Have you ever considered looking at your patient? Seriously, there’s a real person, a laboring woman behind each strip on your computer screen.
While walking the hospital halls recently with a client of mine who was in active labor, I caught snippets of the conversation between the charge nurse and my client’s certified nurse midwife.I knew exactly who they were talking about. They were looking at the computer screen containing my client’s EFM strips. The nurse said, I can see that the baby is doing fine, but I need to know what is happening during this time. When is she having contractions? Is she even having contractions? How do I know that she’s in a good labor pattern?
Dear Miss Labor Nurse, Please turn your head away from the computer screen and actually look at this person who is in your care for the night. If you look at her and listen to her, you’ll see that she is in labor and experiencing strong contractions. A cervical check not too long ago showed 6 centimeters dilated. Upon admittance at the hospital, she spent 30 minutes on both the uterine monitor and the external electronic fetal monitor. Perfect strips.
The midwife explained to the nurse that she was sitting with her patient and that she was having good strong contractions and that the baby was handling those contractions fine. The nurse just didn’t get it. She wanted to see proof on her computer screen and on the paper printouts.
She wanted a record of the contractions. A continual record of the contractions.
Only minutes earlier, we had all been in the room, my client sitting on a birth ball leaning over the bed. Her husband was doing counter pressure on her lower back during contractions while the midwife sat beside her, holding the doppler up to her contracting baby belly both during contractions and in between them for some “continuous fetal monitoring.”
Beautiful heart tones. Strong. Reactive. Variable. No decels.
The midwife didn’t bother putting the contraction monitor on my client because she knew it bothered her and everything was going ok, so there was no reason to. The LDR nurse walked in the room and wondered if the monitor were working, only to discover it had not been placed on her patient.
My client didn’t want it on. She asked what information it would provide. The LDR nurse said they could monitor her contractions. The LDR nurse said so you are refusing? My client asked her if she needed it. The LDR nurse said that they were watching the baby’s heart rate but they didn’t know when or if she was having contractions.
Then I said, your midwife is sitting right here next to you and SHE is monitoring the baby’s heart rate plus SHE knows exactly when you are having contractions because she is right here with you and she is watching your baby during the contractions and so far your baby is doing fine.
With that, my client said that she refused the uterine monitor. A new nurse stormed in a couple minutes later; the charge nurse who I spoke of earlier in this account. The nurse demanded, “Where is she?”
I said, you mean A? (the midwife).
“No the patient.” The nurse hadn’t even bothered to find out her name.
I said, “P is in the bathroom.” The nurse did a quick 180 and stormed out.
This was the first time I’ve doula’d at this hospital, and perhaps my last. There are other doulas who absolutely refuse to go there. I loved my client; I had been to her previous births at a different hospital and I didn’t even consider not going to the birth just because of the place of birth.
Labor nurses: every once in awhile you’re going to get a woman coming into your labor hall who doesn’t need continuous monitoring because she’s not using pitocin. She’s not having an epidural. When a woman doesn’t get those drugs, the rules can be different. It’s fine for a midwife to watch a woman in labor, using her eyes and ears and hands to help her patient. Labor progresses. Birth happens. Mommies and babies thrive without machines and paper printouts.