#21 Labor Support for Vaginal Birth

Justine:

Today, we’re going to talk about a practice guideline that AWHONN released all about labor support for intended vaginal birth, which is right up our alley.

I am so excited about this episode, I can explode.

Right.

And reading this, I was like, ooh, ooh, ooh, ooh. So, yeah.

So good.

We’re pretty bummed about it. This document validated a lot of things that we believe here at Bundle Birth and Bundle Birth nurses. And so I think that if you’re listening to this, you’re going to feel really excited or hopeful about the things you already do or the things that your unit can implement because of this document and all of the research. So, what is it? It’s a guideline and it promotes all the evidence based clinical practice recommendations to support individualized labor based on all the best evidence. They’ve gathered all the evidence. That’s one amazing thing AWHONN does, is they do all that grunt work and hard work. There’s team of scientists to find that evidence for us so that we can give better care. So, the goal of this document is to provoke safe vaginal birth with limited medical interventions.

We know that medical interventions save lives, and it’s just we’re trying to avoid the unnecessary ones. Labor support strategy should be provided from admission through birth and should be used to compliment the labor process for people who choose to use pharmacological agents for pain management. With this guideline, they want to accomplish a few things. They want to empower people in labor to be able to achieve what they want in this whole labor and birth process using shared decision making, they want to provide labor support strategies to incorporate into the birth plan, they want to minimize technological interventions during labor, and they want to ultimately decrease cesarean. We do know that nurses play a key role in preventing unnecessary cesarean births. There’s studies on that that we can, as nurses, actually cause C-sections. And maybe that’s another episode we need to do. We should add it to the list. We know that promoting comfort and supporting people to achieve the birthday desire will ensure the safety of the maternal field diad, which means the couplet is, and that’s a primary goal of perineal nurses during the care that we give.

And so we also know that the birthing person satisfaction with labor is tied not only to how well their pain was controlled, but how included they felt in communication with their team and how much they had to say and how much they understood. And so all of the little things that we do and say here at Bundle Birth nurses, like sitting at the bedside, calling them by their name, getting them involved in the plan all leads to supporting vaginal births. So, we’re excited to talk about this. One part that they added that I think is super important that we bring up is the topic of disparities. And I’m going to quote what they said because they summarized it really well. So, black, indigenous and people of color are disproportionately affected by severe maternal mortality and morbidity that cannot be accounted for by social demographic risk factors alone.

Bias, as well as structural and systemic racism, affects the care people of color receive in pregnancy during labor and birth and postpartum, which may negatively affect the birth experience, as well as the maternal and neonatal outcomes. The equitable provision of continuous labor support, access to doulas in midwifery services, use of shared decision making and thoughtful listening to the voices and needs of people of color will help to ensure the provision of respectful, culturally appropriate and equitable care and minimize disparities in outcomes. All the things we teach at Bundle Birth nurses will help minimize these disparities and outcomes for people of color. So, we’re going to get into it. We’re going to keep talking about all the different parts of this practice guideline. Sarah’s going to input here. She was like, “I’m going to…” Justine is summarizing and Sarah’s going to be giving some input. It’s going to be a good time.

So, they start off with a bunch of statements. One of the first one they talk about is this document. The first thing you need to do is create an environment of support. And I put, hello, Bundle Birth nurses, because that’s what we’re all about. And so one of the first ones was, you want to be trauma informed. And they go over the four R’s of being trauma informed, which is realized, recognize, respond, and resist retraumatization. They elaborated this on the document. Again, it’s from AWHONN. Members get it for free. You want to respect and support all people in labor. You want to advocate for pregnant people’s choices. We want to integrate birth plans if they have one. And I will say, if they don’t have a paper one, we recommend just like, what did they think about when they thought of giving birth?

Ask them. Just ask them.

Yeah. We just need to know what their wishes are. You can’t advocate for someone if you don’t know what they want. And you might say, they might literally be like, I just want my baby to be alive. Okay, well, it’s a baseline, right? Let me be safe.

What else though? “What if you dreamed a little?” Is what I would ask.

