Why Evidence Based Birth is Wrong with Nurse Carrie — Episode 101

Evidence Based Birth is a great advancement in labor nursing, but all too often I hear “the evidence doesn’t support that” and I get frustrated. Today we’re talking about what evidence based birth DOESN’T take into account, so you can more fully understand your prenatal care.

Today’s guest is my friend Carrie, she has about 20 years of OB nursing experience as well

Big thanks to our sponsor The Online Prenatal Class for Couples — it will help you make the best choices for YOU when you’re in labor. Plus, it will share more of the options that you’ll have to make as you progress in labor. Do NOT miss it!

In this episode

What evidence-based birth is (learn more here)

How you can apply it to your care.

Why your doctor might recommend something against evidence based birth.

How to make your choice when things are different than you thought.

Other things that might interest you

Why informed consent is important

My Episode on how to say no in labor

Producer: Drew Erickson

Check out my other pregnancy podcasts:

Transcript

[00:00:00.210] – Hilary Erickson

Hey, guys, welcome back to the Pulling Curls Podcast! Today on Episode 101, we are talking about why evidence based birth is wrong. It’s not wrong. Hello, click bait. Let’s untangle it.

[00:00:21.810] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls Podcast we untangle pregnancy, parenting, home and even travel. We know there’s no right answer for every family, but hopefully we can spark some ideas that will work for yours. Life’s tangled, just like my hair.

[00:00:44.110] – Hilary Erickson

OK, guys, before we get started, now is the time to subscribe, it’s 100 percent free. You know, there’s those podcasts to charge you. That’s not me to subscribe. Thanks.

[00:00:54.040] – Hilary Erickson

OK, guys. Today’s guest has 20 years of labor and delivery experience. She is the mom to four and she had two Nike babies. And I have to say she did not have like the picture perfect deliveries as the labor nurses do. I want to introduce my friend Carrie.

[00:01:10.040] – Hilary Erickson

Do you feel prepared for your delivery in just three short hours? You can be prepared for the competent collaborative delivery you want, you’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor, stories from my 20 years in the delivery room to engage both of you. I love how Alissa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page from Bump to Bassinette. Join the online prenatal class for couples. Today, you can save 15 percent with coupon code UNTANGLED. You can find the link in the show notes.

[00:01:45.450] – Hilary Erickson

Hey, Carrie! Welcome to the Pulling Curls Podcast.

[00:01:47.740] – Carrie

Hey, Hilary, how are you?

[00:01:49.590] – Hilary Erickson

Carrie trained me at my last job for like one full day, right?

[00:01:54.150] – Carrie

Very scary.

[00:01:55.350] – Hilary Erickson

Oh, when we were in the OR and we couldn’t figure out how to fix that thing.

[00:01:59.520] – Carrie

That’s right. I forgot. Yeah, that was my first time. And I was training you at the same time. And the doctor didn’t know how to use it for good.

[00:02:06.660] – Hilary Erickson

Yeah. I mean, you have to realize that a lot of nursing is like that. And honestly, every time I would mix it after I would think of Carrie.

[00:02:13.800] – Carrie

I don’t think I ever mixed that again.

[00:02:15.270] – Hilary Erickson

I probably only mixed it like two or three times later. Thank you.

[00:02:22.710] – Hilary Erickson

You’re welcome. You appreciate that. OK, before we get started, I want to tell everybody that I love evidence based birth. I think it’s so important that patients understand the studies and all the things that support why they’re making the choices they’re making. Don’t you think?

[00:02:37.900] – Carrie

I agree. Yeah. And it’s good to know the evidence that’s out there so you can take it yourself.

[00:02:43.920] – Hilary Erickson

And because the evidence changes often, yeah, we have a very different population than when I started 20 years ago.

[00:02:51.000] – Carrie

Yeah, for sure. There’s a lot more people that are getting pregnant now with a lot of underlying health conditions that didn’t 20 years ago when we started doing this. So no.

[00:02:59.700] – Hilary Erickson

Well, especially my hospital. I delivered like a ton of 16 year olds, so they didn’t have time to get underlying health conditions.

[00:03:05.740] – Carrie

So they were too healthy. OK.

[00:03:08.840] – Hilary Erickson

And Carrie and I were talking before we started that. A lot of times a lot of what we do in labor and delivery guys are going to hate this. It’s just like this is what we do. And we were talking about eating because evidence based birth shows that eating really isn’t that big of a deal. Like the the risk of you aspirating as a normal, healthy human is pretty small, pretty small, but we really push eating and drinking when you’re there.

