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Presence of nurse during labor

By Rupa Inayat Ali

Labor support has been described as an important component of intrapartum care Miltner, (2000). And has been linked to positive maternal and fetal birth outcomes.Hodenett, (2001).For most women and families , labor and birth is a time of excitement and anticipation along with uncertainty, anxiety, and fear. Giving birth represents a major change in a woman’s life.

During my Advance Concept in Community Health Nursing, clinical rotation of reproductive health, I got assigned to X labor room, 25-year-old female 3rd gravid a Para 2.She belongs to nuclear family. Married since 4 years and has been the only concierge of house. On physical examination patient cerveix was 3 cm dilated with 50% effacement, station – 2 , 3 contraction were coming every 10minutes lasting for 30minutes. According to the attending gyneacologist all multiparas delivery progresses fast and soon deliver the baby .The doctor instructed nurse that when crowning occurs then call, and doctor left the room. In labor room one Senior RM and 2 nursing student including me were assigned and there were only 2 patients in labor room .Patient was moaning and weeping because of pain. After inquiring from patient I came to know that patient is in labor since 5 hours patient stated that “please help me I am fed up of this I could not continue please God forgave me for my sins” Nurse did not do any thing for the patient and she was busy in completing her stock items she also instruct student to complete the stock with her. Furthermore she told the patient that “this is not the first time that you are delivering you must need to be clam every woman has to bear”. As I was also assigned there I went to the patient’s took her hand and start talking to her. I offered her glass of water moreover; I taught her deep breathing exercise. After her delivery she was thankful to me that I was there during her delivery. I agree that nurse was busy and she had lots of task to do, but I was concerned that at this critical time, nurses working during the birth possess should have the knowledge, skills, and experience to provide competent care for mothers and babies. I was thinking if there is any other way to give comfort to the patient? Bowers (2002) reviewed 17 qualitative studies of women’s perception of support. She noted that women’s perceptions were influenced by the interpersonal communication style of care givers.”

Later on when I reflected that what happened to the patient, I thought that health care providers did not inform the mother about the health information and care of plan. Furthermore Nurse did not assess the women’s ability to cope with her pain and assist her appropriately. I feel disappointed when patient was lying on bed; she seemed like speechless human being, wanted to say but could not say any thing and she was left on the mercy of health care team members. The health care providers do not communicate and collaborate effectively. On other hand nurse did not show the caring behavior with professional competency that foster the holistic care for patients and promote positive childbearing experiences.

The incident would have affected the client and newborn .Though the goal of nursing was to provide comfort, yet patient was suffering. The patient and his family would feel that their needs were not met by health care providers or health care personnel are not competent enough to take care of patient’s condition. This incident would increase the anxiety and they would probably loss trust on health care personnel including the nursing staff. It also would give continuous discomfort to the patient which could lead to prolong labor. According to Enkin, Miltner. (2000) “Although supportive care during labor has been shown to decrease the likelihood of medication for pain relief, operative delivery and low 5-minute Apgar scores in the newborn.”

When I pondered over the reasons of this incident, number of questions flashed my mind. What are nurse’s responsibilities in providing professional support during labor? Why nurse was judgmental that multipara doesn’t need any support during labor? Were there any other strategies to reduce pain and provide comfort? What was the nurse’s role in this incident? Why nurse didn’t play the role of advocate for her patient? Why family centered approach was not utilized by the nurse? Why nurse didn’t provide holistic care that includes mind, body and sprit?

After asking myself I came up with lot of assumptions, may be the doctor and nursing staff did not know the comprehensive intrapartum assessment in managing pain during labor which involve various factors. May be nurse was judgmental that multiparas doesn’t need any support during labor. May be nurse had lots of task to be done. May be patient was in anxiety. May be nurse thought that it was not her responsibility to assess patient’s pain and evaluate the condition or advocate the patient. May be nurse doesn’t have knowledge about beliefs, customs and practices of different cultures should be incorporated in labor. Knox (1999) recommended that “numerous barriers prevent nurses from providing this type of care such as inadequate staffing, lack of time, lack of training, hospital policies or routines that emphasize technological care, and physician’s resistance.”