I like that. And then they want to… And I think this is really important, especially if you’re working at a hospital that admits everybody that comes in. They want to encourage patients to be at home in latent labor. And I think that that’s easy to say, like, “Oh, they’re two or three. Bye. You’re gone.” But it’s how are we sending them home? And I actually thought, Sarah, do you have a YouTube video on-

Oh yeah.

… sending home, you get sent home from triage, what to do?

How to labor at home. I have like-

SO, we should have-

… 20 tips for laboring at home.

We will link that on this episode, and that would be a great… Even just giving that to your patients.

Oh yeah.

Okay, you’re laboring. You’re going to go home, but these are some tips. And so I like… If you have the early labor warmup, I think that’s really great to start and show them what to do-

Definitely.

… and they can go home and do that. That’s on our badge buddy. And so that’s a really great tool. And that sums up creating an environment of support. So, you have respect, you have trauma informed, know what they want and advocate for and encourage them to labor at home until they’re in active labor. So, what do you think about that first one, Sarah?

Well, I’m listening to all this and I’m looking at… I actually have the… What’s it called? The table of contents from the guideline up. And I’m like, this is why I love AWHONN so much and why I want everyone to make this connection, is that we are so complimentary of each other and why we keep bringing these guidelines up that as nurses, we are called to a higher standard of learning, of research, of understanding what is evidence based and practicing in a way that is evidence based, not trendy, not what everybody else does, but knowing the evidence and advocating for the evidence. And we have AWHONN here that is like, “Here you go. Let me make it so easy for you.” And I think about literally every program that we offer, mentorship modules, every product that we offer that… I actually got a DM yesterday that was like, “Do you guys have any clinical data that shows that your particular class equals blah blah blah?”

And I was like, “No, but the whole class has clinical data on everything that we teach. That is how it helps with vaginal births, et cetera.” I’m not just pulling this out of nowhere. We’re going to these main sources. For us, as perinatal nurses, that is AWHONN. You need to be a member. You need to be reading these guidelines and it makes it so easy for you. And mind you, I will say that we compliment each other so well because everything is through the lens of everything said here. This just validates everything that we do, thankfully. And that’s what we want and how we want to practice as nurses. To me, that’s an example of what it means to be an exemplary nurse, is one that knows that these guidelines exist and follows them and pursues bringing that information to your unit and making changes in your practice that support the evidence.

So, I’m excited. And this is probably my favorite document that they offer of the thousands because this is truly… I could put this into this is our business model. This is what we do here for you, this is what we do for families, and this is really what equals everything that we want as a culture change in birth, is decreasing disparities or eliminating that gap and caring for people in a way that they come out not traumatized, and providing autonomy over their body, helping them feel connected and not alone, attending to the psyche side of things, helping pursue vaginal births. That’s literally our mission here. And that’s also AWHONN’s mission. So, we’re very much aligned in that way. And the moment we have research behind it… By the way, this will be a huge component of a document that I use and have been using for Cancun in helping us follow the evidence. I don’t need a study to teach you a class because I’m teaching you what the data already says. Does that make sense?

No, it totally makes sense.

So, I love this. And I think that that’s the value that I see of a lot of these things and why we keep bringing them up, is like you need to know they exist and you need to start learning that this is your ammo for practice on the unit, of like this is how you can say this is important, because it leads to better outcomes and I’m following the evidence.

Yes, I love that. And actually into part two, this is how you say you got that DM about, do you have this and this so I can… Basically, nurses want to get it funded by their unit. I need to prove to my management that this makes sense and they should pay for my class. Well, in part two of this document, they talk about continuous labor support. And we know this is why doulas are so important. If you are not team doula, we believe you should be team doula. But we do know that in our world right now in our units are not as staffed in a way that we can provide that continuous labor support, but that doesn’t mean we can just throw in a towel. And so they recommend that we should still be growing our practice in this. They say take coping classes.

And guess what? Bundle Birth nurses has a coping class. And so you could literally show this document and be like, well, AWHONN says to continue my learning and learn how to help patients cope. And Bundle Birth nurses has this coping class that provides CEs, so put it together. Those are ways that we can get creative about getting funding to take our classes, because it is true, your hospital should be giving you education money. And new nurses that are listening to this, or nursing students or nurses that plan to go to another unit, when you are interviewing that hospital, because yes, you interview them, ask them, what do you provide in terms of outside education and how many hours do you pay for? And can I go to conferences, et cetera?

