your OB is not on your team…

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!

14 thoughts on “your OB is not on your team…”

  1. yeeeeaaahhh… learned this the hard way. So thankful for my healthy baby girls. still a little sad about the (possibly unnecessary) scar on my abdomen.

  2. great post! and it’s so true, it touches most mommas.

    and i do think you’d be a great midwife! loved my mid wife with my first but then insurance changed and we weren’t able to do the midwifery thing after that. but looooove the midwifery center here that is located within a hospital in case necessary actions need to be taken. but i will say that even they do have some strict guidelines in order to be able to birth there.

  3. I am so with you. I planned for a natural birth, midwife, doula and all and still ended up with a c-section. I work in a hospital as well…its a mess

  4. I am thankful to have given birth naturally with my son (and attempted to do so with my daughter only until even my midwife and doula were pushing the epi to get me to relax so the baby would come down) in a hospital known for supporting natural birth – they are the “water birth” hospital, where all the “crazy ladies” go to have babies, where the midwives run the floor. Pretty awesome environment, outside of home. My midwife now only does home births and I have no qualms about having a home birth next time, because I know that she just left it all up to me when I was leaned over that bed pushing my baby boy out. Anywhere else would have been self-sabotage, it is nearly impossible to try to have a natural birth in any other hospital, outside of your doula barring the door… this may not be entirely true, but it’s not far from it. You can read Noah’s natural hospital birth story here:

  5. I feel incredibly lucky, because I delivered at the biggest hospital in our area, which is part of the biggest hospital system in eastern Wisconsin. My OB is part of the physician network that is partnered with the hospital system.

    We had a labor and delivery tour during my pregnancy, where they showed us all the things the hospital has and encourages using–squat bars, tubs, balance balls. They taught us not to be embarrassed at any point during labor, but rather to do what is most comfortable. They also taught us that if you plan to have an epidural, you still have options for laboring naturally, using those tools, prior to receiving the epidural. They only use the heart rate monitors if the woman is having a complicated pregnancy.

    With a twin birth, that was induced because of the development of twin-to-twin transfusion syndrome, I had to have the monitors and IV, and couldn’t use all the available tools, which both my OB and my L&D nurses apologized to me for.

    Because of the nature of my induction, I was in the hospital for three days before delivering. At one point, I asked my doctor if I was going to have to have a c-section, now that I was being induced. He told me over and over again that I would deliver naturally, unless it was a must to do a section.

    I had to deliver in a c-section room, because twin B was transverse and they weren’t sure which way she would turn after twin A was delivered. When twin B went into the perfect position to deliver naturally, the doctors and nurses in the room congratulated me and my daughter, because no c-section was needed. Also, on a side note, one of the most supportive and wonderful people in the room with me was the anesthesiologist who needed to be on hand. He was funny, he comforted me, helped coach me, and even went out in the hall a couple times to give my family updates on how I was doing.

    Another thing that was phenomenal is that the hospital has a policy of not limiting visiting hours at all. However, my main delivery nurse let me know that if I needed people to leave, I could let her know and she could ask them to go (so I wouldn’t feel bad about it). Fortunately for me, I feel best when I’m surrounded by my large, loud family, so I had a great experience.

    I’m sure that not every woman who delivers at the same hospital has such an amazing experience, but I guess it’s pretty clear that the hospital policies and the doctors and nurses are a little more forward thinking than in other places.

    Thanks for sharing your knowledge with us. I hope that expectant mothers do as much research as possible to find the best hospital and OB available to them in their area, so they can have the best experience possible. In so many situations, the hospital is the safest place to deliver and if it’s your only choice, you still want the best experience you can have.

    Sorry for such a long comment!

  6. wonderful post!

    such an important point you make. i had a vaginal, hospital birth and the experience was actually great. BUT I was in San Francisco at a very progressive hospital and I’ve since realized it’s not the norm! My nurses massaged me with mineral oil, I got to push for 4 (!?!?) hours without one mention of a C-section, etc etc!

    It makes me sad it’s not always this way, since many of us (especially for baby #1) feel more comfortable in a hospital, but still want minimal intervention. Sigh.

  7. I would have been devastated if I couldn’t have my natural med-free birth. I gave birth in a small rural hospital where I used to work and while being monitored didn’t but me at all, I specifically asked for no IV unless medically necessary and for me and babe to have skin-to-skin if safe for baby right after birth. The only medical intervention I needed with L&D was oxygen for me during pushing, which was fine by me. I had a wonderful hospital birthing experience but I can see why it might get sticky with hospital policies.

