personalities and whoever you're dealing with at the time, but that you actually have work orders to follow what they say you do also work for them. And you do also work for the hospital. Like if you were to see something grossly unethical, I'm sure you have an obligation to report it to the hospital. So your jobs, by definition are almost impossible to really, to really do. Because who do you work for? It's it's truly everyone you have you have an obligation to the patient because of informed consent laws, but then you have all these other work obligations? I can't even imagine how you can answer that answer that question without grappling with it. Because your heart wants to say one, but the reality is like your job is on the line. I just think it's it's very difficult to be a labor and delivery nurse, I imagine. So on that note, can we go really specific now? What are some of the most disappointing things you've witnessed, seen heard behind a mother's back? When were you just really disappointed? Being close? And being that person there? What have you seen or heard, just tell us a story or two each of you.

So I've got a couple of stories, but I'll share one first that there's a physician and this physician is still practicing. And I remember one time that this physician looked right at the patient and said, If you don't do this, you and your baby will die. And that was very

horrible. And I knew

Have you only heard that one time?

Well, once that was one specific time where really stuck out to me where it was like, I mean looked down on in this patient's eyes and was like, if you do not do this, now you will die. And then as this patient is being transported, where I worked, we only had a level three NICU we didn't have or excuse me special care nursery, we didn't have a NICU. So if they knew that something could potentially be wrong with baby, they would transfer the mom out if they could prior to baby's delivery. And so as this mom has been wheeled away on the stretcher, she says you might die on the way to the hospital. Unbelievable.

I cannot believe that's allowed.

Correct. And this it was very, and that's why I say yes, I've heard that before. If you don't do this, you or your baby might die. But in that specific example it was so it was so strong. And it really sticks out to me because I mean, this patient is being wheeled away and she specifically says you might die on the way to the hospital. And there was nothing that the patient could do differently. And now you have this fear instilled in this mom's heart and her husband was there and it was just a very, it was very dramatic and also very traumatic. It was something that sticks out to me. And yes, there were many instances when doctors would say oh, if you don't do this intervention, you know your baby could die or you might die, but this was one where they were like you will die. Or you might certainly die in the ambulance on the way to the hospital. And then that puts that doubt on that mother to, you know, you think, oh, what this doctor just told me that I could die on my way to the hospital. And now you're going through all these things. And that one really stuck out to me. It

literally increases the likelihood of a person dying, as soon as that person hears it and believes it is there is a placebo effect for all of us. And they've done tests, even when people like there have been people who thought they were dying on drugs to learn later that it wasn't the drug that they thought and then all their symptoms immediately vanished when they were in the ER, there. But even from a spiritual perspective, like the fact that anyone would say a horrible thing to you, that could happen to me. I couldn't I couldn't tolerate that even in a friendship. If someone said something like that. It's just like, the opposite of emotional intelligence. And I find it very ill hearted. I just think like you don't say that when you get when you actually care about someone. You say you're going to be safe. You're in good hands. Yes, I cannot believe anyone says that and gets away with it. And I'm convinced it's a trend because it is for the first 10 years I did this work and worked with the first 1000 women. I never heard it once. And I was shocked the first time I heard it. And now we hear about it constantly. It's the thing doctors say now.

I feel like it's a trend that we're seeing doctor saying that more because I think that people are starting to question doctors more. So they're using that when people are starting to question and when people didn't question them as much. 10 years ago,

they're upping the ante. Yes, they're fighting back. Yeah, and because it gets people's attention, because we fold like you say the baby's at risk I fold, do what you have to do,
especially if you're not educated. And you're a first time mom, and you want to trust this doctor. And one thing that I've learned is that women who are in the birthing atmosphere, they are very vulnerable and open to suggestion. Incredibly, because you are in this fragile state, where we're told that we should fear this, we're told that we can't do this without medication, we're told that it's a dangerous situation. And so we're more open to suggestion. And if a doctor who is an authority figure in most societies, is saying if you don't do this, you or your baby will die. And then you almost feel you're responsible. If you don't,

I would do it. I would do whatever they said in that moment. Almost anyone would when they when they put that threat over you. That's the why they do it because they know how powerful it is. It's the highest card they have

anything to add about things doctors have done.

I can think of a few examples that really grinds my gears. First one was we were having a really crazy night on the unit and we I was rolling back probably the fourth or fifth urgency section of the night. For a 12 bed labor unit. That's a lot of unplanned unscheduled C sections. And as I was wheeling my patient back for a stat C section she's obviously very scared. Lots of process within earshot doctor that was standing at the nurse's station saying Money money money while we were rolling back. And I don't think she heard it and I hope to God that she didn't hear it, but I heard it and I was infuriated that someone's life that someone's birth story that someone's body. Yeah, it was really devastating. Another provider in the break room one time made up a song like from The Little Mermaid, you know, go on and kiss the girl. He's saying go on and cut the girl. Just like really dehumanizing things behind closed doors that I just morally cannot be a part of. And then the last story that comes to mind is I had a laboring mom come in who was very prepared to have an unmedicated birth. She had HypnoBirthing tracks going she was very in control. She had worked with a doula her entire pregnancy to prepare for birth. She had a written out birth plan that was concise and respectful and very appropriate. There weren't any crazy demands, like a very reasonable birth plan. A lot of the things the unit that I worked on, were not familiar with such as waiting until white like until the umbilical cord is fully drained. Usually they cut the cord within 60 seconds and call that delayed cord clamping between 30 and 60 seconds is delayed cord clamping according to hospital. So just you I just warned my class about that on Sunday as well. I said they tell you it's optimal between 30 and 60. It is not true. They need it needs to fully finish pulsating. Okay, so she her birth, her birth plan asked that they wait until white, which could very well, that's very reasonable. And then she also wanted intermittent monitoring. So instead of wearing the monitors 24/7 while she was in labor, she wanted intermittent monitoring, which is also very reasonable because she was low risk had no risk factors was not on any medications was not being induced excetera. It's safer. It's also safer. So the doctor that was taking care of her came up to me and said, Are you the nurse for room? Seven? I said, Yes. And he said, I just read her birth plan. Why would she ever give birth here? Doesn't she know that we don't do any of these things, and put the ball in her court and blamed her. For him not being comfortable with physiologic birth. He said, Doesn't she know we're gonna give her pit if she doesn't advance it one centimeter an hour, doesn't she know we're going to put a fetal scalp electrode on her baby, if we can't hear the Doppler for one time of intermittent monitoring, and just really broke apart her birth plan and didn't even know how intermittent monitoring was done. He didn't know about waiting until the umbilical cord was white. He said, how would we even do that? And didn't he couldn't even think of a way to accommodate that request.

There's nothing to do you wait. I mean, what is he that he he doesn't know about how this works? They don't know how to weight it. But I mean, he doesn't understand how it works. It sounds he treats sounds like he truly doesn't understand what happens because he's probably never seen one lasts more than 60 seconds. He couldn't he couldn't figure out a way that we could have like birth the placenta and keep it attached to that. He's like, Well, where would the placenta go? I and how to

assess the baby like, what do I do with the baby? What do I do with the baby after baby kind of touched on why you like baby has to go to the warmer? The problem with what you just that story you just told the problem for the mother is that probably she expressed some of these desires in her prenatal appointments. And they were probably all affirmed. Yes, yes. No problem. We do delayed cord clamping Yes, yes is intermittent or monitoring is something we offer. And then mothers get completely bamboozled when they get into the hospital. And suddenly, their birth plan is wiped out like, either because who's on call that night doesn't get it never saw it or Truly, it was never gonna happen with any provider because the hospital has their own set of rules that didn't, you know, the communication is off, like, they get this reassurance, prenatal. And then they get into their birth, and they lose all the control in an instant.

It's really heartbreaking. And I know that the provider had seen it prior a different provider or some some provider in that practice, because it was already uploaded into her chart from a prenatal appointment. So that was already reviewed with her birth team. And then it's now being completely disregarded. And they don't want to turn him away in the prenatal when they review the birth plan and say, You know what, our hospital doesn't really support this, because that's money off the table. It's like you, you turn away the patient now you just lost the 15 Grand you're gonna get right. Also, just to follow up on your comment about the money, money, money, how often do you guys see and believe that C sections are done prematurely? Because they pay more? Like, how much? Do you believe that that's true? In your experience?

