If We Want to Change Birth, We Have To Reclaim Nursing

I hear this over and over again when I travel across the country teaching: nurses want something more. They want to practice to their full capacity as healers and caregivers. They want to be able to give the care they know people deserve.

I hear seasoned nurses bemoan that newer nurses are just “trained to the tasks” and I see this reflected in younger nurses’ statements about their own lack of confidence in supporting unmedicated births or a fetal demise. I see nurses just plain tired from challenges in relationships with management and colleagues with differing values around supporting birth (Another 39wk elective induction?!). And we certainly see families coming in with limited understanding of the process, who aren’t being set up for success in their births--which can lead to unrealistic expectations, disappointment, and trauma. So the question is: How do we move from where we are to where we want to be?

If we want to change birth, we have to reclaim nursing. What skills are we centering in our nurse residencies, employee orientation, and our continuing education? How do we define our role? We know our job is about more than just running Pitocin or evaluating blood loss (of course, let’s have solid skills there too, please!). The core of our work is in the art of nursing, the art of giving care. Our so called “soft skills” are meant to be equally valued for their contribution--like two wings on a bird. AWHONN’s 2019 ‘Back To Basics’ tool reminds us we can improve someone’s birth experience and perception of their care through simple actions: by being present, listening, and through the power of touch. But we need to go further than including a poster in an orientation packet: We need to provide in depth training to support excellence in this arena. These skills, not unlike our skills in NRP or obstetric emergencies, require attention and repetition for nurses to move from novice to expert.

I think of communication, presence, and touch as physiologic skills: “an ability to activate the body’s own mechanisms for promoting growth and healing.” These are the primary skills needed to promote safety in birth. Medical interventions should be used rarely and judiciously. When we are skilled in physiologic care, we can support rather than disturb the physiologic birth process. When we are lacking in physiologic skills, we rely on intervention to solve problems. Have you ever seen a nurse suggest an epidural because she was unsure of how to help a patient cope? And perhaps that epidural then results in blood pressure bottoming out, fetal distress, and a trip to the OR? How might developing our physiologic skills lower Cesarean rates, improve patient satisfaction scores, and reduce secondary trauma for us as nurses? Keeping birth safe by understanding how to support normal is a win-win for families and care providers alike.

The pressures that we face in our daily work drive us to serve so many things: hospital policy, physician’s orders, staffing issues. We cannot let normal get lost in the mix. Physiologic skills are not a half day class tacked onto nurse orientation, physiologic skills are the core of what we do. If we want to serve birth first, it is time to center physiologic care. If we want to grow our profession into the future, it’s time to reclaim our physiologic skills! 

More to come on how we can nurture ourselves as nurses and grow our skills...