If you have ever had a baby in a hospital or if you work on a labor and delivery unit, particularly in community and private hospitals, you may already know that NURSES play a HUGE role in the way your labor progresses. The things that happen to, with or for you are often decided because of the information provided BY the nurse TO your provider. One of my favorite questions from a woman or her family is “When is my doctor coming?” I smile and politely say tongue in cheek… “When I call him?” I then go on to explain to them that NO your doctor will not be here while you labor. NO your doctor will not be here while you push your baby from a plus one station to crowning. NO your doctor will not be doing vaginal exams, or rubbing your back, or giving you updates on your labor progress. It is primarily the NURSES who do the majority of the in-patient work and the doctor will be called, updated, and sometimes cajoled to come in when it is actually time for you to birth. In my experience, while some few doctors may want regular updates, most simply want to know
A. Is she progressing “normally” … OR …
B. Is it time for me to come in, suit up, & catch the baby.
They don’t want to be there longer than needed and in this case… less is more. If a woman has an epidural this is a much easier call but if she is having an unmedicated birth… well… that’s a whole other story.
I started a recent shift with two laboring mothers. Both were having their third baby with spontaneous labor. Both had previously had unmedicated births and were committed to an unmedicated birth this time around. Neither was laboring with an epidural so this set me up for the worst of guessing games. A woman having her 3rd baby can easily move from 5cm dilated to delivered in 30 minutes. OR… they can stay at 8cm for an hour. You NEVER know… In this situation (keeping the above information about timing in mind) as nurses we are given the job of trying to decide WHEN to call your doctor and as we debate this with our colleagues, we all still know, we are damned if we do and damned if we don’t.
Mom #1…. Had been laboring all day and was exhausted. She was contracting infrequently. She had walked, showered, changed positions etc and at this point… just wanted to “get it over with” so she get some sleep. She had progressed slowly. She was 5 centimeters for hours and then moved to 7cm where she stayed for a couple of more hours. I was pretty sure her baby was OP and that this was going to be her biggest baby to date. Her first two babies were less than 7 pounds. After awhile, we talked about the option of starting a little Pitocin. What we often call a “Whiff of Pit.” I told her while I could not guarantee it I was pretty sure that she would go on to deliver within the hour. She agreed, and the plan was set. A short while later she was a different kind of laboring woman. Her contraction intensity had increased and she was moving toward delivery. I called her doctor and said… “She is still 7cm but I started Pitocin about 15 minutes ago and her affect has completely changed. I think you should come on in.” She said “I am on my way…” I hung up the phone, got a few things that I needed for her birth and went back to her side to hear her say… “He’s pushing out…. He’s making me push” The “He” was her baby. I quickly called for back-up, put on a pair of gloves and two contractions later… her healthy baby boy was born just 13 minutes after I had called her doctor and just about 30 minutes after her “Whiff of Pit.”
The best part for ME… I got to catch her baby!! Every time that happens, I am reminded why I went to midwifery school. Her baby had indeed been OP, he was slightly greater than 7 pounds and he was coming down with a hand next to his head… all of this could have explained her progress. She was elated. This was a Pitocin story gone good. (Pitocin is NOT all bad) Her doctor arrived shortly after her birth to give her a hug and to congratulate BOTH of us on a job well done.
This brings me to the second birth, and the comment I heard from a different doctor who also missed her patient’s birth because she wanted to argue with me about WHY on earth was I calling her. I called and gave a similar story… “Your patient is 7cm. She does not have an urge to push at this time but she is 7cm and a multip” Her response included the fact that her patient had been progressing slowly and “What makes you think I should come in NOW?” She asked if I thought she should come and SLEEP at the hospital for an unknown amount of time?? WTF!!! She wasted 5 minutes arguing with me and who knows how long she spent before she decided to come to the hospital arriving almost 15 minutes after the baby was born. Based on past conversations with this doctor I know she does not have faith in women and was in SHOCK that her patient had a COMPLETELY unmedicated birth. (Ignoring the fact this was unmedicated birth #3).
She says… “You are the type of patient that we always say could put us out of business. If everyone birthed liked you then everyone would just start to stay home BUT you know yourself how things can change in a minute so you DEFINITLEY did the right thing. You are here with us safe in the hospital” I almost literally LOL… and I thought to myself…. yea with a physician who wasn’t even present for your labor or birthing experience. WHATEVER!!!
If you are having an unmedicated birth do know that it is very possible that your provider (if they are not sleeping in the hospital) will miss your birth. Also know that WE as nurses have done this before. WE do our best to call your doctor in time but the timing is never perfect. We are trained professionals. We know how to catch babies when we have to. The babies that fall out are not usually the ones we have to worry about. And at the end of the day we know… BIRTH Happens!!
Did your doctor miss the birth of your baby?? How did that make you feel?
Are you a labor and delivery nurse playing the “When Should I Call Game?”
How do you make the call when your mom is having an unmedicated birth?
I use the 7cm rule. What about you?
In Birth and Love