I don't know that it's so much a financial aspect. I feel like I've seen them done prematurely to suit. Doctors schedule more necessarily in the money. I've never, I've never heard a doctor discuss getting more money for a C section. But I have heard them discuss that they wanted to get home to see their kids at night.

I agree with that. I think it was just an offhanded comment about it was a very profitable night for the hospital. Yeah.

Alex, anything on that?

I just I agree with that too. But I do think they probably are incentivized a little bit when they do perform C sections, because they do make more, but I never heard them specifically say outright, you know, this is going to be more money or anything like that. But I did hear like Lindsey and Capel said schedules. Oh, you know, I have to get to this tonight or I don't want to miss this. So we might as well just do a C section now because it's going to go to C section anyways, when it probably wouldn't have.

I just don't understand why they can't leave her there in the hands of the other doctor who's on staff. It's like they always want to close the deal or something before they leave. Lindsay, can you please take your turn in responding to the question that I had asked about? Yeah, I have two

examples that I can think of, and I think they speak a lot to the mindset of the doctors. So one is there was a woman who was having her not first baby she was in Multiple second third, I don't remember exactly. She was not my patient. I was sitting at the nurse's desk when the baby had had a prolonged heart rate deceleration. So they briskly took her back to the or the physician that came out of the room before she went back to get ready and said, This is what she gets for refusing Pitocin yesterday. This is what she gets. And I think my jaw had to have dropped onto the floor, because I cannot believe that I heard somebody say that.

It's unbelievable. Yeah, the second instance that I have is talking to a doctor one time. And she was putting some people on our calendar for inductions. And they were elected if I remember correctly, and she said, You know, when I was in school, I was all about spontaneous Labor's and I really wanted to see spontaneous labor, she said, but you just get burnout. I've always been on call. And it's just so much easier to schedule them.

And, Kate, what made you choose homebirth? I'm guessing some of those comments that you shared earlier that you heard like, why would they birth in a hospital? If that's what they want? Is that what happened for you? Yeah, so my first birth was prior to me working in labor and delivery, I was just a pediatric nurse. I'm actually 30 weeks pregnant with my second baby, and I am choosing a home birth again. And I've gotten questions from friends and colleagues. Now that you worked in l&d, are you going to have a hospital birth this time? And my answer to that is I've never hoped that I can have a home birth more since working in a hospital.

How many nurses are like the three of you?

I think that the nurses that I worked with, I think a lot of them really do have the patient's best interests at heart. I think that nurses go into nursing to take care of human beings and people with stories and souls. And I think that along the way, some people get jaded, or they get burnt out. And they just clock in and clock out of their shift. And however, I think that a lot of the nurses that I worked with, I learned a lot from a lot of them took it upon themselves, to have a group of them go to spinning babies classes, and like a lot of them work really, really hard with moms to have their birth goals accomplished.

I think it's getting better. I mean, off the top of my head, I would say about 30% of the nurses are probably similar in their beliefs as I am, I was just wondering like, how rare it is because we do at least in the down to earth community, we meet such incredible nurses that are just so wonderful. And I just wonder if that's the norm, or the exception. But I think at a minimum, I think, again, while we're generalizing, and I said that those who are drawn to surgery are now naturally going to gravitate toward obstetrics, I do have a belief that anyone who goes into nursing dreams of being a nurse, they have to have an inordinate amount of empathy above the average person, they want a career where they're just taking care of someone all day, I just cannot even imagine that that is your whole to your career. Like let me just take care of people and comfort them all day, and learn this science and medicine on the side like it is definitely not just a regular person who is drawn to nursing. So you'd think that they're not too many steps away from having the compassion, but they also have to have the intelligence to want to learn all this because you aren't getting that in nursing school. So they also have to be intelligent. On that note, can we wrap up with this question? What specific tips would you give women who want a beautiful physiologic birth experience in a hospital? And please, let's steer away from the general that we always hear, like, get educated, did it like let's get be really specific? What are the most specific piece of advice you can each give?

