thinking about taking a hospital job

[lorijds]

I'm thinking about getting back on the horse, so to speak. I worked as a nurse in a birth center for a long while, then went back to school to finish my RN (I'm an LPN). I've been working on the medical floor of my local hospital and I have loved it up until the last month or so.

We had a dramatic change in policy that has basically changed my job description, and I am no longer happy as an LPN on my floor. I don't have that much longer to go (four months), and could certainly suck it up if I have to until graduation, when my status changes to RN.

But I recently did a pediatric and nursery rotation in our hospital, and I found myself yearning to be back with the mamas and the babies. I have thought about going back to the birth center, and I still do a little prn work there. But a) it would be a very large pay cut, one that I'm not sure we can afford; b) the hours are longer and more random; c) it is in another city and I have to commute 45 minutes each way to get there.

I am also looking towards my future, and I think that if I ever continue on in school, it will probably be as a nurse practitioner with an emphasis in women's health, or as a CNM. I'd like to get the hospital experience as well, not only for the perspective, but to see conditions that we do not see at the birth center, with our relatively healthy mamas.

This week the director of the Mother Baby unit asked me to apply for a position. There are other applicants, so I am not assured a place, but I thought it was encouraging that she remembered me from my clinical rotations and called me to encourage me to apply. My job would be floating between pediatrics, nursery (level II), and mother/baby. Although my job description is an RN, since I am so close to graduation, she said she would arrange for it to work until I have taken the NCLEX.

I am concerned that I won't like the atmosphere, though. I really feel like birth choice is paramount, and I've come to peace with things like choice sections, epidurals, etc, *when they are the mother's choice*. The medicalization of birth, not so much. I have always felt this hospital was way to conservative; and I still see lots of room for improvement. But I was surprised at how comfortable I felt when I was doing my clinicals on the unit, how nice and accepting everyone was of the different types of birthing and parenting philosophies, and also how supportive everyone was of breastfeeding (which has changed since I birthed my babies there).

On the other hand, I feel that I could bring a lot to this unit. I love love love teaching post partum mamas, and I love taking care of babies. I am comfortable with natural birth and laboring mamas, so in the event that I would end up cross training for L&D, there would be one more supportive nurse for the mamas who should have been at home or at the birth center, but weren't for whatever reason. I am no longer uncomfortable with mothers who birth in ways I would not choose. Maybe I've worked long enough on the medical floor, with people who make so many life choices that are so far from me, that I've just come to accept and even appreciate that variety in the human experience.

Are there any practitioners here who work in the hospital setting who could offer some advice or support? I really think I want to take this job, if I get the offer. I just *know* so much about this area, having been in it for so long, I really want to go back to being within the birthing/post partum community. But I'm older, less passionate perhaps, and simply less able to work all day, stay up birthin all night, and work all day the next day. You know? I feel like I was an outspoken, ueberpassionate birth activist for a long time, and now I just want to support women, love them and their babies, and help them be good mamas, whereever they birthed.


Does that make sense? Am I crazy to think that I won't go crazy in a hospital setting? I know we have motheringdotcom mamas who work in hospital settings; you want to give some input here? Are you happy with your jobs? Do you feel satisfied? Like you fit in? Do you feel like you are making a positive impact in your birthing community?

Thanks,
L

[applejuice]

No advice here, but I am sure wherever you go, you will be in the right place because you shine!

[GrannyLC]

Working in a hospital

I just want to say that I am a lactation consultant (RN, IBCLC) who has worked in a hospital LDRP unit for the past 19 years after assisting with home and birth center births and teaching childbirth classes. There are some days where it is rewarding (like when you see a couple that you taught in Bradley classes come in and have a beautiful natural birth with one of our CNMs) but there are many more days that are a complete frustration (watching a mother convinced she needs a cesarean because you know the doctor wants to get home for dinner rather than stay to wait for this baby).

