Passive Descent vs Pushing in Second Stage of Labor

Most recently I was asked to comment on whether during the second stage of labor ( which is the onset of full cervical dilation) should be passive descent vs. pushing.  In my opinion, it all depends on what policy the treating practitioner uses.  I worked at a high level labor and delivery unit up North where women were flown in if it was an emergency or bad delivery anticipated or trauma.  But we also were a Catholic Hospital and took care of the indigent. We had a teen obstetrics clinic in the area (not related to the hospital) but it was across the street.  They handled all the teenage pregnancies that came through their doors.  It was managed by two very caring midwives.  At this clinic, the girls not only received prenatal care but they also received information on how to take care of their babies.  The girls were referred to pediatricians to get healthcare for the babies and to school counselors to help them get their GED’s.  But the best part was that these midwives taught natural childbirth at their clinic.  When a girl came into labor, they went into the birthing room and they did perineal massage to do natural descent.  They worked with the contractions.  These girls rarely had any perineal tears.

One day one of the midwives was on vacation and the other one was in the clinic and could not get there this one time and one of their girls came in almost completely dilated and effaced.  The resident on duty that evening was one of the most arrogant doctors I had ever seen, he had smart remarks before he even got in the room with her. He went inside to do her exam and he rammed into her and the girl nearly jumped three feet, I calmed her down as she was a scared 15-year-old girl.  She screamed and he said listen you had something much bigger in there than my finger, I quickly stated, doctor that is enough.  He said,  yes she is dilated,  get her in the delivery room, I said that the girls go to the birthing rooms and deliver there in a more holistic approach; his reply was, we don’t have time for that garbage, get her pushing and delivered.  This poor child gave birth and had tears from front to back, she was in such pain, as she could not have an epidural or pain meds since she was already effaced and 10 cm.  I did not have kids at that time, but could only imagine by the grips of my hand and the tears and screaming that she was suffering.  I was barely 21 years old.  The midwife came finally after she closed the clinic at 7pm to check on her patient and was so angry after the patient told her what happened. She brought up the incident to the hospital administrator who placed the doctor on probation.  He had a few incidents with me and some other nurses and eventually was fired from the residency at that hospital. Knowing the hospital’s practice for each unit and also what the practitioner believes is very important (Denisco & Barker, 2012).  Some doctors will approach labor and delivery with a more holistic approach.  This would be an approach that Jean Watson’s theory on caring would fit in to.

 

 

References

Denisco, S. M., & Barker, A. M. (2012). 25. In Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). Retrieved from https://campus.capella.edu/web/library/home

What is a Father’s Role When the Doula is There?

The doula never takes the father’s role in the birthing process.  The doula enhances and compliments the father’s role during the entire birth.  In this generation, more fathers are becoming involved in the process of birth.  However many fathers still want to be there for their partner, but maybe not in the coaching aspect for fear that they may do something wrong.  Have no fear dads, you cannot do anything wrong.  When the doula is there, she will guide you through the process of being your partner’s support system.  With the doula there it gives the father flexibility to rest, has a bathroom break, eat, and most importantly learn the techniques that will be needed during the difficult time of labor.

www.windermerebabyandfamily.com

 

Critical Consciousness

My awareness of critical perspective has expanded beyond the arena  of where I work, it has involved my charity The Gift of Life  and my wedding business 27 Miracles.  I started out my nursing career working in a high risk labor and delivery unit.  In labor and delivery you meet all kinds of people from different walks of life, different religions, different ethnicities and socioeconomic status.  During a critical time such as labor when there is pain, this is when you learn about other people’s cultures and how pain is perceived by them.  As a nurse we learn about those different cultures through experience so that when we do encounter them, we can understand what level of privacy and respect they need.

parents-in-labor

My husband and I own a wedding and event planning business called 27 Miracles.  Through the years we have become well known in our town for working with ethnic weddings from different countries as well as interracial.  It has allowed me as an individual to learn many cultures and be able to show respect for other cultures and their ways of communicating.  It is a beautiful thing to see love spoken and expressed in so many different languages and cultures through music, food and traditions.

wedding

I have learned through my nursing experiences and my wedding experiences how to appreciate people more and take interest in who they are as a person.  As nurses we get  busy when we work on the floor or in an office and talk about our patients as just another number because we are  in a hurry.  Even on our busy days, we need to stop along the road and take a moment to say hello to our patients, provide a gentle touch to their hand or shoulder, and a listening ear.  These are all part of critical perspectives or as I like to call it cultural awareness.

Nurse holds elderly patient's hand

Many say that the parents of premature babies experience preterm birth  because the parent did something wrong, they smoked, drank, did drugs or a teen age pregnancy caused the premature birth.  Although some of those reasons may be true, there is another side to prematurity that people do not think about.  The mother that develops maternal illnesses like Diabetes and Hypertension, or the baby that for some reason starts developing intrauterine growth retardation and it is unsafe for him or her to be inside the womb.  It is very easy to judge when you don’t know the situation or have never experienced it, but as nurses we need to develop  ways of thinking that allows us to be aware about ourselves and those around us  (Gotzlaf & Osborne, 2010).

nicu-mom

Working with a population of parents that have premature babies, has shown me that premature birth happens all over the world. Premature birth limits no race, religion or economical status.  Our job as a nurse is to be aware of the different cultures and take the time to learn about their culture and how you can work with that person.

new-moms

References

Gotzlaf, B. A., & Osborne, M. (2010). A Journey of Critical Consciousness: An Educational Strategy for Health Care. International Journal of NursingEducation Scholarship, 7(1), 1-15. http://dx.doi.org/ 10.2202/1548-923X.2094