Nurses Make the Call… Did Your Doctor Make Your Birth?

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
Nicole

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20 responses to “Nurses Make the Call… Did Your Doctor Make Your Birth?

  1. My doctor missed my child’s birth, and the nurses made me lie on my side and hold the baby in to wait for the doctor, even though I told them the baby was trying to come out. They just told me to keep my legs closed and stay on my side. Finally when baby’s heart rate dropped like crazy, they all panicked and let me have the baby. Doctor showed up a little while later. Now my uterus is tilted to the left and u have lower back pain in my left side. And this is the years later.

  2. Nicole, my 3rd baby (3rd unmedicated) was progressing slowly (for me). My prior two had been born within 2 hours of arriving at the hospital, as I labored at home as long as possible. For this birth, I had arrived at the hospital at 6:30 p.m., and was at 5 cm. By 10:30, I was only at 7 cm, though laboring fine. My dear friend (who is a doula at heart) suggested, after the nurse left, and I was a bit discouraged to still be 7 cm, that I simply turn on my other side. (I know now to be more mobile during labor, but for my first two, I was practically in transition when I arrived, and it was never an issue — never really time to walk around.) Literally, about two minutes after I turned, I felt more pressure, and knew that I was fully dilated and the baby was starting to crown. I felt pushy, so I asked my friend to call the nurse (again, 5 min or less after she left my room), and the nurse replied, “I was just in there. I’ll be back in 20 minutes.” I was a little mad that the nurse did not believe me. This was my third baby, and I was 28 years old; I was not a 16yo primip, know what I mean? But, I decided I didn’t care, and I just pushed the baby out on my own — the nurse came in the room, calmly pulling on her gloves, pulling back the curtain, and said, “What’s this talk of your baby crowning??” Then, her tone shifted dramatically, as she saw that literally seconds before she sauntered in, I had my 10 lb baby boy popped out in a whoosh — my hubby didn’t even make it down there in time, and he sailed onto the bed — I was sitting mostly upright, and the lower part of the bed was not was not broken off, good thing, that! The nurse started hollering, “Has anyone called the doctor?” No one had, of course.

    So, I had an unassisted hospital birth. 🙂

    A doctor or a nurse actually would have been helpful, because I started pushing like a mad woman, and tore… I didn’t know back then to be more gentle with my pushing. IDK if it was 1st degree or 2nd degree (wasn’t 3rd degree).

    Still, a 10 lb baby. No nurse or doc. Pushed out in three pushes, less than five minutes.

    The only thing about the birth that bothered me — bothers me to this day — was that the nurse didn’t believe me.

    • WOW! You are a rock star! 🙂 … I don’t know if this will help change your perspective on the part about that bothered you but let me give you another way to look at it if you will. I remember being a new nurse and not understanding LOTS of things especially how, why a 3rd, 4th etc baby would take longer than a 1st or second. Over the years I have come to understand a lot. The most important thing I have learned is when an experienced mom says “baby’s coming” you HAVE to believe her regardless of when and what the last vaginal exam was. I am positive she was a new nurse. Consider yourself a WONDERFUL teacher. I bet she is telling your story to this day and shares that experience with all the new nurses she works with. So with that in mind I would encourage you not to be bothered but to be PROUD of the lesson you taught then and continue to teach. She didn’t believe you cause she was too new to understand. Just like children often don’t believe LOL… you showed her! 🙂