Because that’s a really important side note. So, they talk about that, and I think that there are so many little things we can do. You don’t have to stand there for three hours doing counter pressure or double hip squeeze to fulfill this need of continuous labor support. There’s little things you can do. Everything we do matters, right? Micro actions create macro impact. And then in our trauma class, we have with Krista. I love her point on the attempt counts, and so the attempt at helping our patients cope and the attempt of giving our patients this labor support counts. And so, anything you can do to help your patient feel like they’re being continuously supported.

Yeah, and I think that you hear about continuous labor support from labor and delivery nurses. I know there was that study, I think it an Avon study a while ago that looked at the outcomes of C-section rates. And they were like… I remember I was on the floor when this came out, and they were like we’re going to track nurses C-section rates. And I’m like, if I inherited that patient who’s had the papers pulled and was already getting ready for What? And so that was sort of the movement back in the day. So, I think is a little of, it feels like our responsibility, but this is a team effort. When they say labor support for intended vaginal birth, they’re talking about your birth setting mattering, doulas, mattering the pursuit of physiologic birth, the understanding the techniques regarding physiologic birth. By the way, we have a class for that.

The fact that there are outside factors that contribute to their support or their ability for support, some of them being disparities and that we lack research in a lot of these areas that this is a… It’s not just the nurse, right? But yet, as the nurse, I sort of see us as these little… Think about you’re the charge nurse of your room that you see the big picture and all the players. And your job is to utilize your resources to the best of their ability. I’ll use the same example of being in a business, right? I’ve had this conversation with Brie many times where I’m like, “I’m not going to ask Justine to do that because it’s my job to know what the skillsets of my team are, and then amplify and pull that out and say, “That’s a job for Diana. That’s a job for Justine. I’m going to take that on because I have that skill skillset,” and it makes sense that I do that for all of us, right?

And so in the same way in the labor room, it’s like, this is a great option for the partner. Let’s pull them in here. Ooh, doula, you’re looking like deer in the headlights. Let me grab you. And I have this technique. How does this feel? Patient, what’s your intuition? What do you need in this moment? Right?And it’s the same idea of what in this room is stressing you out, or is there anything in this room that you feel like is causing you any sort of anxiety? I’d love to help decrease that anxiety for you, and it’s the button on the wall or I see the baby warmer and I don’t know this answer. All of that contributes to down regulating their nervous system and helping them feel supported. You look them in the eye, you call them by name, that means something. And I know we talk so much about staffing. We have the staffing standards thing and like everyone’s talking about the we don’t have staff. We don’t have staff.

And very quickly… Here, I’m coming in hard again. Here’s my drop, right? You don’t have staff but you’re there, and that patient in front of you matters. And so when you walk in that door, look them in the eye, call them by name, give them what you have in that moment and write. If you have seven patients, then fine. Of course you have, you’re going to have to flex and flow and manage and do the best you can on those days, but that is not every single day. And if it is-

Quit. I had seven patients the other night though-

No, I know. That’s why I said.

… which is why she probably. And I will say that I had a patient that came in that wanted to be a home birth, but she moved from Arizona so she ended up coming to her hospital cause she started to bleed. And after the birth she was like, I am so thankful. I was so scared to deliver in a hospital, and this experience was amazing. And I still did that with seven patients. And I wasn’t doing much, just being a nice human, listening to what she wanted.

Yep.

So, all of that is great Sarah. And yes you did, you did. You got on your soapbox drop.

It was a tiny one.

Mic dropping, right? It’s a little baby one. Okay, so part three and four, they go into the non-pharmacological pain management. And this is cool. When I was looking at it, there’s things like hydrotherapy, which they split up between shower and water immersion. They talk about safety of both of those. The idea behind both of those. They talk about upright positioning, [ 00:15:29], birth balls, peanut balls, they go into hot and cold therapy, and they even talk about aromatherapy, which I’m excited about and want to delve more into because I want to get that on my unit. Music, massage, reflexology, they give the research behind these things and why they work, which is so great. And so they’re not telling you what to do, but they’re telling you why you need to do these things or why what the evidence says about them. And so they give at the very end, they give a chart of how well this works via evidence and how well it doesn’t.

