What Women Want

December 8, 2009, University of Maryland School of Nursing, Baltimore, MD
Amy Polk spoke to nursing students about the consumer's perspective on birth. The students were all studying to be either labor and delivery, neonatal intensive care unit (NICU), or post-partum nurses. Amy based her talk on the results of a request for comments put to two parents' groups in the Washington, DC area, with the simple question: "What do you want maternity ward nurses to know?"

The response was immediate and substantial: over 25 women wrote back in less than 24 hours. From these comments, Amy compiled a list of Do's and Don'ts, grouped into several categories: patient interaction, your legacy, labor and delivery, NICU, breastfeeding, post-partum sleep, learning more, and final thoughts.

Patient Interaction

Do interact with your patients in a respectful manner. Treat them like rational adults.
“If you sound like you are talking to a first grader in a high pitched sing-songy voice, then you are doing the opposite of empowerment.” –MM
“’That's just your hormones speaking.’ is not a helpful phrase to hear.” -BI

Don’t talk about your patients in their presence as if they aren’t there.
“We mothers in labor can hear you! Our ears still work!” -NE

Don’t assume that patients know everything you know.
“Remember that even an experienced mother probably won't be familiar with the policies and services at your particular hospital. She shouldn't need to ask to find out what's available to her.” -TL
“If there's a cart with supplies next to the mom, remember to orient her to it. Years after that birth, I think about the cold packs in that cart drawer.” -MB

Don’t make assumptions about teen moms, especially about breastfeeding.
Teen moms are “often treated like they don't want information about what's going on, since they are hesitant to ask, but most often they really do want to know and to have a voice in their treatment.” -FE
“More often than not, it's assumed that [teen moms] will bottle-feed and are given very little guidance in breastfeeding.” -FE

Do ask moms about their vision of birth.
“Take time to ask her what her vision of her birth is.” -MN

Don’t attend a birth whose vision you cannot support.
“If [your patient wants] a natural unmedicated birth, and you prefer attending women who have medication, then please ask another nurse who does like to be with women who labor naturally.” -MN

Your Legacy

Do remember that birth may be routine for you, but not for the parents.
“Please try to remember that while L&D will become your day-to-day job, a trip to the maternity ward is a life-changing event for the parents.” -KE
“Remember that the new mom has never done this before, even if you have done this thousands of times.” -FC
“Treat each mom as a person going through a normal life process instead of as a medical condition.” -MN

Do know that you will be remembered!
“You are part of a birth story that may be told over and over again as well as remembered by the birthing mother for her lifetime.” -DD
“I can still remember all seven of my L&D nurses' names and faces. They were way more consistent and supportive than the docs.” -CD
“Even years later, women remember the kindness and understanding of particular nurses.” -MB
“I still remember the name of the L&D nurse who was with me for the end of my first labor, though I have no idea what the OB's name was.” -BE

Do go the extra mile.
“One of [the nurses] even stayed way after her shift had ended so that I wouldn't have to change to a totally new person in the middle of pushing.” -CD

Do remember that you can be an advocate for the mom, even to her husband or partner.
With my first child, “the L & D nurse actually just placed her body between [my husband] and me” which gave him space to respect my wishes for no pain medication. -NC

Labor & Delivery

Don’t treat the parents like freaks when:
The couple brings a doula.“Doulas can be [nurses’] allies, not competition.” -MN
The mom doesn’t want pain medication.“Please do not assume that all women feel pain while birthing. Some really do not code the sensations as such.” -MN
The mom uses a way of dealing with the pain other than drugs.“When a woman says that she is using a particular technique, please ask questions instead of turning up your nose.” -MN“I didn't care for the nurse who brought me oxycontin because she ‘couldn't keep getting more ice.’” -TQ
The mom wants to eat and drink during labor.
The mom questions a procedure or intervention.
The mom wants some time (e.g., 30 minutes) to consider an intervention or other difference from what she envisioned.
The mom refuses a procedure or intervention.“Recognize that when a woman refuses a procedure that she still does have the right to do that, and do your best to let it go.” -MN
The mom labors and/or gives birth in unusual positions: standing up, squatting, etc.“My L&D nurse somehow did all of the things she had to do while I was in some very contorted positions. It really helped.” -NS
The mom wants the baby placed on her chest immediately after birth for skin-to-skin contact.“Please realize that skin on skin is essential and that does not mean putting a towel on the mom then putting a baby on top of the towel.” -MN
The parents want to wait until the umbilical cord stops pulsing before it’s cut.
The parents want their baby with them, not in the nursery.“Some [nurses] strongly disagreed with my wish to keep my baby in the room with us. I had to struggle with them at midnight over not taking him away from us.” -KX
The parents focus on their own needs rather than yours.“When a mom comes in and has to answer questions, it is frustrating as she has answered these before and just wants to focus on her body and her baby.” -MN

Don’t ask routine questions of a mom in active labor, especially if this information has already been collected before.
“I wanted to do something very mean when I was asked for the date of my last menstrual cycle, my weight, my address for the third time at 5 cm dilated.” -MR
“Late stage labor is not the time to insist that the mother, not the husband, give the intake nurse your Social Security number a dozen times to fill out in the computer.” -NE

