Dad vs. Nurse: Advocacy in the Labor Room (part two)

GUEST POST by Melissa DuBois

If you haven’t already, please read DAD VS NURSE: Advocacy in the labor room, Part 1

In part 1 of this blog, I discussed factors that influence the relationship between a partner (especially a male partner) and a labor nurse. I also discussed why some approaches and gender dynamics can create a defensive and adversarial relationship between dad and nurse when a dad is attempting to advocate for the mother’s desire for a natural childbirth.

So, what’s a dad to do? Here are some tips from myself and some other amazing and experienced, NCB-friendly nurses.

 

Tips for Being a Respectful and Effective Advocate

1)     Prioritize your choice of clinician and birth place above all else

You can take a stellar class, hire an amazing doula and luck out with the best NCB friendly nurse on duty, but if your hospital has high intervention rates and your clinician follows a medical model of care, it is going to affect your birth experience, period. In the end, nurses can advocate for your wishes until they are blue in the face (and I have) but if the clinician believes that medical or surgical interventions are the only way to avert  poor outcomes and trusts technology above all else, you are working an uphill battle and are setting yourself up for a fight.

Here’s an off topic but good example of this.  I severely injured my tailbone a few years back and went to see several practitioners for advice: 

1-The doctor prescribed me narcotics

2- The orthopedic surgeon discussed surgery

3- The chiropractor performed adjustments

4- The physical therapist recommended rehab and at home exercises

The truth is my doctor was a fantastic doctor; she really listened to my concerns. But in the end, the only tool her training and expertise offered was narcotics, and since that's all she knew, that’s what she recommended. She was even open-minded about me going to a chiropractor or physical therapist, but had absolutely no advice or guidance for me if I wanted to pursue that route. And since I didn’t want narcotics, I ultimately left that office empty handed. Now, I could have also had a doctor that was not so understanding or one that told me false information about physical therapy and chiropractic work based on ignorance or one that got defensive when I even asked about alternatives to narcotics.

So first and foremost, patients need to understand that a great doula, nurse and husband as well as good information can only go so far if you don't make it a priority to find a birth place and clinician that follow your philosophy of care.  These things should be your priority over all else.  It really doesn’t matter how nice the clinician is, they need to put their stats where their mouth is.

Bottom line: If you want a low intervention birth and the only tools in your clinician’s tool box are medical intervention, that clinician will at least be unhelpful and at most be contentious during your labor. And even if your nurse is amazing and on board, if she works at a hospital with an 80% epidural rate, she might not have a lot of experience with actually supporting a mother through natural childbirth even if she wanted too! So find a supportive clinician and birth place FIRST! Even if you have to transfer at 38 weeks. Even if it's a drive. Even if it's inconvenient. Even if it's unfamiliar. DO IT.

2) Hire a doula

When I had my first child in 2012, not only was I a labor & delivery nurse, I was actually delivering at the hospital that I was working at. I knew everyone on staff intimately. I also was totally equipped to be my own advocate and had a very deep understanding of labor and medical interventions. I taught childbirth classes. I had an amazingly supportive husband and mother who had 4 vaginal births of her own. And I was under the care of one of the most respected midwifery practices in all of New England.

And I still hired a doula. ‘Nuff said. But if you still need more convincing, read this.

3) Ask for an NCB friendly nurse

However…phrasing matters. Instead of “We want a nurse who is the most knowledgeable/experienced with natural childbirth” try “Are there any nurses on tonight that have a particular interest in natural childbirth?” Regardless of their experience, nurses generally either like working with NCB moms or not. This phrasing takes away the chance for whomever you are addressing to get defensive.

However, you can’t always guarantee you will get along with your nurse. So see #2.

4) Ask for the nurse’s expertise

Local L&D nurse and mom of 5, Sarah Carter McRell, RN advises asking for a nurse’s opinion to help build a bond in the labor room:

“I think when dads ask a nurse’s opinion about a situation it helps to build a bond. Say mom doesn't desire to have pain medication. He could ask ‘Can you help us/her avoid pain medication?’  Most nurses have seen what has helped other patients. Also a nurse can let other care providers know that a patient doesn't want to be offered and epidural every hour. Valuing the nurse’s opinion in the room helps build a bound and reach a common goal. “

Examples:

• Instead of: "She doesn't want pain medication.”
• Try: "Can you help us to avoid pain medication?" or even throw in a compliment like, "You have so much experience, we'd love your advice on what to try next. Sally told me she wants to try everything before thinking about an epidural."

 

• Instead of: "We don't want Pitocin."
• Try: "We are motivated to help her labor get going. Do you know any positions or strategies that we can try before the next check? Could you show me how to help her? She's really hoping to try everything we can before Pitocin"

 

• Instead of: "Sally doesn't want..."
• Try: "Sally keeps saying her back hurts. She stands firm on not wanting an epidural but I'm out of ideas. I'm sure you've seen this before. Can you show me some things I can do to help her back feel better?"