And so there’s even a point though that I wanted to mention, I think for years I thought everyone needs music and labor, everyone up to pushing. And Sarah, you’re the one who taught me that that’s not necessarily true in transition. They need quiet and they need… Do you want to explain.

Literally at any point. Yeah, I mean, I think what I’ve learned is, very often, I want… Selfishly, I’m like, I want to listen to music. Can we get some jams on? Do you want a listen to something, because the quiet is like, “Oh, what the do, to do?” the whole time. But for them, very, very, very often, I’ve been shocked at how people actually don’t want music or don’t want sound, or the vibe changes very quickly where they’re like, “Oh no, that’s bad. No, no, no it’s not right.” But that’s also sort of a nervous system thing of what’s being triggered in you, certain tones or even vibrations. Music sound is vibration, and so sometimes that hits different in your body. I know if I listen to certain things, I’m like… We know this, right? I’m like, I want to be calm. And it’s like (singing).

But there’s calm music, and then there’s like, I need to pump myself up. Prior to a physiologic birth class. It’s like Ariana Grande all day. And so there’s different vibes based on the mood, but more often than not, I’m finding that people, they having the option. And that’s the sort of piece of continuous labor support that I see that is this autonomy over your decisions that you feel more supported when you feel like you have a choice, that it feels supportive to be asked. How do you feel about that? What’s going on in your head? Would you like some music? Oh my gosh, they’re thinking about me. It’s that connection piece that so often, I think… Even with something like this, we can look at like, “Okay, I’m going to throw on some heat,” that feels good, or “I’m going to rub their heels because there’s supposedly a…

I love your accent.

I don’t know what just happened.

I like it.

I’m going to rub their heels. I’m trying to be a robot, so maybe I’ll go into robot voice, but I’m going to hip squeeze, or let’s change a position. It becomes very robotic for us when there is an art and a humanity that is being brought in and I think is the essence what of what I know AWHONN wants for us, that if we’re going to summarize what labor support looks like, just think about the word. And the word means that connection, that there’s a visceral… I see you and I see who you are, and I am sorry that it hurts. And I also believe you, that you can do this, regardless of epidural or not. And I think it’s easy to think labor support because for those that aren’t coping and it becomes this coping measure, when it’s not. This is a huge life transition for them.

And there’s things that I’m sure they’re scared about, and there’s things going on in their minds that worries about their vagina or a story that they’ve heard or a C-section, blah blah blah blah blah. Whatever it may be, we’re not writing their story, but we need to be there to connect and say, “What do you need?” And we have options. And that’s what I love here, of summarizing the evidence of get them upright, let them move around. That freedom of movement is literally the title of that section of like that means freedom in their choices, that if they want to move their body, that they can move their body, and AWHONN is saying that. And we know that on our units, it’s not always the case that the evidence aligns with our practice. And so when you are getting your patient up to move, and yes, you’re monitoring your baby or you’re doing and following hospital protocol, et cetera, that you’re saying I have ammo to help them move and get them changing positions and grabbing…

“Let’s get you on the ball,” or “How would it feel for you if we brought in this? How do your hips feel here?” Wow, they really care about me, because you’re paying attention. It’s not a robotic, “I tried this, this, this, this.” And that’s how it feels a lot of times and you’re new. But I think if we can all sort of begin to think big picture, this is what I talk about in physiologic birth class, is like this overarching bird’s eye view as an outsider looking in and going, how can I protect this space? How can I provide support in this space based on what they need? That might be a hip squeeze. That might be a massage. And if you need a massage guide, by the way, we have English and Spanish versions in our store now as of today, or that might be offering music or aromatherapy, or I don’t know what it is.