    Rachael, could a mama not sign an AMA (against medical advice) form if she didn’t want to be hooked up to a monitor etc.? That’s what we do at hour hospitals here.

  8. I, too, had a good hospital birth experience, although it’s obvious to me now that my midwives went against many, many policies.

    I ate and drank freely, I moved freely, etc etc. I DID have to be hooked up to monitors, but only ten minutes out of every hour. I pushed for 45 minutes and my midwife massaged my perineum the whole time, so I didn’t rip at all (and my daughter had the biggest head the midwife had seen!).

    My midwives have since switched hospitals, because they were fighting the hospital I delivered at SO much against the policies they had in place. They’ve since switched to a newer hospital, and say that all the things they fought SO hard for at the former hospital are just common practice at this one. I’m so excited for my upcoming birth in March! In my state (KY), home births are illegal. I also live in a very, very rural area (an hour and a half from a hospital I trust), so a home birth is just simply not an option for me. I wish it were.

    Last time I DID have a IV because I tested Strep B positive. This time I don’t know if I’ll have to or not, but I will deny pitocin after the birth, among other things I learned from my last birth. I trust my midwives so fully that if they said I had to have a section, I wouldn’t doubt it. If anyone else said I had to have one, we’d review their reasoning. LOL!

    I know what you say is true though — The most known hospital (and university in my state, ahemahem) in Lexington is absolutely NOT natural birth friendly in ANY way shape or form. My sister-in-law was given an epidural there (because they wouldn’t let her move, she’s had 3 want-to-be natural childbirths and due to policies has never been successful) and due to the doctor WATCHING A FREAKING BALLGAME they let her son crown for TWO HOURS and wouldn’t let her push. I’ve never heard of someone having a natural, intervention free birth at that hospital.

    beautiful post my dear!

  9. I’m an L & D nurse at a large hospital in Canada, and I think our rules are slightly different here. A mama doesn’t have to have an IV unless she’s high risk… or unless she’s GBS positive (given that she makes it to the hospital in time for one before delivery). We have some of the lowest c-section rates in Canada, and mamas are allowed to have births with intermittent monitoring, provided everything is a-ok.
    I liked your post. Reading a lot of pro home birth posts on the internet, I get the feeling that they think L&D nurses aren’t so great, when the truth is I love my job and just enjoy helping mamas deliver their healthy babies. I try to honour my patients beliefs as much as I can. I don’t want to ruin their birthing experience, I want to do what I can to help them.
    I honestly do believe it is different here in Canada, at least at my hospital. We believe a c-section is a last resort, and our statistics show it.
    Anyway, I read your blog often and I appreciated your take on the subject.

  10. I always love the way you are able to articulate what it truly means to be in the medical field. We want to give our patients everything yet we also have to live up to a certain standard of code and conduct in order to protect ourselves and our licenses. I have some patients whom I would truly like to pack up and bring them home with me. It’s a fine line: giving of yourself but also stepping back and doing what is expected of you professionally. I think natural childbirth is an amazing, beautiful thing and should be not only allowed, but encouraged. However, I think that women need to get the correct info and research their hospital facilities, not their OBs. Some hospitals just don’t accommodate natural birthing and while that is unfortunate, it is what it is. Doctors need to be more forthcoming with that info and steer their patients in the right directions to get the info they need!! Great post ma lady!

  11. Loved your post, Rachel!

    Both of my births took place in a military hospital and were fairly run-of-the-mill, I guess. With my second pregnancy, I considered a home birth or a water birth, but I just felt really hampered by having to use Tricare and the hospital itself. Having said that, both of my labors were easy-peasy and the nurses were awesome. My doctor humored my nonsensical ‘dealing with the pain’ chatter and engaged my slightly shell-shocked husband in conversation.

    Recently I watched a documentary on Netflix called “The Business of Being Born” and it really opened my eyes. It features erstwhile talk show host Rikki Lake and her childbirth experiences, as well as some of the misconceptions held by society and by other medical professionals of midwives. If I get pregnant again, I’m definitely going to do a better job of informing myself and doing what I want, and not just coasting along.

    Thanks for this post, it was lovely!

  12. thank you for this. this helped me to see a different side of the hospital. i had planned on a home birth, but when i went into preterm labor at 33 weeks that all went out the window. i ended up having my birth, in a hospital, and felt completely unsupported and poorly treated. this post has really made me feel a bit better about the whole experience. thank you.

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