By Elke Bachmann, RN, MSN, CNM
The Labor and Delivery Rotation: You Want Me to Stand Where?
It's the first day of your labor and delivery clinical. You’re somewhere between thrilled about seeing a baby born and desperate to find something large enough to hide behind. Maybe you’ve heard horror stories or been through a traumatic experience with birth yourself. Maybe you’ve had great experiences and are eager to help a patient have one too. Maybe you have no experience with birth and the whole thing makes you nervous. There’s one solution: labor support. No matter what your outlook is going in or how limited your professional role is in the clinical experience, you can make a contribution that helps your patient have a positive outcome, helps your preceptor manage her assignment, and helps you understand the process of labor and birth.
For the patient, having someone at her side, willing, and able to support her, reduces her risk for having a cesarean, reduces her use of pain medication, makes labor more likely to progress normally, and reduces the baby’s chances of being admitted to a special care nursery. For you, taking an active role, staying present, observant of the family’s needs and the events of labor and birth, gets you out of your own head and brings the words in your textbook into reality. For your preceptor, you can fulfill a wish. Many labor and delivery nurses wish they had more time to provide labor support and will be grateful to see someone taking the initiative to make it happen. Tell your preceptor you are interested and ready for an assignment where extra support is needed and you might make her day.
There are a few key strategies keep in mind when providing support in the birth room.
- Keep it positive
Women and their families can have a lot of stress and fatigue during their labor and birth experience and they are likely to verbalize negative thoughts. You can redirect negativity. If the mother says “I’m scared.” your response can be “You can do this. You’re safe here.” If she says “It hurts.” say “I know and you’re doing a great job handling it.” When she says “I can’t do this.” you can say “You’re doing it right now. All this work is getting you closer to seeing your baby. “ If the family says “Why is this taking so long?” you say “Faster isn’t necessarily better. Its normal for this to take a while and that’s ok because mom and baby are doing well.” Whenever you hear a negative word, reply with reassurance and affirmation of normalcy.
In addition, the language of birth can be violent or make the mother feel helpless. Change that by saying “If you need stitches…” instead of “If you tear…” Say “give birth” instead of “get delivered”. Say “release amniotic fluid” instead of “break your water”. Listen for language that is subtly violent or implies the mother is helpless.
- Keep it calm
When there’s a change in the labor process like an increase in intensity of contractions, fetal descent, a complication that needs to be addressed, and especially when the baby starts to be visible, there can be a lot of agitation and raised voices in the birth room. You can, with a light attitude, remind everyone to keep it calm. Say something like “OK everybody, let’s help mama stay calm.” Model calm behavior by moving slowly and smoothly and keeping you own voice even and low. Watch the mother’s breathing, call her by name, and ask her to look at your face. Ask her to breathe with you to slow down her respiratory rate.
- Monitor the bladder
Encourage the mother to empty her bladder every two hours. Help her to the bathroom. An empty bladder facilitates fetal descent and decreases bleeding after the birth.
- Watch the mother
Be alert for signs of discomfort. If she keeps licking her lips, offer lip balm, ice, or water. If she keeps pushing on her hair, ask her if she wants you to put it up for her. If her head is sideways, move the pillow. If she throws off blankets, fan her or put a cool cloth on her head. She may not be able to articulate what she needs.
- Try position changes
Helping the mother keep moving or change positions at least every 2 hours when resting prevents blood clots, changes the bony relationships between the fetus and the pelvis, helping it to descend, provides a distraction for the mother, and helps her discover what is most comfortable for her.
- Tell the mother what’s happening
Don't just do things. Say “I’m going to try rubbing your lower back when you have a contraction. Tell me if it feels better or worse.” or “Its time to listen to the baby’s heart.” If staff members come in and do things without explanation, explain. For example “ She just turned up the IV fluid because it improves the circulation to your baby.”
- Think about the family
Introduce yourself and learn their names. If you notice the grandmother, for example is pacing or fidgeting you can ask “Are you felling anxious, Nancy?” and open a conversation where you can reassure her or give her a way to help. Ask the mother’s partner if he needs a break to take a nap, or a walk, or a cheeseburger. Tell him you’ll hold down the fort. Tell them they’re a good team.
For more information about labor support check outwww.lamaze.org, www.bradleybirth.com, www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/labor/sls-20077009 , and “Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM”