Labour Question...

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A bit of background; I'm a medical student assigned to delivery ward at the moment. I've been doing my best so far; trying to be helpful (fetching water, sheets etc) and trying my hardest to make small talk with the mum-to-be and the father. The thing is, my imagination is really limited and after an hour or so, my stockpile of questions has pretty much run out.

Last night, I was on duty and sitting with a woman whilst she was about mid-way during labour. It was about 5am in the morning and everyone involved was quite tired, and the woman herself was in a lot of pain and just sort of sobbing quietly to herself. At the time, I thought asking banal questions was innapropriate and I just sat silently, out of the way, until her blood pressure needed taking or something needed fetching (I'd ask every so often if the pain was getting better or worse). Her husband was also sitting beside me and every so often, he would hold her hand; I felt that to start patting her or stroking her would a) achieve nothing, b) annoy the s**t out of her and c) be way too innappropriate; we're always told that pregnancy is not an illness and whilst I felt awful for her and really really wished I could do something about the pain, I felt that a perfect stranger going up and patting her would appear at best patronising at best, and at worst, technically assault. If she had asked for anything or had tried to say something, I would have listened and tried my best to carry on the conversation, but the woman herself did not seem to want to chat.

However, whilst I was sitting there, a nurse came in and asked for a word. I can't remember all the details, but the gist of it was; "that woman's in labour and you're just sitting there on your ass staring at her (I thought I had arranged my face into a look of deepest compassion...); you need to talk to the patient and build rapport (which I had been doing previously)... basically, I was being told off for acting compassionless (I think). I burst into tears (in my defence, it was the end of the graveyard shift and I was shattered) and she became a bit nicer, saying that I 'just need to work on it...'

I guess that's what got to me; I was working at it. I spend my life 'working on it' and trying to appear caring and empathetic, and I was making a special effort this week to make things a bit easier on the poor women, but once again, I f****d up and came across as Hannibal Lecter. Now I'm geniunely confused; I had thought out my previous actions quite well, and neither my boyfriend nor I can understand what exactly I did wrong, except that perhaps this particular nurse hadn't seen me chatting to the patient earlier or due to never having been pregnant or a nurse, I have missed something really obvious... My bf also suggested that because I'm a girl, maybe I was supposed to fuss over the woman more (the nurses didn't though, that's the thing; I was kind of looking to them to know how to act).

I've a question for anyone who's ever gone through labour or been with someone who has; what helped? (apart from an epidural and other medical pain relief). Did having your back rubbed or shoulder patted help? Would you have felt it appropriate for a student to do this? Did conversation help?

Also, what sort of stuff should I talk about. I already ask things like baby's gender/names/siblings/cousins/parents' jobs... any suggestions of other topics would be greatly appreciated.

I was going to write this in the Haven, but I'm over the sobbing and now genuinely puzzled. I realise that as the people on this forum are mainly AS, responses might vary from those that NTs would have. That said, any advice on what to talk about or how to act would be very welcome.

When I was i labour I certainly didn't want any questions. I didn't even had a nurse in my room all the time (I would dislike that too). They would come from time to time to check me out. But I am a quite different than most women so I would ask if she needed anything or if something would help. You can also encourage her, like "you are doing great" from time to time. What helped me was that I knew the timeline (2-3 hours after 5 cm so I could anticipate the end).

For me, what helped me was to be left alone so I can concentrate on the pain. It pissed me off tremendously when they started to count during the delivery (1-10 push-push..). It ruined my concentration and it was stupid because I feel the contractions better than them so I would know the right moment. I am just saying that their protocols do not work for all women and that you were right to listen your own intuition.

Chatting is definitely not going to be welcome past the very early stages of labor. When I was in labor, there was often no staff in the room with me. When there was, they would generally do stuff like offer ice chips, remind me how to breathe properly, or tell me what the fetal monitor said about a contraction (it was subsiding, it was about to start ...). Basically, they were helping to coach me, probably modeling for my husband. They did NOT touch me, and I would not have wanted them to. I think that before touching a woman in labor, it is essential ALWAYS to ask first!! !

Thanks for your responses Jat and Anotherone. I usually do try to tell the mum how things are going; unfortunately in this lady's case, she was stuck at 5-6cm for hours and nothing much was happening (was even talk of a c-section but they hadn't told her this yet, so I couldn't mention it). I did tell her that she was doing well, but perhaps I should have said it more often (I was talking to my mum earlier today and she said that it's ok to sound repetitive in this situation).

Yeah, counting down till contraction sounds stupid; they don't do that in the hospital where I work- we just tell the patient to push when she feels she has to.

I'm finished for the next while anyway (too shattered to go in tonight; I'd just be in the way), but thanks for giving me some perspective for next time!

Well I gave birth at home as I was quite afraid of being a 'patient' when there was nothing wrong with me.

But I know I was in no fit state to chat, I'd have hated it. I was in my own world. I think I've heard it called Labor-Land. So many hormones your brain stops paying attention to what's going on outside. Now I wasn't in agony... I had apparently a comparitively regular labor. But my mind wasn't in a state to be chatting.

Now I would suggest that maybe you could ask on a forum without Aspies? It does occur that I get nervous around strangers, and I hate making small talk with ANY stranger. So Labor would certainly emphasize that.

I'm the NT mother of a auntie and just pop in to the womens forum to see if I can be any help to younger women now and then. I had my first son so very fast and it was a bad birth that there was no down time so this trying to interact with nurses ect never came up. With my younger son it took abit longer and was a normal birth. We talked about family like my aunt and her 9 kids and the nurse told me about her sisters new baby. They also used actupresure to help ease the pain alittle but they did ask first if I'd like to try it. The talking helped take my mind off the pain alittle and the smiling faces made it alot less stress full them my frist birth with all the worried faces and the agurment over what should be done. It's good thats done out side of the room where you work. All women are diffrent some won't want to talk some like me need to keep talking out of fear and pain it depends on the person just let the mom lead the way and try when you are able to stay upbeat, Never do what the doctor did when my sister had her son and tell the mother to buck up that it's not that painful and don't be such a baby, male doctor I'd like to find him and give him a good kick.

Oh jeez. I've had two kids -- both at home so no nurse was involved at all -- but I certainly would not have liked small talk. And I don't just think it's because I don't care for small talk at the best of times.

In fact, what I remember is thinking, "If neither the midwives nor the doula are concerned, there obviously is nothing out of the ordinary going on." It was reassuring. Chances are I'd be wondering why I was being distracted -- was something wrong?

There are such things as "knitting doulas" who sit around and just knit. They look up periodically at the labouring mama and if everything is going well, she goes back to knitting. Birthing is a very (imo) private, intense thing. I agree with your thinking. I wouldn't say much except to encourage the mom when she's feeling like she can't do it any longer.

Something like this:
Labouring mama: "I can't do it."
Nurse: "You ARE doing it."

I've never given birth myself, but when my mom gave birth to me she did not say one word the entire labor process. She even cut off my dad when he tried to encourage her. Every women is different, but from what I hear most prefer to be left alone to do her own thing. But if a woman wants to talk, she'll more than likely start talking with you and you'll know she'd want a conversation. If you ask me you should ignore the nurse because if I was in the mom to be's situation I know that I would not want a nurse or anybody else asking me questions.

You should follow your heart and like the poster above me said, let the mom to be lead the way.

Please read anything and everything by Ina Mae Gaskin, a fabulous and famous midwife! I've had 4 babies, but only two labours. Four c-sections. I hate small talk in a time as sacred as labour, yet that is a personality thing. I think the main thing is to reassure the Mother that you are there to do anything for her and establish that she can ask you for anything and you are willing and desiring to help by rubbing, talking, waiting quietly. The most important thing is not to put Momma on a timer. Those babies have to come in their own time and keeping the Momma feeling safe is the best way to get baby out the fastest. Lots of verbal encouragement is great, just make sure you have let the Mom know in no uncertian terms that anything you do that is annoying can be cut off in a minute, then don't take it personal when they ask you to do so! Don't be afraid of brith, trust birth and trust that the womans body will do what it needs to and exude that confidence in her body back to her when she is feeling tired, weak, and worn out. This is the most amazing gift anyone can give, just give yourself to the experience and let the Mother determine what role you play. Keep learning! It is such a worthy profession, with your desire to do the right thing I know you'll do great!

Ina! Yes! I also love love love the book Birthing From Within. Yes to trusting birth! The mama should run the show, not the nurse. Not even the head nurse who may have attended 100 births or whatever. Each woman will be different.

My daughter was delivered in a hospital, but without medication. I had a doula (labor support person) and the best thing she did was help my husband help me. So, instead of her talking to me or touching me, she gave ideas to my husband and it was up to him to do them. Cool washcloths for my head, for example. Or having my husband take my hand and get next to me and breath gently on my cheek (while not in labor, I probably would smack him for that, but in labor, it was nice) to guide my breathing. Deep massage on my lower back when I had back labor (again, my husband did this for me, with the doula's guidance). Asking if I'd like to walk, stand, change positions or try the birthing ball or tub.

General small talk things to say are that she's doing a great job, encourage her to think about holding her new baby soon, etc. Anything telling her she is working hard and you recognize that.

You definately don't want to be too pushy, but at the same time, having someone sit in my room and say nothing would probably irritate the hell out of me!

I don't envy your assignment, as it's a tough thing to do (assist labor) when you don't know the woman, her preferences or her personality.

Best of luck to you!

I love that book too! I read it before last baby was born and I was SO ready for baby after it!

Hi everybody,

It's been a while since I looked at this thread, but thanks so much for all your responses!

I have an exam coming up soon and one of the questions is on communication and demonstrating empathy, so I will try to keep your advice in mind (won't necessarily be a labour situation, but I think the advice here could be used for other events too).

Thanks again!

Lene

Fwiw, Gaskin and the homebirth movement are controversial at best. Keep in mind that the OP is from a med student, who probably isn't going to be helping out at home births with no medical intervention whatsoever.

I'm a little puzzled by the scenario presented, to be honest. Why did you have to hang out in the room for so long? Usually laboring patients at the hospital I work at aren't hovered over so constantly, even by nursing staff. If it were me, the last thing I would want is a stranger hanging out in my room the entire time, much less yakking at me all night long.

LKL, I'm not entirely sure why we were supposed to hang around the entire time either. The nurses certainly didn't. We were told at the start of the rotation to look 'ultra enthusiastic' though, so disappearing off to read a book wasn't really an option.

I agree, I think if I ever gave birth myself, I would suggest to the student that they vanish until the baby was just about to come.

Please don't stay away entirely, though. During my most recent labor, the nurse was barely in my room at all and my labor progressed very fast. I desperately wanted pain meds but by the time we found the nurse, I was already at about 8cm. The anaesthesiologist showed up 20 minutes after my daughter was born. Had he come in the room, I might have hurt him.

Sidenote for homebirths: Neither one of my children would be alive today if we had done a homebirth. Complications can and do come up. It is obviously a very personal decision that families should be free to make, but there are real and frightening consequences to consider.