I am not sure what my advice would be. I know over the years I have helped many couples successfully birth and breastfeed their baby but it did take it's toll you me emotionally. Most days I am ready to chuck the whole American way of healthcare and join Michael Moore in SICKO!

On the other hand, you will probably learn alot that you can carry to the birth center after you graduate.....just don't let the medical world "suck your soul out".

[Mollyred]

I am a L&D nurse at a very conservative hospital. I've been there for 15 years. I really do not agree with the homebirth with the midwife thing but only because I've seen too many things go wrong during labor and delivery at the hospital and I know if some of these were homebirths then the outcome would have been bad. I have always respected moms wishes as much as I could in the hospital setting as long as it did not jeopardize the health of her or the baby. I don't know if I'm the person who should give you advice because of my views. I've had two children and have another on the way and I would consider nothing but a hospital birth. Having that monitor on next to me gives me great comfort as a mom and nurse. Epidurals are heaven sent. They help moms to relax and enjoy themselves during active labor. Todays epidurals are much better than they use to be. That being said. Just remember that your liscense are on the line anywhere you choose to work. Make sure if you choose a birthing center that there are clear policies and procedures for your job position. A lot of people in this country are quick to bring a lawsuit against everyone involved when something goes wrong.

[bryonyvaughn]

Originally Posted by Mollyred

I am a L&D nurse at a very conservative hospital.

Molly when you say *a very conservative hospital* do you mean socially conservative or conservative in way the practice medicine? Conservative practice of medicine always baffles me because I'm never if the speaker means conserving the natural process and intervening as minimally as practical OR CYA medicine to conserve one's position. If you meant something entirely different please let me know that too. I'm just clueless on the concept.

That being said. Just remember that your liscense are on the line anywhere you choose to work. Make sure if you choose a birthing center that there are clear policies and procedures for your job position. A lot of people in this country are quick to bring a lawsuit against everyone involved when something goes wrong.

While that might be I true for some, I think most Americans only use a lawsuit as an absolute last resort. The personal mental, emotional, physical, and financial toll is just too high.

I'm not implying anything about you when I say this, Molly, but the single class most likely to sue following a bad birth outcome is OBs followed by other doctors and then nurses. OBs get sued at a higher rate than CNMs who get sued more than DEMs. Those in hospital get sued more than those at FBCs who get sued more than those in homes. I don't recall the researchers distinguishing between hospitals and hospital-based birth centers. The researchers definitely said the lawsuit rates didn't correlate much with attendant mistakes nearly so well as the nature of their relationships with their patients. They didn't study midwifery and lawsuits but my personal hunch is folks seeking the midwifery model of care might be less inclined to sue as they'd take a greater personal responsibility for their own health care. Remember, I'm speaking in generalities and individuals behave as individuals.

~BV

[pamamidwife]

Originally Posted by Mollyred

I am a L&D nurse at a very conservative hospital. I've been there for 15 years. I really do not agree with the homebirth with the midwife thing but only because I've seen too many things go wrong during labor and delivery at the hospital and I know if some of these were homebirths then the outcome would have been bad.

I have always said that if I worked in a hospital setting then I would definitely have some serious concerns and worries around birth. Of course you see things that are complicated - hospital providers are exposed to much more than the average low-risk, healthy woman. You see interventions like inductions (be they necessary or not), breaking the water to "speed things along", babies who have medications in their system, mothers or babies that are stressed because of augmentation or position (like women on their backs), etc. You also are likely to see women with crazy high hypertension, pre-eclampsia, HELLP syndrome, preterm babies, babies with anomolies, placental abruption, drug addicted women/babies, etc.

These are things you see in a hospital setting. Even the seemingly low-risk woman often turns into something more terrifying and urgent in terms of delivery because of interventions.

I can totally understand why someone who works in that setting views birth as risky - and has a favor for medicalized, "controlled" birth.

I have always respected moms wishes as much as I could in the hospital setting as long as it did not jeopardize the health of her or the baby.