[00:03:29.820] – Carrie

But I always tell my patients before you come on, make sure you get something to eat and drink or starve. So, yeah. So if you’re heading into the hospital, get a good snack because your labor could be long and you’re going to get hungry.

[00:03:40.860] – Hilary Erickson

Yeah, and here’s the newsflash. Carrie and I can’t feed you. We can’t take a tray of food in there. But if your husband goes out and get you a burger, I’m not going to slap that out of your hand.

[00:03:51.210] – Carrie

I mean, only if I want to take a bite, but that’s about it.

[00:03:56.700] – Hilary Erickson

I mean, I probably educate you on the fact that you might see that again and then I would just put a little barf bag by you.

[00:04:02.370] – Carrie

Yeah. I mean, we see it all the time, the barf, so we can handle it. But it’s not always the most fun when you’re in and then throwing up. Yeah, I know. From experience.

[00:04:11.910] – Hilary Erickson

No, not fun. And I just want I don’t ever want you to be like, well you didn’t tell me I might throw up.

[00:04:17.190] – Carrie

That’s true. Kids are like that. What you didn’t tell them? Like I thought it was implied. So I guess you got to let you know.

[00:04:23.670] – Hilary Erickson

Yeah. We need to give informed consent for everything. Yes, sure. If you ride through that puddle, you might get wet. OK, so I just want to go- going in. There are things and especially in specific hospitals when I change hospitals. Carrie, did you work at that one hospital the whole time?

[00:04:41.340] – Carrie

So no, that was my second.

[00:04:42.900] – Hilary Erickson

So- OK.

[00:04:43.740] – Hilary Erickson

And as you change hospitals, each hospital has their own weird cultural things that they may just do at that hospital, because it’s kind of like the culture of that hospital. And that doesn’t mean that you can’t make a different choice.

[00:04:54.360] – Carrie

Yeah, and I think it’s based on geographical area too. Right. Like the women that you’ve been around or whatever they’ve chosen for things and they talk to you about it a lot. So you just assume that sort of stuff everywhere else on the move for your second pregnancy. It’s like, wow, definitely here. It doesn’t mean it’s wrong. It’s just different. Yeah.

[00:05:12.360] – Hilary Erickson

Just like there would be a different culture anywhere about anything like school, church, all those kind of things. So anyway, love evidence based birth, use it, use it, use it. But there are some times where it goes awry. So again, we were talking about eating. Yes. I think you probably should be able to eat in labor, especially light snacks. I would not have your husband bring you a hamburger and eat the whole thing.

[00:05:32.910] – Carrie

And I don’t think you want to feel like eating that much, but a little bit is good.

[00:05:39.360] – Hilary Erickson

Yeah, maybe take a bite of his and then have something small on the side. And I guess I wouldn’t do it like after a girl or anything. I don’t feel like early labor. You know, when it’s normal to drink, like if you’re at home labor, you would eat and drink there.

[00:05:52.740] – Hilary Erickson

Yeah. But there are specific times you really shouldn’t eat or drink, right.

[00:05:56.400] – Carrie

Again, like your epidural. right.

[00:05:58.530] – Hilary Erickson

Or if we really think there is a dependency section, a very likely C section, if yeah. And if you feel the stress.

[00:06:07.290] – Hilary Erickson

Yeah. So even though evidence based birth says it’s safe to eat and you’re going to come in with that headline in your head, the reality is it’s not always safety because if you’re looking at a close C section that it’s very likely it’s really not that safe to eat because well, it is very unlikely that you throw up. If you really ate a meal and then had a C section, you’re not going to feel that great and it’s not going to be your on your intestines either.

[00:06:28.290] – Carrie

And I can think of two other circumstances. If you’re going to be back, which is a vaginal birth after Caesarean, I would probably avoid it at that point to just because there’s more of a risk that you could have a C-section. So I probably avoided at that time. Also, I feel like if you have twins or any multiple. And I guess and you’re trying to do a vaginal birth, I probably avoided at that point, too, because your chances of survival higher than just having one baby in there.

[00:06:54.530] – Hilary Erickson

Yeah, although for either of those, if you were still in early labor and we just had you like at the hospital, you still probably could eat. I would definitely talk with your health care team, but I would agree especially with twins. As you get close to delivery.