 

[Author’s note: If phrasing things this way to get what you want leaves a bad taste in your mouth... welcome to our world, brother. Nurses have to speak similarly to doctors every. single. day.]

 

5) Be liberal with the “honey” and avoid the “vinegar”

This may be cliché, but it works. As Maureen Hodges, RNC-OB, an L&D nurse in Austin, TX advises, “Kill them with kindness. You’ll gather more bees with honey.”  Take a step back and be nice. Don’t bark orders. And don’t come ready to fight because if you do, it will be a self-fulfilling prophecy. Remember your job first and foremost is to be her physical and emotional support, not (as Nurse Hodges put it) be her “protector against those mean nurses!”

[Insider tip: I might be breaking some nurse pact by admitting this, and even though it’s not a requirement, bringing a treat never hurts. Honestly, it’s shocking. Patients walk onto L&D all the time and we know nothing about them. They could be serial killers and yet, if they bring a treat all of a sudden you hear:

Nurse 1: “Who brought the donuts?”

Nurse 2: “Oh, the patient in room 5. They are such a wonderful couple.”

Nurse 3: “Well isn’t that nice! I saw them at the registration desk. They looked lovely.”

 

On a serious note, I think this is so effective because bringing a treat is just a simple and universally recognized way to say “I appreciate what you do for me, even though we are strangers.” My grandparents taught me this trick as a young child. They brought Dunkin Donuts everywhere: to the bank, to the dentist, to the doctor’s office. It wasn’t about bribing anyone.  It’s just a “pay it forward” kind of gesture. And you should have seen the line at my grandfather’s wake.]

 

5) Appoint dad as official “question asker.”

Here’s where teamwork comes in. FIRST the laboring mother needs to speak up for her own wishes and THEN the partner can take on the role of "question asker.” Asking questions helps mom gather more information, sort out her desires and also gives her time to decide whether she consents or declines (or at least it stalls until she can tell the staff she needs more time to think about it.)

Let's look at two scenarios:

Scenario 1:

Mom: "I don't think I can do this anymore."

Nurse: "Well let's just get you an epidural then. You don't get a medal for going without one. Don't torture yourself!"

Mom: "I don't know…"

Dad: “We don't want an epidural!"

Nurse: "It doesn't matter what you want! It's her labor.

Dad: “But she doesn’t want an epidural!”

Nurse: “Sir, I need to hear from her. (To mom) Honey, what do you want? Do you want to keep suffering like this? Just get the epidural."

Dad: "I said SHE DOESN’T WANT AN EPIDURAL! WE WANT ANOTHER NURSE!!!"

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Scenario 2:

Mom: "I don't think I can do this anymore."

Nurse: "Well let's just get you an epidural then. You don't get a medal for going without one. Don't torture yourself!"

Mom: "I don't know…"

Dad: "Sally has been saying her entire pregnancy she really wants to avoid an epidural. Do you have any other ideas we can try?"

Nurse: "Well we can get some IV pain medication, but by this point, it's not going to provide as much relief as an epidural."

Dad: "She was asking for the tub a few minutes ago. What about the tub?"

(Tip: Not "can" we use the tub.)

Nurse: "Well that's not going to work for very long, she'll be begging for an epidural 5 minutes after we get her in there!"

Dad: Is there any medical reason why we can't try?

Nurse: "Well no but..."

Dad: "Sally, what about the tub?"

Mom: "Okay, yes. I want to try the tub. "

(Tip: Don’t be wishy-washy, be clear.  Either you want the tub or you want another idea.)

Dad: "Okay then, I don't mind doing the work. I'll start running the tub. Do you need to do anything with her before we get in the tub? Are there any special instructions for the tub?"

(Tip: This type of advocacy is going to be more second nature to a doula. So again, see #2. But all support persons can use this strategy too.)

 

In conclusion, I’ve been a nurse for 10 years and have been on both sides of the fence: the laboring mother and the labor nurse. I’ve also been both lauded by a couple for my advice, assistance and advocacy as well as distrusted and rejected simply for the letters after my name.  I hope this blog post has helped you understand where we as nurses are coming from and given you some ideas on how to work together with us for a safe, positive and empowering birth experience for all involved.

 

 

Melissa Anne DuBois, RN, BSN, CCE is an OBGYN nurse that works in the greater Boston area. This picture was taken after 3 years of infertility, 38 weeks of pregnancy, 3 days of prodromal labor and 36 hours of back labor (27 of which were unmedicated). She might very well have ended up with a cesarean section if it wasn’t for her wonderful CNMs, her choice of hospital, her amazing husband and mother and her incredible doula. She is also a BIC mom and breastfed her son until age 3 with the help of the breastfeeding support she received at BinC!