  3. 3 births of mine were missed by the doc. My #4,#5, and #6. The first one was a nurse who seemed inexperienced. I went through several bags of IV fluid in the short time before the birth, and I said to her at one point, “call my doctor, I think it’s close.” She said, “we have to wait until you are 8cm.” Well, I had come in at 4 cm, labored away, and warned her I go fast. I warned the doc at several appointments that I went fast with #3. I then told the nurse I felt pressure, and she said, “Oh, it’s just your bag of water, it’s bulging.” I then said, “break it, ” and she said, “no, we cannot do that without the doctor. She went aroudn the room preparing things, and another nurse came in and was writing on papers. I said suddenly, “I have to push,” and they said, “don’t” but I could feel baby crowning, and I yelled, “ring of fire.” The baby came out with meconium and bounced on the bed. My husband later said she was facing up on the bed. The nurses actually argued over the time of birth. They did take the baby to the NICU for observation since she had mec and they didn’t get to suction. Maybe a little covering their backsides was going on…I felt unhappy with the doc who knew I went fast and didn’t have it on my chart or whatever as she assured me there would be plenty of time and she’d be there, but also annoyed with the nurse that overdid the fluid (my heart was racing the whole time, I was very nervous, I just felt overwhelmingly anxious…the nurse said she gave me too much fluid and it was causing me to shake…but that could have been transition shaking…)
    #5 was awesome. The nurses met me as I came off the elevator. There were 2 adn they were playfully arguing about who would catch my baby. The doc was smart and it was on the chart, but they didn’t realize it at first. I didn’t want the on call doc, so that took time. I was there for 2 hours again, and they had called the doc. I labored in the shower and got out, the nurse peeked in on me. She saw me leaning over a sink and shaking my leg. She had me get on the bed to check my dilation, declared me at 6, and then within a few minutes I had to push. She caught my baby and there again was mec. The other nurse had caught the baby’s body. They took her to the warming table and used the deelee? to suck out mec. I guess I had LOTS of mec. Doctor laughed at having to catch the placeta. She said, “yay, I get the best part.” You’d think after that, I’d get a doc for #6, but my doctor who wanted to be there was off for an appointment herself the afternoon I went in (I got the impression she was there in the morning). I had a terrible nurse who was scared and didn’t let me leave the bed, and checked me every 20 mintues. I had at one time 2 ob’s there for just me as it was shift change and the first one wouldn’t leave, but then it got too late and she had a meeting, so she left. The nurse didn’t let me go to teh bathroom, didn’t let me leave the bed, and had me pushing at 9 1/2 cm for an hour and 1/2. The doctor checked adn discovered an OP baby adn said I needed to move around. Other nurses came in as it was shift change, had me move. WIthin 10 min my baby was born in the caul (this is awesome) and the doc who was on the floor didn’t make it…he missed it because I didn’t feel the urge to push and baby wouldn’t come out until I finally did…only two short pushes. The nurse caught, but not my annoying one. I credited the nurse on the birth certificate this time.

    I have had good and bad experiences with nurses, but most nurses are great. The tone of the birth depends greatly on the nurse you get. Now with #7 I had a midwife at the hospital who stayed with me the whole time. I didn’t really even interact with the nurses there…she stayed and did everything. I had an OP baby with a tilted head…and tore a bit…just a little bit. I had 10 minutes of pushing with that one because of the size and position. I think I will always have position issues now with mine…and the midwife will have time. But then again, who knows?

    • WOW!! What great stories. I can so see each of those scenes in my head vividly. One thing I am always sure of and share this with new nurses I work with. If any mom but especially and experienced mom says “it’s coming” put on some gloves and pull back the sheets cause the baby is comin LOL. That 6 cm story is so my experience. And the 8cm thing is true in the sense that doctors will say… “Call me when she is 7cm” and I always laugh cause many women don’t stop at 7cm. They are 5/6 and then a few minutes later just like in your case they are delivered HA!. And so goes birth… with or without us 😉

  4. I’m also a L and D nurse but we have in house MDs, so it makes it both a little easier and sometimes a little harder. I still end up catching some babies! It’s hard because some OBs really start chafing at the bit if they are in the room for more than 5 minutes prior to delivery, so trying to estimate when you call them into the room is even trickier. Our CNMs push the entire time with patients, which is much nicer.