[00:07:05.570] – Carrie

I’d think about it in the back of your head and follow your instincts. As far as moms, even if it’s your first baby, you’re about mom, about baby. And you follow those instincts what you feel like you should be doing for all of that and ask lots of questions.

[00:07:19.730] – Hilary Erickson

Yes. Say I’m starting to feel a little bit hungry right now. What do you think I should do? Sometimes I’ll be like, let’s try an Icee. Yeah. And see if that does anything for you. If it doesn’t, then we could escalate it to like broth really a anything. Yeah, definitely ask questions because again, sometimes the providers just says, I just saw a tick tock. There was a super controversial birth where the doctor was like, come on in your waters broken because that’s normally what they say, that’s their culture.

[00:07:49.850] – Hilary Erickson

But in reality she wanted to stay at home in labor for a while. And the doctor, when she suggested that the doctor was like, sure, great, just make sure nothing goes up your baby exit and watch your temperature.

[00:08:00.260] – Carrie

Yeah. And I think we’re so worried about Prolapsed Cord. Right. But the reality is that very often it’s happened to me twice in a 20 year career, but it’s happened. And so prolapsed cord is when the baby’s a vocal cord comes out ahead of the hip and that’s an emergency and delivery needs to happen immediately. So that’s the concern when your water breaks and you’re at home. But it happens so rarely. I don’t know if you had any hope because I’ve had three.

[00:08:26.360] – Carrie

I think I might have had three, but two that I can remember.

[00:08:29.630] – Hilary Erickson

Yeah, one of them was kind of like man, like the head was just kind of impinging on it. So it wasn’t as exciting as sometimes it is. Yeah, but also your doctor could tell you do a finger sweep up there and just make sure nothing’s in your vagina. Although the ones I’ve had were fairly obvious, I think the person would have felt it, definitely. But especially if baby’s moving and all that jazz, that’s a great sign.

[00:08:51.380] – Hilary Erickson

Everything’s good.

[00:08:52.340] – Carrie

And I mean, I feel like labor better at home than being stuck in a bed because we’ll feel bed and set you there. I mean, you can get up and walk, but you’re on monitors and and that kind of thing. So it’s not as free of an environment as it is at home. So if you’re feeling like everything’s going well, but if you ever feel like I don’t feel right, come on it come in any time in your pregnancy, you’re like, I don’t feel good.

[00:09:12.350] – Carrie

Come in, get it checked out. It’s OK. You might get sent home.

[00:09:15.350] – Hilary Erickson

But yeah, I mean, that’s really what we do for most of our patients is reassure them and we’re happy to see a great look at baby too. Nobody’s- when somebody comes in saying the baby’s not moving, we’re just as nervous as you are at that point.

[00:09:28.970] – Carrie

And we get so excited when we see that baby moving around and the tracing on that baby’s heart rate looks good. Yes.

[00:09:35.930] – Hilary Erickson

So, yeah, because we I would say that most of the labor nurses have been in that position to where they’re like, I’m not feeling the baby move.

[00:09:42.560] – Hilary Erickson

Yeah. And then you eat or drink something and you’re like, oh, there they are. Yeah.

[00:09:46.310] – Carrie

It’s scary sometimes. So if you’re ever worried on, we’ll get it checked out. No one to make fun of you. So we’re all just. Yeah.

[00:09:53.900] – Hilary Erickson

And don’t forget your doctor’s office to a lot of times I think people come to labor and delivery when I’m like, you probably could just pop to your doctor’s office for a quick lookeeloo.

[00:10:01.430] – Carrie

And if you can’t, then maybe we’ll look at who your physician is like if that makes you nervous to either call them or pop in and see and they’re not wanting you to come in. You might want to think about your provider because you want to feel as comfortable as you can with that provider.

[00:10:15.410] – Hilary Erickson

Yeah. And they should want to be able to see you, because I will tell you also that your visit to your provider is so much faster than your visit to me, because I have to go through every question since you were born.

[00:10:26.570] – Carrie

Yeah, that’s true.

[00:10:28.340] – Hilary Erickson

Yeah. So I had an evidence based birth quandary with my last baby. I did not want to have my water broken because I wanted to let the water stay intact for as long as possible. But I stalled out.

[00:10:39.110] – Carrie

You were just a chicken. You didn’t want to feel the extra pain. I can come up to your room. Sure, that’s what it was.

[00:10:43.940] – Hilary Erickson

I already had an epidural, carrie and I was being induced. But finally I was like, fine, break my water. And then I had a baby like forty five minutes later.