It might be looking at them and going, “I see tension between your eyebrows. Can you try and just soften your face?” Right? Or, even saying, “Can I touch your forehead,” or “Can I touch your shoulders?” And that human touch connection, just a simple hand makes all the difference. Think about yourself. When you’re feeling alone and you have somebody that you trust and you know cares for you and lays a hand versus you have somebody that it’s a stranger lays a hand, those are totally different scenarios. Do not touch me if I don’t know you. Who are you? Versus, oh, and you feel it in your body. Think about that sensation in your own body, of like, oh, okay, I’m safe here. That’s what labor support looks like. That’s the ultimate, right? I’m safe here, I’m confident, and we have tools to help with that, thanks to this guideline, and also thanks to who you are as a nurse when you place that intention in the right place of, I’m going to care for them regardless their background and I’m going to protect them regardless how different they are from me.

Her face right now. That was great. And I will say I wanted to share how important the first interaction we have with patients is because of what they do bring to the hospital and the stories they have heard. And we talk a lot when we’re pregnant and we talk about our experience a lot when we’re pregnant. And nurses in hospitals don’t have the best reputation sometimes, and so your first interaction that’s loving and supportive and I see you can really set a foundation for the entire experience.

Completely. Completely.

That’s really important. Okay, so then it goes on to normal medical interventions of labor. And this is going to kind of impact a little bit of fetal monitoring. And so it talks about how, yes, medical interventions are life saving, but unnecessary ones can lead to a cascade of more interventions. For example, fetal monitoring. So, there is tons of research that suggests that intermittent oscultation, which is with a doppler it’s not just intermittent monitoring with the external fetal fetal monitor, it’s the intermittent oscultation, is the best way to monitor our low risk patients. But they even shared that only 1.6% of people in the US are being monitored with IA, which is so low.

That is bonkers.

Yeah, this is a skill that I think is dying in our country. And my hospital, we don’t train for this, and it’s a shame. I’ve never done intermittent oscultation on a patient. I’ve done intermittent monitoring. But now I know that that’s not evidence based. I’ve never done intermittent oscultation, we need a push to do more IA. And if you’re in mentorship, they’re in our fetal monitoring class. We do talk about IA.

So much.

And one of our mentors, Brie, is like this is her love language, is intermittent oscultation, so we have that resource too on calls.

We actually give you a sample policy and process in mentorship, and we actually provide it in physiologic birth because we know that in the promotion of physiologic birth and decreasing C-sections, one of the very simple interventions is the pursuit of Ia. It does have better outcomes, it does. Vaginal births, less medical interventions, better patient satisfaction. But the way that we have medicalized, the system has decided that it’s not as comfortable for us.

And I will say that staffing, again, is going to impede. You want to be one to one with the IA because you have to do it so much, but that doesn’t mean you won’t be one to one day.

I have to say something here. This is such a good point. Here we go. Here we go. I don’t actually think that staffing is an excuse for IA. I know that… Okay, so here’s where the workflow changes, because you do have to actually be in the room every 30 minutes in the active phase. Depending on your policy, likely early labor you’re every hour. And then once you become active, it’s every 30 minutes. And then once you’re pushing, it’s like every five to 15. So, depending on your policy, et cetera. So, with that though, you are in the room osculating for one contraction. Say this is five minutes, right? A contraction’s about 60 to 90 seconds. Let’s say it’s 90. You’re waiting for the contraction. Takes a minute. You find the heart rate that you’re doing while you’re waiting for the contraction. You listen through the contraction, a little bit after, depending on your policy, usually a minute after. It’s a five minute process, right?

And then you wipe off your machine, you set it down, and you have nothing to watch while you’re outside of the room. There is something… I’ve done a lot of IA in my practice, and there is something actually extremely freeing about IA because you’re not looking at the monitor, and like, “Oh, I’m in a room or I’m peeing and I got to go to the bathroom, but can somebody watch my tracing?” And you’re so on edge. It’s like I don’t have to worry about it. And then all you have to do is set your clock to go back in there and listen again.

And we would say you should be in there every half hour doing physician changes anyway.

Exactly. And you need to lay eyes. If they’re in active labor and their IA, which means they don’t have an epidural and they’re coping on their own, you need to be watching for progress, you need to be palpating contractions. How are you supposed to chart on that on the strength of your contractions with external monitors if you’re not palpating contractions every 30 minutes. So, it’s actually not that much harder. And I think that that’s an excuse that people make. Here I am coming down hard again. I love you all so much and I believe in you so much, which is why I say these things, but it’s five minutes of your time you’re laying eyes. And then guess what? I’m crossing my hands, wiping my hands off, like, “Okay, bye. You good? Cool. See ya.” Go into my other patient. And now you have 20 minutes with your other patient before you have to come back.