  5. I read the post about how OB in the late 70’s were a better bread than they are now, hmmmm… I’m not sure I agree with that idea.
    My two daughters were each born on Friday the Thirteenth, first in’ 78 and then the second in ‘ 79. I was 23 and 24 1/2 and looked 16. This was both a good thing and a bad thing for me. I got incredible care from the nurses since I seemed so young, but it also meant that they didn’t always believe that I knew what I was talking about.
    Example: My labors were not spontaneous, both required pitosin. with my first labor I had three different people try to put an IV in my arm, a nurse, my OB and then the anesthesiologist, 9 attempts and only one successful hook-up. My young husband nearly passed out as he watched all the needles being slipped into my arm…I just took it stride. She was born with forceps, poor thing, but perfect and unmarked…I laugh now because as the OB was inserting the first forceps, I rolled up and said over my still huge belly I said ” tell me again just how long you’ve been a doctor?” My inhabitations were the result of a little bit of pain med’s administered for sleeping between contractions.
    I tell you this story of my first delivery in order to have a comparison for my next labor and delivery. My second daughter was a week late and my OB was so sure that I’d not deliver for another week that he went out of town for a short vacation. Well, on April 12th, I climbed into bed at around 10 pm. Just as I was falling to sleep, I felt a “thud” like I’d just dropped my trannie… it was my water sack popping. We lived 45 miles from the hospital, most of the distance was a dirt road, we figured we’d better be safe rather than sorry…our OB had prep my husband on how to deliver the baby if necessary and that was foremost in his mind. So we left home but labor was very sporadic. When we reached the hospital, the doors were all locked. I had to ring a doorbell at the emergency room in order to contact someone. A voice came over the intercom and asked me what I needed. Have you ever heard anything so unbelievable? Glad I was only in labor…not bleeding from a head wound, lol. It was near midnight and when they were about to send me home because my labor was not in full swing…I reminded them that my water had already broke and home was a long way away…they let me stay but would not do anything to get my labor started. I had to wait until office hours in the morning for the on-call OB who would be filling in for my vacationing OB. I didn’t know this guy and he took one look at me and ordered buckle pitosin…horrible stuff and not easily regulated. By 10 am, my labor was in full force with 3 to 5 minute long contractions with 45 seconds between them.
    I kept telling them that I could feel a lot of pressure low in my groin, like the head was pushing against my cervix. Of course, they didn’t think I knew what I was talking about, I was so young and they knew by checking me that I was only dilated 2cms but, they did give me credit for effacing quite fast.
    I knew thing were progressing and kept telling them I knew that it would be soon. Suddenly, after changing positions from my back to my side, I felt something pop and I wanted to push NOW. The nurses came in and lifted my leg and said ” oh my God, I see dark hair”. They put the gurney in motion and headed one room over to the delivery room. They kept telling me to ” blow” to keep from pushing. They wanted the OB to deliver me…Ha, “I would wait for no man”. My body knew what to do so I just let go and went with my natural urges. My daughter Sarah was born at 2cm dilation but fully effaced. No Doctor, not even from the emergency room , my husband barely got his scrubs on and the attending nurse didn’t get the chance to use her episiotomy – scissors…thank God. It was quick and painless even though the she tore my cervix and I needed to be stitched up. This is the only way I would give birth if I was ever to have more children.The lesson for everyone involved was that believing what a laboring mother is telling you might just be a brilliant idea.

    • Hi Teresa, Thanks for sharing your birth stories! I always love hearing them. Now believe me… OBs have been made good and bad both then and now. For me that was a kind of tongue in cheek comparison LOL…. That buccal Pitocin!! WOW! I hear stories of its use and I am soooo happy we don’t use that anymore. It was a dangerous thing. In the end you give a good lesson…. “believing what a laboring mother is telling you might just be a brilliant idea” AGREED!!!

  6. Nicole – I am an L&D nurse, and I honestly don’t have a “set” time when I call the MD/CNM for the birth. Some providers are more proactive in actually checking on their patients during labor, while others are just as you described, and don’t want to come in the room (or the hospital!) until the very last second, and often miss the birth.

    And yes, it certainly is a guessing game.

  7. My current OB has been with me for the majority of my last 2 labors. I have a history of quick labors & I don’t use pain meds at all. With baby #3- I came in at 5 cm & he told the nurse that he was on his way in. He stayed with me my whole labor. With baby #4- I probably came in earlier than I should have, because of my history of quick labors. He let me stay because he was afraid I would go home & deliver there. He slept in the hospital, because he figured he’d miss it if he went home. I was 5-6 cm one minute & almost crowning the next. He almost missed it, even though he was right down the hall.

    • That’s great that you have such an OB. So many women don’t. I have had doctors be fully aware of their patients having a history of a fast labor and yet they STILL delay coming to the hospital. Wonders never cease. Congrats on picking a good provider!