[00:10:53.630] – Carrie

And that’s a hard one too, because some of us feel like I know, especially with my second one, I wanted to try and do it as natural as possible. Right. So I understand that there’s times that that’s what we want for our delivery. And having someone intervene with that and and break your water just feels like, oh, I’m not doing the natural way or whatever whatever you’re wanting from your birth experience. So I get it.

[00:11:16.160] – Hilary Erickson

Or for me it was one hundred percent. I hang up like I want to control.

[00:11:19.370] – Carrie

And you knew it would be it could help speed you up, which is even more funny.

[00:11:23.090] – Hilary Erickson

Obviously, I had been a labor nurse for ten years at that point, I think.

[00:11:27.170] – Carrie

Yeah, but you’re a patient at the time. You know, when I was in labor, I was like, turn the monitor away. I’m not looking at it. I didn’t want to be fixated on what was happening. I need to trust the people that are here to take care of way. Yeah.

[00:11:41.690] – Hilary Erickson

So all right. So what I love about. Evidence based birth and there is an evidence based first podcast, I’ll put that in the show notes there is a website, there’s lots of evidence based birth is a trademarked thing, but there’s lots of different evidence based practices that you can follow and just kind of find someone that you like that teaches in a way that you like and understand. But also that’s why you have a doctor that hopefully has lots of experience, right?

[00:12:05.010] – Carrie

Yeah. And I think you need to ask questions. Right. I want you to do X, Y, Z. Well, why do you want me to do X, Y, Z? Because sometimes just like I’m not doing that, if you think of any kid, I’m not doing that. But if you explain why the thought is that we’re going to do whatever we’re going to do, then it helps you understand more and then you can make a more informed decision.

[00:12:24.690] – Carrie

There’s nothing like making a decision when you have no clue what you’re talking about. So ask your doctor at every time you go in for your appointment. You know, there’s always questions that you have to write them down. And if you’ve heard something from a friend, write it down. What do you do in this situation? Are you wanting me to do X, Y, Z, or what’s your thought on in the piece? Not any of those kind of things.

[00:12:45.300] – Carrie

You know, write them down and figure out what your what your provider does so that, you know, when you finally get to that day that you deliver. Yeah.

[00:12:52.020] – Hilary Erickson

I’m always about like having the notes in your phone with full of questions for them. So I’m so old school. You here, write it down. Yeah.

[00:13:00.380] – Hilary Erickson

So I’m trying to think what I did back in the day that I haven’t. I think I had a notebook in my bag.

[00:13:06.210] – Carrie

Yeah. I wrote it down so I’m old. So my youngest is 15 now. It’s been a while, but…

[00:13:12.090] – Hilary Erickson

I mean by the time I had a phone, like a smartphone, I just told the doctor what was going on. Let me tell you my birth.

[00:13:23.130] – Hilary Erickson

All right. So go to evidence base first, ask lots of questions. I was going to tell a story. So I was in with one of our doctors and all of a sudden she’s just very proficient practitioner. Just did not all of a sudden she was like, I do not feel good about this, just like the mommy gut. And this was somewhat unusual for her. And so she was just she just told the patient, I don’t feel good about this.

[00:13:45.000] – Hilary Erickson

I think we need to go back for a C-section and obviously not evidence based at all. Right. And when she did it, I was just she was she’s not a high C-section rate, does not like C sections. I walked out of the station with her and I was like, are you OK? Like, you need some sugar, what’s going on? And she was just like some I just don’t feel good about it. And I we got back there and actually before they cut, a little fist popped out of the uterus.

[00:14:09.180] – Carrie

A little bit of pressure there.

[00:14:10.800] – Hilary Erickson

Yeah. And I was like, whoa. So as much as there is mommy gut, an experienced practitioner really can just she was like there was something about that I felt about the strip. There was something I just felt and I felt like we needed to go back for a C-section and so her uterus could have ruptured while she was in labor is kind of what we figured. Like she hadn’t had a previous C-section. Things were looking a little iffy, but not crazy.

[00:14:32.910] – Hilary Erickson

She just felt like we should go back. So sometimes the evidence is awesome, but also intuition just for moms and also for providers.

[00:14:39.330] – Carrie

So if you develop that relationship with your provider, when they say that to you, it’s not going to be a shock. And you’re like, well, I know him or her. We have this relationship over these nine months. Yes. And I wonder what they’re saying to me. Yeah. But then there’s those times you get those crazy providers. You might figure out who I’m talking about in this scenario. But he or she would say, like, if you go home right now, your baby could die.

