A few weekends back, I took care of two first time moms with very similar birth plans. They both wanted a natural labor and birth, didn't want to be tied to bed, wanted to move around, etc., the usual requests we see with a birth plan. They both did fabulous! But there were a few differences. The first mom came in defensive and abrasive - she thought I was going to force her to do everything against her wishes, take her baby away from her right after birth and do horrible mean things and ruin her birth experience. Couldn't have been farther from the truth! She allowed me to monitor the baby while I ran through the ridiculous list of questions I have to go through, assessment and calling the doc. She told me NOT to coach her with contractions or direct/suggest anything in labor or when it was time to push - her body would tell her what to do - she'd let me know if she needed me. I'm perfectly fine with that. We agreed that she'd let me monitor the baby and I'd be there just in case she needed something, but she didn't really want any interference on my part. So we had a deal. I call the doc, he agrees to her requests. I place the saline lock, help her into the tub and go in and check on baby every so often to make sure he was doing well. After awhile, she started to get pretty active and she also started to see that I was there to do everything I could to help her have the birth she wanted. No longer did she see me as the enemy, but as her advocate. We were getting somewhere. Generally, at least where I work, that's the case. Us labor nurses really do want women to have the birth experience they want, whether it's natural in the tub or with an epidural or a c-section. We do have rules the hospital puts in to place and a refusal of some interventions requires that a refusal form be signed to waive the hospital of liability. Anyway, she starts to feel pushy and she decides she wants out of the tub. I'm allowed to check her: nine centimeters. She was in that transition phase where she wanted to be done with the whole thing, felt out of control and that she couldn't do it anymore. I felt she was open to some suggestions so I got her back out of bed, on the ball, standing at the bedside, labor dancing leaning on dad, etc. Soon enough, she was complete and ready to push. She started pushing but not effectively - I could tell she was holding back - the urge was there, but her mind was telling her not to push because it would hurt. After awhile of ineffective pushing and not making progress, she started to look to me for suggestions. I then was able to give her suggestions on how to push, got her to try a few different positions - she actually liked the lithotomy position the best (I'm still astounded by that one!) and she started making progress, pretty fast progress at that. All she needed was just a tiny bit of help and she had it. Finally, we were ready for Doc, he came in, and she delivered a healthy little baby, just as she wanted. She told me afterwards she was so afraid that I was going to be this devil of a woman who would make her lie in bed, have an IV, be tied to the monitor, etc. because of all the stories she's heard about how horrible hospitals are. And I'm sure there are true stories like that, unfortunately. But there are a lot of nurses that want moms to have a safe delivery, a healthy baby and have the birth they dream of. She started off defensive, and realized that she did need someone to help support her (she didn't have a doula and didn't take any classes) and when she realized she could trust me, she was able to ask for help and was able to achieve the birth she so wanted. It really was a beautiful birth. Skin to skin right after delivery, baby latched on to the breast shortly after the cord was cut, and a great delivery.
The other momma had taken Bradley classes and was as prepared as you can get for your first run at labor and delivery. She and her husband were very receptive to any and all suggestions I could offer, and seemed to be reassured by my presence. Most times, Bradley couples have this great connection that they don't want disturbed by the presence of a stranger coming in and interrupting mom's concentration on labor. They had great chemistry but they also wanted that reassurance I could give them by checking on the baby frequently. After laboring for awhile, she decided she needed to do something different than sitting on the ball, so I helped her into the shower while I started filling our labor tub. After awhile, she decided the shower was wonderful and didn't want the labor tub. She progressed quickly and was 8 cm when I had to report off at the end of the shift. She did go on to have a drug-free vaginal delivery, after being complete for 5 hours and pushing for 3-4. I think they were probably starting to wonder if the baby would fit, but no time constraints were enforced as mom and baby were doing fine and in the end, she had a healthy baby in her arms. Another beautiful birth!