LABOR! DELIVER! HONORING NATURE, RESPECTING INTERVENTION...Finding the Balance and Restoring the Trust

Background:  The birth of a child is deeply emotional, intensely intimate, and profoundly life changing. It's an event etched within a mother's memory for the rest of her life. We, as health care providers, have an obligation to help make that permanent etching the very best it can be; one that conjures up positive and comforting emotions, not painful and negative ones. Our childbearing families of today seem to come with all sorts of expectations.  Some moms present to the hospital in active labor because their home birth plans went awry, some present with unreasonable demands for instant delivery, and some have no clue what their options are, being quite content to have the "doctor" handle every detail. Still others come to the hospital with reasonable requests that just seem to get trampled on in the "technology" of it all.  This case presentation will outline progressive ways to handle various labor and delivery scenarios, bringing together all parties on common ground and realizing optimal outcomes. It's important that we, as nurses, help our laboring moms find their unique balance in weighing technological birth versus natural birth.  The cesarean section rate is at an all time high, epidurals for labor anesthesia seem to be the accepted norm, and the induction/augmentation rate is constantly climbing. What can we, or SHOULD we, be doing as engaged L&D nurses to maintain some sense of normalcy and balance amidst the ever-growing mindset that technological intervention is best for all? 

Case:  This case study will explore a "high risk" couple's journey through the emotional and physical demands of labor induction, predictions of operative delivery, and the "fine" art of nursing labor support. Methods of pain relief, high risk elements, positioning, mother-directed second stage, delayed cord clamping, immediate skin to skin, resuscitation at the bedside and baby-led latch will all be discussed as an integral part of this case study. Ongoing "informed consent", essential communication with physicians, and balancing medical intervention with patient requests are examined every step of the way. 

Conclusion: It will be demonstrated how one couple's plan for a home birth to avoid medical intervention will be molded and formed anew to produce a healthy macrosomic baby vaginally in a high risk tertiary care setting. Parent's specific expectations, physician's high risk plan of care, and expert nursing support all converge together to produce optimal outcomes for all involved. 

Keywords: Birth Plans, Technology, Intervention, Education, Normalcy, Balance