[00:15:03.180] – Carrie

And I’m like, like, you know, that’s not the thing that we want to say to people. Explain why you think that not that scenario. Like if you go home, this is going to happen or could possibly happen. I guess so. I guess, kind of give you that fear. But explain why you might come back to to this individual, this mom, and explain why you’re feeling that way as a as a practitioner. But I think it was more based on time.

[00:15:26.730] – Carrie

I mean, we have a lot of providers that their time is important. So they’re are at the hospital with you. We want to do whatever.

[00:15:34.380] – Hilary Erickson

So, yeah, I mean, the thing with that statement is at any point in time, your baby could die. You could go get in your car and you could die like you could say that statement just as easily. And that’s probably most likely.

[00:15:44.250] – Carrie

Yeah, but I, I would given some background. So like the previous doctor you talked about, she said, I’m not sure why, but this is the feeling that I have that’s really before he had to explain it to to your mom. To the mom and why.

[00:15:58.570] – Hilary Erickson

So yeah. And she did go over she said, I’m seeing these things on the strip. I know that you’ve had previous deliveries, but they and because she had been she’d been this person’s doctor for a while. So she had done her other deliveries and was just like the last one was a little bit rough. I’m just combining all of these different things and made such a good call. So, yeah, for sure. Yeah. The key is collaboration.

[00:16:19.200] – Carrie

Right. You’re a team that’s it’s called the health care team. Right. And you’re involved in that team. You have your doctor, your nurse, your neonatologists, ones involved in your case because you might have the it’s baby or a baby that has some conditions that need a neonatologist there as well as you and your other two, like that’s your team together. You work together to get the outcome that’s best for you and the baby. Yeah.

[00:16:42.720] – Hilary Erickson

And a lot of times like. Everyone thinks the health care team are the people wearing scrubs.

[00:16:46.140] – Carrie

And they’re not like you’re involved in that team. Yeah, and it’s OK to speak up and say, I’m not really sure about that, but I don’t want to do that. And why do you want me to do that? And that’s totally cool.

[00:16:56.310] – Hilary Erickson

You have the ultimate right of doing that in the room. The nurse does not have that much right.

[00:17:00.590] – Carrie

I can see the nurse that they’re rolling her eyes. That’s probably a good indication that you might want to ask some more questions. Or if you ever hear her say this to you, it’s up to you to decide. You get to make your own decisions. I would have a little red light go on in my head. OK, why does she feel that? Because you can’t say something like that. This is crazy. You shouldn’t be doing this.

[00:17:19.860] – Carrie

So if a nurse ever says that to you, say, OK, why is she saying that there might be something to this that I might need to consider not not doing this or so? Yeah. I don’t know if you’ve ever said that or not. I’ve said it before. I probably could get myself into trouble. But really, I feel like you need to ask more questions. You need to know why why this decision is being made. And do you really want to follow through with it?

[00:17:41.310] – Hilary Erickson

So, yeah. And on the converse side, when I one hundred percent agree with the doctor, I probably wouldn’t drive down that train of like, you can make your choices. I’m watching late after late shift or late.

[00:17:51.450] – Carrie

Then you’re kind of nodding your head with the doctor when they’re telling you what they want to do versus nodding her head. That’s a good indicator, too, that she probably probably agrees with that statement. So, yeah.

[00:18:03.720] – Hilary Erickson

Thank you for coming on, Carrie.

[00:18:05.220] – Carrie

Thank you. It’s been awesome.

[00:18:06.630] – Hilary Erickson

Yeah. So fun to chat with you.

[00:18:08.280] – Carrie

I miss you a lot…

[00:18:11.730] – Hilary Erickson

Everybody misses me…

[00:18:11.730] – Carrie

That’s true.

[00:18:12.930] – Hilary Erickson

OK, guys, I hope you enjoyed that episode because I love evidence based birth. But sometimes I have people who bring up evidence based birth in a situation that’s very unique to themselves. And I just want to tell you that that is difficult. That’s why you have a provider, evidence based birth is for the masses. And when you’re looking at just one specific person, then things change a little bit. So just something to keep in mind.

[00:18:33.630] – Hilary Erickson

Thanks so much for joining us on today’s episode. We know you have lots of options for your ears and we are glad that you chose us. We drop episodes weekly and until next time, we hope you have a tangle free day.