And therein lies the issue. What if a woman wanted to labor on the toilet? Refused antibx after prolonged rupture of membranes? Refused vaginal exams? Wanted to push standing up? All these things are up to the mother to decide - yet what I hear in that sentence is if it goes against what *you* feel is safe, you will not support her.

The beauty of midwifery - most of all homebirth midwifery - is that women are educated about their choices. They know the risks and benefits of particular interventions/tests. THEY make that choice. That is called informed choice. What you see in the hospital is called informed CONSENT because they have no choice...just a group of people wanting them to consent to what THEY want to do. The level of education is slim at best - mainly because of time constraints and the wide variety of education and desire of the population you're dealing with.

Best of all, dealing with unmedicated mothers and babies means that we see better outcomes overall. In those babies slow to start, I very, very rarely ever have to take out my resuscitation equipment. In babies with subtle signs of impending distress, we make it to the hospital in ample time because of solid reserves in this unmedicated, uninterfered with labor.

I don't know if I'm the person who should give you advice because of my views. I've had two children and have another on the way and I would consider nothing but a hospital birth. Having that monitor on next to me gives me great comfort as a mom and nurse. Epidurals are heaven sent. They help moms to relax and enjoy themselves during active labor. Todays epidurals are much better than they use to be. That being said. Just remember that your liscense are on the line anywhere you choose to work. Make sure if you choose a birthing center that there are clear policies and procedures for your job position. A lot of people in this country are quick to bring a lawsuit against everyone involved when something goes wrong.

I agree that you may not be the best person to give Lori advice. She has a very different goal in birth - be it in the hospital or birth center or home - than you do. However, as a birth professional you're always welcome to put in your .02. We all are.

Routine external fetal monitors have been shown over and over in studies to increase the cesarean rate unnecessarily. They also - like epidurals - tie women down to a bed. As a nurse, I can see how this would be convenient. You're likely overworked, understaffed and need these monitors because one-on-one contact with patients is not available on a long-term basis. Midwifery has that advantage, though. We monitor babies using intermittent auscultation (something the ACOG has approved of and stated) and we're there, in close proximity, to mother and baby during labor.

Midwives are experts in NORMAL birth. We are trained in normal natural birth. We do not routinely induce women with Pitocin, Cytotec or other drugs. We do not drug babies and moms with Stadol, Fentanyl, or other narcotics. We do not routinely rupture membranes. Mothers give birth in the position she feels most comfortable - a distinct advantage to being on the back or tailbone (which decreases the pelvic outlet, making that forced counted purple pushing leading to a vacuum extractor or cesarean).

External fetal monitoring is done because there is a shortage of nursing staff available, the strip is handy in a lawsuit should something go wrong, the interventions usually done require constant monitoring (induction or augmenting drugs, epidurals, etc), and the simple fact that nearly all nurses and doctors have no idea how to monitor intermittently with a doppler. They have no idea how to interpret heart rate changes without that strip tracing.

Epidurals are NOT heaven sent. For women who are counting on a painless labor, they may get that. However, for other women they often lead to other interventions, including not feeling when or how to push, increased fetal heart rate complications, increased episiotomy, increased vacuum deliveries and yes, cesareans. Epidurals can also lead to complications just from the epidural - hypotension, leading to a drop in baby's heart rate (of course, everyone is "saved" by that injection of epinephrine), patchy coverage, pain at the site, errors in insertion leading to paralysis, systemic infections and even death.

Epidurals have their place - but I disagree that they are this wonderful thing that all women have great experiences with.

The last line of your post is the most telling: modern obstetrics is highly interventive (and we have the one of the worst maternal and infant mortality rates in the industrialized world, not to mention the rates in states like yours!) and IMHO unsuccessful overall because of fear of litigation. Everything is about covering your as* in case there is a law suit. There are strong pushes to get more and more women to have cesarean sections to avoid these lawsuits (because as it stands right now our courts see cesarean birth as being "safer").

