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Secrets of Labor Room Nurses

Labor Reality
Up close of female nurse of doctor, mask over face

For months after I got pregnant, I stressed over which of the 10 ob-gyns at my HMO would actually be on call for my baby's birth. In reality, it hardly mattered. When push came to, well, push, it wasn't my obstetrician cheering me through gut-wrenching contractions and scoring me a quick, blissful epidural, it was a labor and delivery nurse -- a woman I'd never seen before she whisked me into the maternity ward but who was such a comforting, Angela Lansbury-like presence that I wanted to add her to my Christmas-card list.

I'm not the only new mom who's been surprised at spending the vast majority of labor with a nurse. "I see a lot of women who think that their physician is going to be there most of the time," says Carol Burke, RN, an advanced practice nurse at Prentice Women's Hospital, part of Northwestern Memorial Hospital, in Chicago. "Actually he's like the relief pitcher who shows up in the bottom of the ninth inning when there's two outs and two runners on base."

But in fact that's a good thing, since most labor and delivery nurses are passionate about giving you the birth experience you want. Here, eight of them give us their inside scoop on hospitals, contractions, and why it's okay to poop while you're pushing.

Checking In, Chatting, and Cheering Up

Get seen faster. "When there's a shift change, the nurses getting off work are reluctant to take on a new patient, and the nurses coming in take a while to get up to speed," says Angie Southwick, RN, of Dixie Medical Center, in St. George, Utah. "I hate to say it, but sometimes women can sit in triage [an examining room where a nurse evaluates whether you're ready to be admitted] for a long time." A time-saver: find out what times nurses usually come on shift and hold off checking in until an hour later. (But plan on spending 45 minutes to an hour in triage no matter when you go; that's how long it takes to monitor how your labor is progressing.)

Break the ice. Chatting with your nurse -- about your dog, your day job, your 2-year-old -- helps her see you as a real person. And asking about her not only seals the rapport, it could net you some great advice. "A lot of nurses have kids and have had their own labor experiences," says Amie McAlpine, RN, a nurse at Providence Portland Medical Center, in Oregon.

Deck the halls. To make their hospital room more homey -- which nurses say can keep moms-to-be calm and comfortable -- one family made enlargements of photos they had snapped on top of a mountain. "When I walked in, they had taped five or six of these photographs around the room, so it gave you a panoramic view," says Anne-Marie Combs, RN, a perinatal nurse clinician at Fairview Northland Medical Center, in Princeton, Minnesota. Other tools for giving your delivery room a just-like-home vibe: aromatherapy oils (candles aren't allowed), a small vase of flowers, and your own pillow to replace the crummy plastic-encased one the hospital provides.

Right Nurse, Right Plan, Right Time

Request the right nurse. Most nurses are equipped to help you through whatever kind of labor you want to have. But if you're going for a natural childbirth, it's perfectly okay to ask for a nurse who's either worked with unmedicated moms or delivered that way herself; you can even ask your ob-gyn beforehand for a recommendation. "When you come in, say, 'Is Nancy Jones here today? I've heard great things about her,'" recommends Nicole Hall-Joppy, RNC, of Durham Regional Hospital, in North Carolina. "We won't be offended in the slightest." Just keep in mind that if your dream nurse is busy or otherwise unavailable when you arrive, you'll be assigned to someone else.

Keep your birth plan short and sweet. "If a mom has a typed-out birth plan, that plan will usually accompany her prenatal records. But it's usually not read until she comes in, and that may be at 2 a.m.," says Burke. If you focus on a few key wishes -- like having a mix CD playing in the delivery room, or avoiding an epidural -- your nurses are more likely to make them happen. You can also call the hospital's nurse manager a few weeks ahead of time to find out whether it's feasible to, say, go without an IV or have five people in the delivery room. After you chat, she'll make a note in your prenatal file that she's okayed your requests -- so if anyone balks, you can drop her name.

Wait out your baby's arrival. "A lot of doctors will plan inductions around people's vacations or certain birthdays moms want their kids to have," says Dawn Klecka, RN, of Banner Good Samaritan Medical Center, in Phoenix. "I was at work a few days before Thanksgiving, and a woman was being induced because she wanted to eat turkey with her family." But many nurses worry that some women who schedule an elective induction don't really know the pitfalls -- that your labor may take longer, for instance, or that you're at increased risk of having a c-section. Klecka recommends talking to your physician beforehand to find out what elective induction is really like.

