I wrote this piece for my Modern Parent column.
I’ve since scaled things back a bit, and I’m no longer writing for them.
I figured I’d share it here anyways!
A friend of mine wrote an eloquent & hilarious post on this awhile back, which you can read here. In the last several months, I’ve seen the scenario played out over and over, and I feel the need to address it myself. I can’t throw a rock without hitting a mama who fully intended on a natural birth, only to encounter interventions and uncooperative hospital staff when push finally came to shove (pun sort of intended). Each story ends with a healthy baby and a happy family, and I’m certainly not here to judge. I mean, hello… I followed a spectacular home birth with a big, fat, somewhat elective c-section seventeen months later! But I want to give discouraged mothers the time and space and platform to mourn the loss of something they’d hoped for.
That’s only fair, right? Despite what everyone says, it’s not just about the outcome. It is very much about the process, about the culmination of months spent dreaming and preparing for one moment. If you don’t care about that, it’s fine. But a lot of us do. And when the option for a natural birth is taken away from a mom, especially by a healthcare team she trusted, it is a sad moment for the entire birth community. This is why I care. I’m here to empower and encourage. As a nurse, I get to look at a person hours after joint-replacement surgery and help them dream about the future. About crawling on the floor with grandkids, and sightseeing at their favorite vacation spot. I get to tuck a woman in at night, after placing her wig on the bedside table, and tell her that she will soon grow back hair of her own. These are the moments that define me, that confirm who I am and what I’m really doing on this earth.
Because of my outspoken passion for natural birth and parenting, I get the question all the time, “why don’t you work in Labor & Delivery?” I must admit – it is so tempting! I would absolutely love to spend my days cheering you mamas on, teaching you how to breastfeed, and sharing in your most special & intimate of moments. But the truth is, I can’t. I can’t work in hospital Labor & Delivery, because I wouldn’t be on your team. In order to explain myself, let me give you a little glimpse into how things work, at least at my hospital (which happens to be the second largest system in the country).
Physicians are not employed by the hospital. They are contracted by the hospital, to provide services in the hospital. But their paychecks, their guidelines, their authority… it all comes from a physician network, an organization that does businesses with hospitals. Doctors don’t usually make the rules surrounding a woman’s birth experience. Hospitals have their own policies and procedures that even the doctors cannot control.
So a laboring mom gets to the hospital and is surprised when a nurse puts her on a monitor. Unfortunately, the nurse must break the news to the mom that the doctor doesn’t run the show. This is a hospital policy. You might find doctors & nurse-midwives who let things slide or alter their own practice to fit a mom’s desires. And that is beautiful. But as harsh as this may sound, a doctor is not usually going to fight policy for one mom’s birth plan. So as much as a mom wants to believe that she’s found the perfect doctor, an advocate who’s on the same wavelength, she must remember that a doctor’s loyalty will always be to his or her license – which means following the rules.
The same goes for us nurses. As much as we want to give our patients a caring experience, our backs are to the wall from time to time. I cannot allow a patient to eat before surgery, no matter how much he begs and pleads. I cannot allow an unsteady patient to get up and go to the bathroom on her own, no matter how much she grumbles about my lack of respect for her privacy. If the policy states that all patients must have IV access, then it doesn’t matter what a physician told a mother during a prenatal appointment. When she gets to the hospital, she will have an IV placed.
We are not always on your team. We simply can’t be. And I’m okay with that, when it comes to the medical-surgical world. But I’d put my job at risk if I worked Labor & Delivery. I can’t bear the thought of abandoning a woman at her most vulnerable point during a birth, just to follow (silly, unnecessary, & sometimes dangerous) rules. Honey, I would let you stay in that tub as long as you wanted. And probably lose my job. In the words of Dr. Marsden Wagner, “This is why, if you really want a humanized birth, the best thing to do is get the hell out of the hospital.”
Of course, there should be a middle ground. Women uncomfortable with the idea of out-of-hospital births should be able to have the experience they want in a hospital setting. But that’s a discussion for another time. I’d like to explore the possibilities of a career in midwifery someday. Right now, I’ve got too much to learn and too many mouths to feed.
In the meantime, you’ll be able to find me on the good ol’ medical-surgical floor, packing wounds and hanging blood!