  8. I am thinking that the last time I had a baby in a hospital , my third in 1977, my doctor was there when I got there, (at 7 cms) and came in the room when I was around 8 cms, and was there until the delivery. I was very angry with him because he made me go to the delivery room, and I thought we had an agreement that I could deliver in the labor bed. (Story is on Unnecessarian.)
    I had no idea how unusual his presence for that whole time was. I had very little interaction with the nurses. Not that I don’t believe you, but it wasn’t that way for me. (My second was my first VBAC, essentially my first labor, and the same doctor was there with me for at least several hours. )

    I had the next six babies at home. I had a doctor who came after the birth to examine me and the baby, take the cord blood we had saved to the lab for a crossmatch, and bring me back my Rho Gam shot. For the births, a friend who had been to a few births, then a 70’s era “lay” midwife (that term was used then) and then three where just my husband and myself were there. For the last one I actually got a nurse midwife to come.

    I think I really lucked out on my doctors. For the first where I had a C section for having my membranes leaking and failing an induction, the doctor was in and out of the room all night. I really can’t complain about his presence either.

    I guess they just don’t make OB’s the way they used to!
    Susan Peterson

    • Susan… you are so right.. they do NOT make OBs the way they used to 🙂 As I read your post I just kept saying… YEP that was 1977 LOL.. Things are a LOT different now. A LOT different!

  9. First baby, after a truly awful nurse started things off, doubt and interventions, stalling, refusal to all the Dr, told he would be on shift in the ER in two hours. The Dr gave me an episiotomy and pulled the posterior baby out with the vacuum hours later.
    Second baby, I waited at home until I couldn’t manage anymore. Had the baby 40 minutes after arriving at the hospital. Dr didn’t make it but the resident delivered the baby. Dr came in about 15 minutes later and congratulated us. Nurses were great.
    Third baby, was with a midwife, went quickly, when she arrived at the house I was 7cm, we head right to the hospital, and baby was again born about 40 minutes after arriving. Midwife talked me through my doubt. No nurses.
    Fourth baby, at home with midwife.
    Fifth baby, planning to be at home with the midwife.

  10. Great post! I think that you are so right, it is the nurses that make a huge difference. I am a birth doula of moms who want to go un-medicated and when we get paired with a good nurse who is supportive of their desires, things go so much more smoothly.

    I just had a birth of a VBA2C mom and the nurse is the one who helped it happen! It was awesome. I hope to post that story soon, once mom gives me permission.

    I have only been at one birth where the OB didn’t make it on time and that was with a nurse who was attending her first un-medicated birth (despite being a L&D nurse for 5 years)

    • HA! not surprised that the nurse was attending her first unmedicated birth. I have worked at hospitals with a 90% induction and 99% epidural rate. With those numbers its not likely to see natural birth. Its one of the reasons many nurses don’t know how to support women who are having an un-medicated birth. They have never seen it and just are clueless.

  11. Girl, I WISH my provider had missed my birth, with her scare tactics and threats of a big baby, shoulder dystocia and imminent death! The nurses at the hospital treated me like I was a true ass moron. I arrived to the hospital at 1 am in labor and 5-6 cm dilated. When I walked up the nurse’s station and calmly stated that I was in labor, they rolled their eyes and one said, “You mean you’re here to be induced?” NO BITCH, I’m having a baby! The one who was assigned to me waited until I was fully 10 CM dilated at 3:30 AM to call the doctor and told me that I had to wait to start pushing because she didn’t want to lose her job, with the threat of my “big baby” and shoulder dystocia, she wasn’t going to take any chances. So me, at full 10 CM dilated, waited over 30 minutes before I even gave a push. Can you imagine? My son was born in under 15 minutes and that “big baby” was 20 inches and 8 p0unds!

    • Wow… Yep not only can I imagine I have seen all of that in action…. Sounds like you had a very typical hospital experience 😦 That’s too bad. I used to be a culprit of the “Don’t Push” campaign and now I know better…. when a mother asks “Can I push” I kinda don’t answer. What I know is this… you can say “don’t push” all you want. When that mom HAS to push… there is NO stopping her!

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