From my point of view, I would interpret that this incident had happened because nurses and physician care are not congruent with the need and goals of the childbearing woman. Further more health care team was judgmental and they are imposing their values and believe. Moreover I think that nurse is the primary care giver of the patient. They spend more time than the physician. I think that managing labor and provide supportive care during labor is the challenge but with the team work and collaboration among healthcare team and with emotional support, physical support and knowledge will able to give patient quality care.

After analyzing the situation, I thought that it would not happened if nurse had clear idea what is the supportive care and what are its effects on patient, family and newborn. If nurse would recognize family centered maternity and newborn care are particularly important at this time. If health care providers had played profound role at the time of birth facilitating attachment between mother and the newborn as well as the family. The patient would not suffer if policies and procedures are focused and decisions are made in full consultation with woman and the supporters. Despite of all these nurses should understand that staffing pattern, policies and procedures as well as attitude of staff have great impact on the woman during labor.

At that time I was not able to do much for the patient because I don’t have enough knowledge regarding the presence of nurse during labor .I was too thinking that she is multipara and had her delivery experience. After reading a lot of researches and articles I came to know now that presence of nurse and supportive care during labor will help her to manage physiological and psychological challenges.

If I encounter this incident in future, first I thoroughly assess the patient condition, need and support system because I will not judgmental. I will try my level to provide holistic care for my patient to manage her pain and ensure a peaceful labor and delivery. I will provide the alternative and complementary therapies that are massage, healing touch, hydrotherapy, deep breathing, prayers, meditation, guided imagery, music, hydrotherapy, humor. I will give teaching on during antenatal period regarding childbirth preparation. Furthermore, I will involve the family members. I will suggest the hospital administration to develop policies that support such care.

To support my ideas I searched for the literature and I came to know about the importance of support during labor. According to Doona and Smith (2001) “nursing presence has been described as the essence of the professional nurse’s caring relationship”. Different researchers define labor support differently Hodnett (1999) defines “labor support as supportive care that encompassed physical comfort measure, emotional support, information and instruction, advocacy, and support for the partner.” Copeland and Douglas (1999) believes that “woman’s satisfaction with nursing care during childbirth depends on the women’s perception of support received and the intrapartum nurse’s ability to establish rapport, communicate effectively, and provide competent care. The nurse’s interpersonal skills are perceived as more important than technical skills”. On other hand, environment provide during labor also influence the woman’s care during labor. These include hospital policies, attitude of staff and care given during labor. Gagnon et al., (1997) claims that “work sampling studies in busy hospitals found that nurses devote only small proportion of their activities to supportive care.” Mackey and Lock (1989) defined labor support as support during labor that was provided by nurse and consisted of seven categories of supportive care behaviors: presence, decision making, assistance, physical assessment, information, comfort, and support.” In contrast Simkin (2002) explain that “ no medical care that is intended to ease woman’s anxiety, discomfort, loneliness, or exhaustion, to help her draw on her own strengths, and to ensure that her needs and wishes are known and respected”. S J.donn (2006) explains that a six factor solution indicated the dimensions of professional labor support: Tangible support, advocacy, emotional support-nurse caring behaviors, and informational support.

In conclusion it is essential that nurses and doctors should demonstrate mutual respect, communicate and collaborate effectively. This means that to provide safe and satisfying childbirth need multidisciplinary approach. Thus, all health care professionals especially nurses have the key role and responsibility to perform regular and comprehensive assessment of woman during labor. Then she should plan intervention with collaboration of other health care team and family, and provide six-factor solution that indicates the dimension of professional labor support and complementary therapies which are appropriate for patient in order to give comfort.