Stick with It

Quit worrying about whether your doctor will make it. You've been in labor for 15 hours, and your doctor hasn't shown his face. What gives? Nothing, according to Kathleen Simpson, PhD, RNC, a perinatal clinical nurse specialist at St. John's Mercy Medical Center, in St. Louis, Missouri. "At most hospitals the nurses make two calls to the doctor -- one to say, 'She's here,' and one to say, 'I need you to come.'" Your ob-gyn's already filed standing orders for the kind of pain medication you should have, so she may only show up for the last few pushes. If for some bizarre reason she doesn't make it, your nurse will probably call in another ob, so you'll be well taken care of.

Ask for ideas. Seasoned labor and delivery nurses have seen it all -- and they're usually up on the latest techniques to help you through painful contractions. A favorite of Mary Ann Lovendahl, RN, a clinical manager at Flagstaff Medical Center, in Arizona: raising the bed, then having moms lean over it and rotate their hips in a circle. The move sometimes helps the baby switch positions, relieving back pain. Plus it gives moms tethered to a fetal monitor a little more control.

Let your nurse play the heavy. You didn't exactly want your father-in-law in the delivery room with the camcorder, but ejecting him now would require a diplomacy you just can't muster. So let your nurse be the bad guy. "If someone in the delivery room is just gawking, I bring the mom's primary support person out into the hall and say, 'Is this okay? Do you want me to handle this?'" says Burke. If your nurse doesn't offer, pull her aside and ask her to take charge. Chances are she'll be glad to help.

Plan on pooping. Most first-time moms stress out about pooping on the delivery table, but you can forget about grossing out your labor and delivery nurses. "We really don't care," says Hall-Joppy. "We actually want you to poop, because that means you're pushing in the right spot and that the baby's head is coming down." Still horrified at the idea? Give yourself an enema before you leave for the hospital.

Relationships and Comfort

Get attached...but not too attached. You adore your labor and delivery nurse -- and suddenly she's abandoning you for something as silly as going home. "I've had people say, 'I'll really miss you, can you stay? Will you be back tomorrow?,'" says Combs. Most hospitals have 8- or 12-hour shifts, so if you're in labor for 24 hours you may be cared for by up to three different nurses. Alleviate the stress of change by finding out up front when your nurse will be leaving. If you're ultra-close to delivery, she may be willing to stick around for an extra half hour while the oncoming nurse catches up on paperwork.

Ditch the nightgown. "Some women come in with these white gowns with a matching robe and slippers -- but you're here with sore nipples and a sore bottom, and who wants to put on a white lacy dress when you're feeling like that?" says Hall-Joppy. "Plus you're going to be bleeding heavily, so why mess up your own nightgown? Just wear the hospital gown. If it gets messy or if baby throws up on it, you're fine."

Say thanks. Yes, they're just doing their job, but if your nurses helped you go from a quivering ball of fear to Supermom, it's certainly kosher to say so. "I've gotten everything from flowers to chocolates from patients," says McAlpine, adding that a note with a few snapshots tucked inside is just as sweet. But remember before you go home to ask for a list of all the nurses who've taken care of you. "Cards are nice, but they mean more if we know exactly who they're for," she says.

If You Can't Stand Your Nurse

Most labor and delivery staffers are more Florence Nightingale than Nurse Ratched. But if you and your nurse just aren't getting along, it's okay to ask for a switch. How to do it: Ask to see the charge nurse or the nurse manager. Say, "You know, I'm sure Mary's a great nurse, but for some reason we just aren't clicking, and I'd like somebody else who's going to better suit my needs." Unless Mary's the only nurse around, chances are you'll get your wish.

And don't worry about payback. "Patients are scared that we're going to treat them badly if they ask for a different nurse," says Hall-Joppy. "But if you're not having a good experience with that nurse, you have every right to request another one."

Melody Warnick is a writer and mother in Ames, Iowa.

Birth Stories: Natural Labor
Birth Stories: Natural Labor

Originally published in American Baby magazine, December 2006.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.