To work in an environment that fears birth, that wants to control it, that sees women as less than powerful, is what makes someone have the same concerns you have. I would honestly believe that it's hard to see what you see on a regular basis and not have some serious concerns about birth.

If you'd like to have a discussion about the safety of homebirth, feel free to email me off this thread at [e-mail]. Because Mothering Magazine wholeheartedly supports homebirth, I will not engage in a debate about it's safety. To do so is bordering on a User Agreement Violation. (Just like if you were to come on and praise the "benefits" of circumcision)

Numerous studies and solid research back up my role as a homebirth midwife. Feel free to contact me - I don't bite and could actually offer you a vision of "the other side" - one filled with personal empowerment, safety, independence and gentle birth.

[pamamidwife]

as a separate post, Lori, you know I love you so much. If anyone can bring good things to a hospital setting, it's you. However, it could get really frustrating. I'm always grateful in times of transport to hear of nurses who birthed at home (it seems we get "those nurses" when we arrive - likely not by coincidence!) and those nurses who are true patient advocates.

To me, Mother Baby might be easier than L&D for sure. Imagine all the info you could provide on babywearing, attachment parenting, breastfeeding!

I think that you may already know the answer to your dilemma. I wish you so much luck!

[~pi]

OP, I don't know what would be best for you, but I wanted to mention that as someone who risks out of homebirth (I am type 1 diabetic) I really appreciated the supportive nurses I had at the hospital. I had two nurses (one in L&D and one in postpartum) who were wonderful. During their shifts, they really helped me feel like someone at the hospital was on my side.

[Mollyred]

I'm sorry but I did not mean to upset anyone by my views. I do have a right to my own opinion even her at mothering. I know there are many moms who hang out here that have had hospital births with epidurals. I realize that mothering supports homebirths but we also support hospital births.

[lorijds]

I appreciate all the input. It's nice to hear your point of view, Molly, because if nothing else I think it gives me insight into a commonly held viewpoint in the hospital setting. I appreciate your honesty.

Pam, I really wanted to hear from you; I love you too! I also think you are right, I already know what I want to do, I just needed to work through it, and to see if it really would make me happy. If I don't get this job, I think I will probably request to keep my resume on file, in the event another mother-baby/ped/nursery position opens up.

Thanks ladies! I feel the love, and I was needing that.

Lori

[Om Girl]

I'm not a nurse, but I can offer my experiences of working as a birth professional in a hospital setting. I am a childbirth educator and a yoga instructor that works within one of the most conservative hospitals in my area. I teach both CBE and yoga within the hospital and often work as a doula to my clients.
I spend a fair amount of time on the floor and have worked with some great "open-minded" nurses and some "regimented" nurses. The open-minded nurses have been wonderful suggesting additional comfort measures and letting the mother lead her birth.
There is a HUGE need on the floors to bring these components of woman centered birth to hospitals. I know that as a mom who labored and birthed within a hospitals midwifery unit I appreciated a very woman centered labor and delivery nurse!
I'm sure you'll be a wonderful addition wherever you choose to work, but consider the hospital as I'm sure you're needed there more than the birth center, if not for the other staff for the women who will birth with you!

[georgia]

Hi, everyone Just to clarify, please remember that here at MDC:

Mothering.com is the website of natural family living and advocates natural solutions to parenting challenges. We host discussion of nighttime parenting, loving discipline, natural birth, homebirth, successful breastfeeding, alternative and complementary home remedies, informed consent, and many other topics from a natural point of view.

From MDC's Web Statement of Purpose, topics hosted here regularly include:

Natural Pregnancy
Midwifery/Doula Attended Births
Drug-Free Childbirth
Homebirth

Here are several Mothering Magazine links about birth interventions:

Hidden Risks of Epidurals

Obstetrical Interventions

Epidural Epidemic

Hormonal Blueprint for Labor

Mothering invites you to read and participate in the discussions on the MotheringDotCommune forums. In doing so we ask that you agree to respect and uphold the integrity of this community. Through your direct or indirect participation here you agree to make a personal effort to maintain a comfortable and respectful atmosphere for our guests and members.