Don’t freak out about tearing or aggressively push for episiotomies.
“The only thing that the L&D nurse did during my first delivery was she kept talking about how I was tearing, and it made me really afraid to push. She kept saying I should just get and episiotomy.” -XT

Do perineal massage.
“My second delivery the nurse did a lot of perineal message and I didn't tear at all.” -XT

Do understand the Sphincter Law.
“Sphincters function best in an atmosphere of intimacy and privacy.”
“Sphincters cannot be opened at will and do not respond well to commands, such as ‘Push!’ or ‘Relax!’”
“When a person’s sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated or self-conscious.”
From Ina May’s Guide to Childbirth (Ina May Gaskin, 2003), p. 170

Don’t give up on teaching effective pushing.
For my second child, “the nurse-midwife said one thing that made it click, and it went fine with my 9-pound son.” -MB

NICU

Do remember that you can be an advocate for the parents to pediatricians and other specialists.
While my baby was in the NICU, “there was so much new information coming at me at once, it was the nurses who helped me understand which orders from doctors were standard and probably necessary and which decisions made sense to question.” -LI

Do help new parents feel like parents, even in their baby is in the NICU.
“The nurses who treated me and my partner like we were the most important caregivers for our baby were lifesavers for me.” -LI

Do welcome parents into the NICU as a way of teaching them how to handle a newborn.
“If possible, invite the first mom(s) or dad(s) to come to the nursery when the baby goes for routine stuff. Not only does it support the bond that is occurring in those first special hours/days but it also helps the parents to see someone experienced handling the baby.” -KK

Breastfeeding

Do arrange for the lactation consultant to visit the new mom right away.
“Lactation and nursing can get lost in the shuffle which may bring about problems later that could have been avoided with some simple attention.” -KK

Do recognize how difficult breastfeeding can be, especially at first.
“Have empathy and patience.” -LO

Don’t make the mother feel guilty about breastfeeding if the baby has lost a little weight.
“Every single baby loses a small amount of weight after birth.” -KX

Post-Partum Sleep

Do let mom sleep.
Recognize “the profound effects of sleep deprivation” can have on moms who have just given birth. -LO
“Don't wake up a mom with questions that are not urgent.” -FC
“I had a maternity nurse who quickly realized that I was being awaken every hour on the hour, i.e., meds, nursing, changing my dressing, etc. She quickly combined what she could to minimize the number of times she needed to wake me.” -NB
“It would be nice if they didn't take the baby out in the middle of the night to get weighed.” -DD

Do help mom sleep.
“A wonderful nurse finally sat me down and said that she was not going to wake me to go nurse [my daughter in the NICU], that I needed to rest. She then gave me a sleeping aid to assist me.” -OC

Learning More

Do read birth books.
The Doula Guide to Birth by Ananda Lowe & Rachael Zimmerman (2009)
Your Best Birth by Ricki Lake and Abby Epstein (2009)
Our Bodies, Ourselves: Pregnancy and Birth by Judy Norsigian (2008)
Cesarean Voices by the International Cesarean Awareness Network (ICAN) (2007)
Pushed by Jennifer Block (2007)
Born in the U.S.A. by Marsden Wagner (2006)
Baby Catcher by Peggy Vincent (2003)
Ina May’s Guide to Childbirth by Ina May Gaskin (2003)
Spiritual Midwifery, 4th Edition by Ina May Gaskin (2002)
The Thinking Woman’s Guide to a Better Birth by Henci Goer (1999)

Do see birth movies.
The Business of Being Born
Home Delivery
It’s My Baby, My Body, My Birth
Laboring Under an Illusion
Orgasmic Birth
Singing the Bones

Do see birth in out-of-hospital settings.
Attend births in birth centers.

Bay Area Midwifery - Annapolis, MD
BirthCare - Alexandria, VA
Family Health and Birth Center - Washington, D.C.
Marshall Midwifery Birth Center - Marshall, VA (opened December 1, 2009)
Special Beginnings - Arnold, MD

Attend home births.

Talk to and “shadow” doulas. Take doula training.

List of birth centers, home birth midwives, and doulas available at Birth Options Alliance website http://www.birthoptionsalliance.org/.

“We need as many angels in the hospital as we can get.” -NC

Final Thoughts

PN (mother of two) says:
“Give new mamas support rather than judgment. Give information rather than directives.”
“Remember that laboring and recent postpartum mamas are at their most vulnerable.”
“Never assume that you know what is best for baby or mama. Remember you are part of a team that has the responsibility to get mama and baby off to the best start both physically and emotionally.”

MM (childbirth educator) says:
“Women can be strong if you teach them how and empower them to do so.”

MN (doula) says:
“The birthing mom looks to you for guidance since you are the caregiver in the room most of the time.”
“Trust the birthing process and recognize that birth is not cookie cutter.”
“Please bring positive energy to the mom and her partner.”
“Trust your instincts as a woman.”