By Madeline Holcombe, CNN
(CNN) — Most people anticipate the day of their child’s birth to be one of the happiest of their lives, but the experience isn’t always so uncomplicated.
Things can change quickly when delivering a baby, and the experience could start to look different from what you expected, said North Carolina-based labor and delivery nurse Jen Hamilton.
The goal of labor is to have a happy and healthy mom and baby at the end, but it should be the minimum of what we strive for, she said.
Hamilton spoke to CNN to share how patients and providers can work toward better birth experiences.
This conversation has been edited and condensed for clarity.
CNN: What do people need to know about the birth experience?
Jen Hamilton: Birth trauma does not have to mean that you had an emergency C-section. It doesn’t have to mean that you had a really traumatic-like delivery with forceps.
Birth trauma can come from just not being listened to. It can come from not feeling prepared. It can come from not having things explained to you. It can come from having not the right people on your team, whether it’s health care providers or your own personal support team.
CNN: What should people going into delivery expect from their health care team?
Hamilton: I want people to know — especially if they’re my patients — that we are there to advocate for them, to listen to them, to believe them, and we’re there to make sure that they feel safe and supported. And what’s happening in obstetrics right now — that isn’t always what people feel when they come.
I also want them to know that they have choices in labor. I feel like that’s something that we don’t do well, and obstetrics either it’s kind of like, this is what we’re going to do, rather than this is what we recommend and why we recommend it, and these are the alternatives, and you make the choice for yourself. So, I think that knowing about autonomy in birth is so important.
CNN: When can people having a baby be advocating for themselves in the hospital?
Hamilton: I think basically the whole thing. I think that people don’t know that at any point we can stop. We can talk; we can ask questions; we have time. Unless something is an emergency, then we have time to talk about things and to discuss it before anything happens.
I have a lot of patients who come in who are terrified, and they don’t know what questions to ask. So, as they come up, you know, it’s important that they are able to articulate or have someone there with them that feels confident and comfortable in articulating those concerns or those questions.
But I think most of all, the burden falls on us as health care professionals to set up that environment where patients feel safe to do so, that we’re not making them feel like they’re a burden, that we’re not making them feel like they’re bothering us. We are literally there to make sure that they feel safe in every moment.
CNN: It can be scary when a birth plan doesn’t go as expected. How should families coming into labor and delivery make one — even knowing it may change?
Hamilton: I am all about a birth plan because it helps me get to know who you are as a person and what’s important to you before we get started. I also think it’s so important for us as health care workers to talk about possibilities on the horizon.
I’m very much a fan of what I call birth vibes. Meaning that it’s A-OK if somebody comes into the hospital and they really don’t know what they’re going to want. Because there are a lot of people that come in with birth plans, having researched so many things and what other people think that they should do, and whenever they get to that point, it doesn’t fit what they thought they wanted.
But some things will never change, like they want to feel respected, they want to feel like they have a choice.
I have created like a birth vibe template, and that is really just for me as your nurse to be able to see how you like to be cared for best. So for instance, like whenever I was little, it was comforting to me if my mom put a wet rag on my forehead if I was feeling bad, right? But something that’s not comforting to me is like someone touching my hair … I don’t like that.
It gives me ideas of how I can support you in labor. And also talking about how you like to process information: Are you somebody that if something is changing, you want to know every single detail? Are you somebody who wants to know just the nitty-gritty? It helps me to be able to communicate with you, knowing who is important to you and who you do not want to be there.
Those are some good birth vibes to think about, but any plan that comes in obviously is subject to change. But I’m going to follow it as closely as I possibly can and advocate for every patient. I just want to make sure that all of their decisions are informed, empowered decisions.
CNN: Are some birth plans better than others?
Hamilton: There’s a very big push to do everything natural and to not intervene at all. I think that the word natural kind of can cause some birth trauma and some grief if things don’t go that way.
There are natural processes that happen that are not positive. Infection is a natural process. Other bad things that happen are natural processes. But there are things that can happen in labor that may be seen as interventions that are there in place to be a tool.
(For example), someone … comes into labor and delivery, and everyone has told them to go “natural,” but what that means to them is unmedicated. They don’t want an epidural. They don’t want any medicine. Sometimes they get into labor and realize that that is not what is going to be a positive birth experience for them.
And then they’re in this panic of “I didn’t expect this. Now what do I do?” and they’re having to make decisions on the fly, when they may not feel informed or empowered about those decisions, because they expected it to go a certain way and it didn’t go exactly the way that they want.
Pregame those conversations like, “OK, well, what if I get into labor, and it isn’t what I thought it was going to be, and I do need help? What would I be willing to use as a tool? And what are the pros and cons of using that tool?”
CNN: How should someone having a baby pick the people in the room with them?
Hamilton: The No. 1 thing that you can do in that situation is bring the right people. Sometimes, your baby’s father is not going to be the support person that you need, and that’s OK to make those decisions based off of who you know will be there for you in labor.
I tell people however your partner treats you when you are sick is likely how they will treat you when you are in labor. If your partner when you have the flu expects you to cook and clean and make dinner for them, they are likely going to be this kind of person who is asleep on the couch while you’re going through labor.
If you’re unsure about someone, don’t have them come at all.
If people want to do things on their own to try to ensure a positive experience, the biggest way that you can do that is by picking the right provider. If you’re going with a doula, having the right doula on your team is going to make a world of difference.
And if you’re in the situation and you feel like people on your support team, like your health care team, are not the right people for you, you can ask for a different nurse, you can ask for a different provider in that moment.
Say, “This is not what I want, and I need somebody different.” I tell people, there’s always another nurse, always. If you feel that that person is not listening to you, that you’re not getting what you need, don’t continue going down that path with that person.
And if you’re looking for a provider, that means asking around and (checking with) maybe some moms groups or other people that have had babies, and bonus points, if you know any people who work on labor and delivery who can talk to you about how that provider is you know in an actual real-life situation.
CNN: How can someone in the room best support their loved one having a baby?
Hamilton: I think a great resource is learning about labor, taking prenatal classes with their partner so that they are aware of things that happen.
But I think also some support people can be very strict on a birth plan when even the pregnant person is wanting to change that plan. For instance, I’ve had patients come in who say like, “I do not want an epidural at all.” And then whenever they get to a moment where they’re like screaming for an epidural, their support person (is) saying, “No, you can’t have it.”
Be able to support decisions that that pregnant person makes in the moment — those game-time decisions that they’re making, supporting them throughout those decisions.
But I love it when support people are engaged in the process. Please do not just sleep on the couch the whole time. Don’t bring your Xbox to the room. Don’t eat a deep-dish pizza in front of your partner. I’ve seen so many wild things.
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