Any further questions or comments should be directed to a moderator, specifically either Arwyn (this subforum's mod) or myself. Thanks for your cooperation and understanding

[AngelaB]

Hi Lori,
I gave birth at the birth center and you were my nurse! I am Angela and I had Milo Atticus there in 2006. He is now 15 months old and I am planning a home birth!!
When I was in labor with Milo you said "well next time you will have your baby at home" and thats always stuck with me. It is the natural progression of events for me.

I just wanted to say that I think whatever you choose to do you will be fabulous!The moment we met you I felt like you were a friend. You were so kind and gentle and made us feel like we were at home and THANK YOU SO MUCH FOR TAKING PICTURES!!! I have the greatest birth pictures and I didnt even ask you to do it, I didnt even think about it in labor land.

I think mamas and babies definately benefit from having you there at such a precious time in their lives.
Good luck
Angela

[lorijds]

Hey Angela!!!

I'm so happy to hear that you are having a homebirth! Wow, it's great to hear from you!

Your words and encouragement mean a lot to me, Angela. I really, REALLY appreciate it.

Happy birthing!!!!!!!!

Lori

[lorijds]

I took the job in September.

Somethings are great--how can you not love working with moms and babies? But this hospital is just too frickin conservative, and I can't do it any longer.

Although many people give lip service to the idea that CNMs and midwives are fine attendants, ANY time we have a home birth transfer, there is nothing but trash talk at the desk. If a mom with a birth plan comes in, they all just roll their eyes and say, "Anyone want to take bets on when this control freak is going to get her section?" They scoff at anyone wanting a natural childbirth, "Just get the epidural for god's sake, why experience the pain when you don't have to?" They try to be supportive of the mom when they are with her, but out at the desk their true feelings shine.

It's even worse for me, because otherwise I really like these women. They are funny, supportive coworkers--but the birthing atmosphere at this hospital just stinks. I can't do it any more. I have quickly come to the conclusion that I personally cannot be a CNM in a hospital environment, and frankly, I like being a nurse and I think I will not further my education anytime soon. I hear about wonderful hospitals where the epidural rate is not nearly so high, where there are many nurses truly supportive of natural birth, where VBACs are still encouraged--but I dont' know any in my area, and I'm not willing to spend a year at one facility and then another to find it.

Frankly, I also miss the adrenaline rush of the acute medical floor. I miss the variety of pts, the pace, and the skill level involved with taking care of someone who is very ill or crashing. I think this is a crazy feeling that only ER/ICU/Acute care workers can understand--but it's very real for me, and I miss it.

So I emailed my former director and asked for my job back. If I can't get it, I'll go to another faciliy, to the ER or medical floor. I'm sad it didn't work out and that I don't feel like I have a "home" anymore; but I'm glad to come to the realization that hospital birth is not for me. It's also a bit refreshing and freeing to think that I am not going to be in school for another 4-5 years getting my CNM/ARNP. I guess in discovering where I do NOT belong I narrow down more where I DO belong, and I belong in acute care.

I'll miss the babies and the mamas, and I continue to take occasional call at the birth center, to get my fix. Thanks for all the advice and concern and the shoulders and support. It is difficult for me to accept that this isn't working. I mean, part of me feels like I should give it a while, or that *I* didn't work hard enough to make this work. But most of me feels like this isn't me, it's not just philosophical, it comes down to the fact that I really like medical-floor nursing, and want to return to it.

Thanks again, ladies. Carry on all your amazing birthing and birthing support. I can't help but hang around the threads from time to time--gotta get my fix here, too. But I guess the hospital and birthin is not my path after all.

Love you all==

Lori

[nimblemama]

I'm glad to see that you have discovered where you need to be. I'm sure it is hard and your co-workers comments make me shudder. It's too bad that the nurses have attitudes like that. I hope you can use your skills to touch many people's lives, regardless of where you are working.