Mine is to have an advocate for yourself, whether that is a doula and I know that's kind of broad, for example, because when you're birthing it's a very vulnerable state again, and you have to have someone who's going to stand up for you. And you'd like to hope that your nurse your doctor would but that's not always the case. So that's my my first piece of advice. And yes, of course, the education side and all of that. But then also being willing to fire your doctor, if they're not serving you and staying home if you want to deliver in the hospital if that's where you feel safest. That is okay. That's what I always tell people that I'm talking to, you know, I don't feel safe delivering it home. And that's okay. Because you might not you might feel safest in the hospital setting. But you have to understand that delivering in the hospital setting you will have some kind of battle. Whether it's a you know, outward battle or an inward battle there is going to be some kind of battle at least to some extent, it might be minor it might be major. If they say you need to have this intervention. You Take a step back, what I like to do is I have a card and you write it down. And you ask them these specific questions when they say, Okay, I see that, you know, you're not progressing, how I want you to be progressing, they probably wouldn't phrase it that nicely. They'd say, you're not dilating, we need to get you dilating. And you'd say, okay, so what are you suggesting? What will happen if I don't do this intervention? What will happen if I wait? And are there any other things that I could try instead? That way, you're getting the power back, you're still working with your doctor, you're being respectful. But you're taking the power back, you're putting that ball back in your court? So yes, they're telling you to do an intervention, you're not being irresponsible by asking what your other options are? You're being responsible by asking yes. And then you have that responsibility. And just understanding again to that. It's never not going to be a fight, because it is a system. It's a medical system. And even if it's all if they mean, well, and they yes, they want you to be safe. But again, hands are tied, the nurses, the doctors, they have to follow rules and policies, so know that you're likely going to have to fight. So have an advocate. Be prepared to ask questions and know that no, is a sentence, you can say no. And that's it. You don't have to explain yourself.

I would say my biggest piece of advice if you want a physiologic birth in a hospital, is piggybacking on what Alex said is to stay home for as long as possible. Because the second year admitted that clock is ticking on the providers watch, and they're looking at you. How is the room three progressing? How's room three progressing, and they can't start the clock until you get there? So stay home for as long as possible?

Yeah, they don't care. If you labored home for 45 hours, they'll be like, Whoa, How you holding up and then all of a sudden, they care so much about how long it's lasting?

Correct? Isn't that silly? It's like stay home for as long as possible. But the second you get here, we need to monitor your every move and your babies every heartbeat.

When say my best piece of advice would be to get in contact with a local doula. Even if you don't hire this person, get in contact with them and ask them which hospital they recommend to deliver at, because they've been in all if not the majority of hospitals in your area, and then go step further and ask them for a physician recommendation. Also stay at home as long as possible.

And lock the door.

To door. Well, whoever has had whoever has been in the hands of any of the three of you. They were very, very lucky women. Indeed. You're all beautiful, intelligent women. And I'm getting choked up even looking at all of you while I'm talking. I just think we're so lucky that that there is this buffer in the hospital that we have nurses and I hope many nurses hear this and are I'm sure they're going to agree with what you're saying and be moved by it if not inspired. But thank you so much for the work that you do in the world. Thank you so much for being willing to come here and have an honest conversation because so many 1000s of women are going to hear this and they'll be better for it. So just I want to thank you all for taking the time today.

And don't forget that when mothers reflect back on their birth story who they remember most in their care is the nurse that's who they talk about

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What's your favorite thing about your job?

The bond that I create with the people that I get to be there for their labor, I that's my favorite part.

The resilience that I see with my patients and their families, is why I went back to what I do now. And for me, I just really every single time I loved watching the mother become a mother. That moment, even if they've been a mother before, right, your change with every single birth of your baby. And seeing that and just getting to be present in that experience every single time. It just feels like such an honor to be able to be there and witness the strength. Like it's just incredible to me to feel to feel that and see the strength of women birthing their baby regardless of how they do it. And just getting to see that and then of course to the bond that you have with them and it lives on every single One that I've taken care of I remember something about every birth.

And that's what I wish those Mount Sinai doctors had said instead of surgery.