And therefore, then you’re seeing your patients more regularly than letting them sit on the monitor for an hour while you chart your strip reviews for the last two hours while they’re hanging out doing their own thing. That’s not as good of nursing care as IA forces you to have. So, I was never one to one with my IA patients unless they were a multi progressing quickly and I literally couldn’t leave the room because I was like, I got to get my table ready and I’m running around and this baby’s coming. That’s different. But otherwise, I don’t actually think… I think it’s uncomfortable when it’s new, and I think it’s a different skill that causes some anxiety as you’re getting going. But once you get comfortable with it, I actually think IA is easier than continuous fetal monitoring, or there’s something like less anxious about it.

Well, and think about how uncomfortable we were with fetal monitoring in general when we first started, right? Every single dip, you’re like, “Is that a variable? So now, a lot of us are like, “Oh, it’s nothing,” so we’ll become more confident in that skill. That’s helpful, even for me. And I’m thinking too of the people listening, we have no one that’s low risk. I’m sure you have a couple and you can make the standard for them. And so let’s talk about that,

I have a challenge like in this realm because this is a practice change that I think culturally would be very helpful for our country in trying to pursue better outcomes, right? And so what I want people to do, whether you do IA or not, I want you to start triaging your patients. And on admission, when you receive your patient, whether they’re new from the street or new to you as a patient, they’ve been there, I want you to think about, are they a candidate for IA or not? And if you don’t know the answer to that, AWHONN has guidelines. We have stuff in mentorship and physiologic birth, et cetera. There’s stuff online. Go to AWHONN. There’s lots of this stuff out there, or Cochran are all up to date, et cetera. And ask, are they a candidate? And just start there in terms of a cultural shift of, once they’re a candidate, you will find like, oh. And even if they’re a candidate for four hours, first of all, you’re freed up for four hours to run around between other things and not watch a tracing, which is lovely.

And second of all, it increases their satisfaction, it helps with their labor hormones, it’s going to help them have that control, freedom of movement. And from a physiologic birth perspective, they’re able to move around, they’re able to go wherever they want. They’re not tied down. And that, I hear constantly with families, constantly, of like, “I don’t want to be tied down,” or “I was tied down.” I’m like, “You weren’t tied down.” But that way they describe it means something. And we can say, “You weren’t tied down.” But really, how they felt was tied down. Who wants to feel tied down when you’re in labor trying to intuitively feel your body and have this experience? No, it frees them up for those four hours to have four hours of beautiful intuitive tapping into the physiology of birth, helping the baby engage in the pelvis, helping the structure soften and open. Those four hours matter to me, and I’m sure to so many others.

Okay, we’ve been challenged people.

Oh, sorry,

I’m going to do it.

I’m sorry.

And then in this part too, with interventions, they also actually bring up hydration and nutrition. And so if you are a hospital that doesn’t feed your patients, fasting became the standard after 1946 because they found that pulmonary aspiration during general anesthesia was an avoidable risk. And the way to avoid it was to not let our patients eat. Well, that being said, we don’t use general anesthesia nearly as much as they used to in the forties, right? It’s more rare, way more rare, hopefully, on your unit. And so they’re actually saying that there’s insufficient evidence to draw conclusions about the relationship between fasting from letting our patients have clear fluids. And so the World Health Organization states and suggests, and a lot of governing bodies will say that our patients should have clear fluids.

So, if you are on a unit that you’re like, I need them to not be NPO as soon as they walk into the door like they currently are, again, this tool can help you bring this evidence to your management. I know that my unit’s finally starting to be more open to clear fluids. What about Sarah? But you’ve always worked… Well, your second hospital was clear? Was your first one clear too?

Ice chips only?

Yeah.

I remember being so uncomfortable when I was like, okay, I’m going to give them juice.

Som one thing-

It’s not that big of a deal and they’re so grateful for it.

