Originally posted Jan 26, 2009, at the start of my maternity classes.
My maternity nursing classes have been interesting. I've never talked so much in class! I'm the only person in the class with any home birth experience, and I'm also the only male student (out of 3) with any recent birth experience. I think there's 37 women in the class. So I have a weird perspective on things.
For instance, we went over the different positions a woman may labor in - but the teacher said "I have to teach you this, but I also have to tell you you'll never see any of these. As soon as the water breaks, they're in bed until that baby is born." She asked if anyone has seen a woman laboring standing up - I raised my hand, and she said "Well, sure, you have. Your wife had home births, which was great because she could do whatever she wanted." :) She also asked if we felt more empowered giving birth at home. She's repeatedly said that lithotomy is the worst position from which to push a baby out.
She's also thinking of showing The Business of Being Born.
9 out of 10 complications we're being taught about are caused solely by the obstetric process - maternal fever from anesthetics, constricted placental bloodflow from Pitocin, urine retention from spinal blocks, babies with poor respiratory drive and suckling reflexes from opiate use. The most common problem is called supine hypotension syndrome - if a woman labors on her back, her uterus squishes the blood vessels supplying the lower body. This causes a reaction where her blood pressure and heart rate drops, which drops blood supply to the fetus. This shows up as heart decelerations on the monitor. Nursing response? Turn the woman on her side, slap some oxygen on her, start IV fluids to increase her blood volume. If that doesn't work, try the other side - if that doesn't work, prepare for a c-section. The cause? Laboring on her back - so she can be hooked up to an electronic fetal monitor. And the only reason she's on the EFM, as they've repeatedly told us in class: lawsuits.
There's not much emphasis on real pregnancy problems - placental abruption, placenta previa, eclampsia, etc. I have a feeling that OB nursing is all about complications of treatment, not complications of labor. A midwife or an obstetrician has to think about physiological complications, while an OB nurse has to think about treatment complications.