I will say that it’s becoming more apparent to my leadership because they keep talking. Anytime we have ground rounds, oh, we’re postponing that C-section for four hours, we’ll call the anesthesia and be like, “Can we give them clear fluids? Can we feed them? When the last time they ate?” And it correlates to those HCAP scores? That’s going to be a comment, that patients say, when they get called, “I was starving.”

Yeah.

My C-section was postponed six hours and they didn’t let me eat. So, that’s another way to tie it. If you want to increase patient satisfaction, which these studies have shown and give our patients some energy to push these babies.

Meet their basic… Yes, meet their basic human needs. This is Maslow’s hierarchy of needs, the baseline foundation for them to feel safe and secure to be able to transcend to full blown self-actualization, which I believe can happen through labor and birth. They have to have their basic needs met. And part of that is food. Hello? Who wants to be hungry.

So, if you’re listening to this and your unit… Right. If you’re listening to this in new unit doesn’t eat, and you’re like, I have to do this, I have to feed my patience, I then want to plug our leading change class. And if you’re in mentorship, leading change is in our last module. But if you’re not in mentorship, it is available for on demand to just start the foundation of leading this change, any of these changes, IA, feeding. Sarah as raising her hand.

Well, I think with all the changes, I do have to say that for the sake of protecting you and your job, that you need to know your… Well, you need to know your policies and procedures and don’t just start feeding your patient food or clear liquid-

Oh, for sure.

… when you have a policy elsewhere.

You need an order.

You need an order. You do need to follow protocol. And yet, you also need to be aware that it’s not evidence based to give BNPO or even ice chips only. That’s not the evidence. So, then challenge that in a loving way. And we teach you how to do that in leading change.

And then part six, it actually talks about pharmacological interventions. It’s like one little paragraph, which I thought was interesting. But what I liked about it was that it states that even if our patients do get IV medications or an epidural, which is the most popular, we sometimes still need to help them cope, which we talk about too in coping and laboring. And even helping our patients cope with an epidural, sometimes it doesn’t work or it doesn’t work as well as they imagined, or the pressure is a lot, right? And we’re in there still feeling a little helpless. And so we need to be able to know how to give them support. Again, coping and labor.

And coping isn’t always physiologic pain. Coping is also our mental pain. There is a large difference between, my body may feel great, but my brain is not okay. And they even say pain relief alone did not equate to comfort. And so charting that transition of, how’s their pain? It even says new nurses routinely assess for pain but may not always assess for comfort. What does comfort mean to you? Think about that as a nurse, and then ask them. What would feeling comfortable mean to you right now? Do you feel comfort in your brain and your body? And that may even just help them say, well, “My body feels great, my epidural is working like a dream, but I am freaking out about,” fill in the blank. And then you can provide comfort, which is truly support to help them to feel more safe and calm and have a more positive experience, which ultimately helps the physiology of labor.

That’s really nice. I like that. I think too, you might find things like your patient that thought she was going to die-

Oh yeah.

… the whole time. And you had no idea until you figured, asked her what was going on in her head. So, we just have to ask these questions.

And that means being connected, and that also means building rapport, which is all core concepts of what we teach here at Bundle Birth, whether that be online, but particularly through mentorship, et cetera, is like you don’t have… You’re not entitled to those answers until you work for them and you build that rapport. And if they choose to set the boundary that, “I don’t feel comfortable talking to you about that,” our answer needs to be, “No problem. Tell me what you need from me. I’m here to help you and your baby be safe, both physically and also emotionally. So, if there’s anything I can do to help you feel more safe and comfortable, I’m here for it. Just let me know.”

So, yeah, so that is a summary of the labor support for intended vaginal birth. And so we will link that on how to get it. Again, if you’re an A one member, it’s free. If you’re not, it’s like $50, so just become an AWHONN member. We have a promo code too, which is in the link as well.

Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps with both if you subscribe, rate, leave a raving review and share this episode of the front. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram.

Now it’s your turn to go and give supportive care to your patients. Think about what that means to you. Read this document so that you have the evidence behind you as you practice as an evidence-based exemplary nurse. Look your patients in the eye and give them that loving connection that they so deserve. We’ll see you next time.