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Monday
Feb142011

Thoughts on "One Born Every Minute"

You can’t Google about natural birth the last couple of weeks without coming up against half a dozen posts or articles critiquing the new show on Lifetime, One Born Every Minute. One of the most vocal was Gina, The Feminist Breeder, who wrote “Lifetime Shows Us There’s One (Unnecessary Intervention) Born Every Minute.” Gina says,

"So I couldn’t help myself.  I took notes the entire way through this train wreck and yelled at the television every 60 seconds.  Here is what I saw, and here (in blue block quotes) is what I yelled at my TV."

Kristen, from Birthing Beautiful Ideas (a blog I’ve never seen before… how have I missed this?) writes in her post Dear Lifetime: It’s not Weird, it’s Normal,

“… I worry about pregnant women and their partners watching “One Born Every Minute.”  And it’s not because I think the show is going to make them want to run out and ask for every birth intervention in the world as if they’re candy.  Rather, I worry that the show will create or even reinforce in women’s minds a pretty bogus distinction between  “What’s Normal and What’s FREAKY-DEAKY-WEIRD-AND-ABNORMAL During Labor.”

I’d considered not watching the series, but since I’ve recently hung up my homebirth midwife hat and picked up my full-time monitrice-doula hat, I thought, “What the heck… how different could it be from what I already know to be true in hospitals?”

Last Tuesday night, I watched both the first segment, “To Medicate or Not,” (the one that had the natural birth couple in it) and the second installment, “Expect the Unexpected”; Sarah left the room. (You can see the full segments in those links.)

It turns out I was right; the shows weren’t all that different from my own personal hospital experiences… as a doula or as a midwife who’s transferred/transported women to them.

I didn’t sit screaming at the TV. I didn’t get high blood pressure from enormous amounts of frustration. Sure, I rolled my eyes a few times (some things said and done were absurd… more below), but, hard as it is to say, I stand behind the “You Buy the Hospital Ticket, You Go for the Hospital Ride” belief I’ve had for years. I don’t know if 28 years in hospitals has numbed me (I don’t believe it has at all) or if my idealistic belief that I Can Change The System has been flushed down the toilet, but I have pretty much given up any hope of seeing massive institutional changes in that area of the birth world.

When I first started, I thought things were so awful –the induction rate, the cesarean rate, etc.- that they couldn’t possibly get any worse. And look! Not only has it gotten worse, it’s gotten horribly worse. I’ve come to the realization that, until we have a 100% scheduled cesarean rate, it can always get worse. Of course I pray for a miraculous change in The System, but I’m just not going to hold my breath anymore.

 So the TV show. I tried to watch it from two viewpoints… one, from a mom who knows nothing about birth and two, from a sociological point of view. Marrying the two, I definitely winced thinking of the messages being conveyed throughout the episodes.

The first was how Blessed (gloriously, exaltedly Blessed) an epidural is. I would swear someone (or many someones) in the epidural industry is paying for product placement in shows like this. I almost sat and counted the number of times “epidural” was said, but decided it was pointless; we all know how many times an epidural is brought up in labor already. And giant pet peeve of mine: “Her epidural,” “My epidural.” Ugh. How did this procedure acquire possessives? Counter that with a cesarean. Rarely do I hear women say, “My cesarean.” It’s usually I had a cesarean.” Are women claiming ownership to the epidural because they can remain more “civilized”… more themselves? Versus a cesarean that very nearly transforms the woman’s perception of herself or, at least, her body? A great topic for someone who studies these things.

Women on the show were so passive. Their bodies doing things they had no knowledge of until someone (or some machine) told them something was happening. “Oh! I’m complete?” I know this is a duh kind of obvious to those of us who know natural/normal birth, but the message is ghastly to those that don’t know any better. It was so funny (not haha), the woman who was on the birth ball, in the shower… she looked so out of place! The same way a woman in a homebirth who did nothing but lie on her back in bed would. Isn’t that just sad?

It’s true, the show capitalized on the friction between Nurse Pam and the natural birth mama, but even in the second installment when there was no natural birth juxtaposition, we could see who the nurses smiled with, who they joked with and who they were the kindest toward: the women who didn’t cause any extra work for them. If a woman needed her belts adjusted because she moved or even if she had “annoying” family members, you could almost hear the heavy sighs as they had to go out of their way to do the task or speak to the family member. Never mind these things are part of their job; if they took an extra two seconds, it seemed an extreme bother.

This is one of the main things I feel I can offer my clients (slight segue), that I work well with hospital staff, helping wherever I can, helping the nurses not have to do things like moving the belts or changing chux or whatever. I’ve spent many a-labor holding the monitor on a swaying, moving mom. This delights the nurse who really doesn’t care if mom’s mobile and rocking, as long as the baby can be seen. I think this was where the natural birth mom’s doula could have helped a lot, by holding the belt on the laboring woman’s belly when she was on hands and knees. If the woman is anywhere near the monitor… on the ball, standing, rocking, etc… why not have her on the monitor so you can get her off without any issue when you want to later? Making the nurse happy AS the woman gets her needs (wishes) met creates a much more pleasant atmosphere and the client has better post-birth memories.

I had a transfer not so long ago and one nurse was initially guarded with me, but warmed up quickly. During the labor and birth, I was encouraged to take a more active physical and even clinical role than I know would have happened if I’d have been Guard Midwife. The birth became a wonderful, empowering moment for my client… her wishes honored and honored respectfully and happily… not just because she was compliant (she refused more than one recommendation), but because everyone was clearly listening to and hearing each other. As I was leaving, the nurse thanked me for all my help and told me it was refreshing to see a homebirth midwife not be combative, that most of the other ones she’d seen have been “bitches.” (Her word, not mine.) I left vowing to repeat this positive experience, that I would work hard not to have my midwife-monitrice-doula interactions be contentious and, somehow, find a way to also help others have a more harmonic hospital birth experience without sacrificing autonomy and self-respect.

I would be remiss if I didn’t mention two incredibly huge gaffes and one smaller one that one of the nurses made. First, when a baby’s heart rate was going down and mom was worried, Nurse Linda, a tiny, older nurse (second segment) told her the baby was just getting used to her lower blood pressure… that she’d had high blood pressure and now it’s normal, so the baby has to adjust. I can only assume this was right after an epidural was placed (can’t tell from watching), but what a stupid way to explain what was happening. The baby’s “getting used to a normal blood pressure?” Geez.

The second thing this same nurse said that nearly had me falling out of my chair in disbelief was when a mom was pushing, had been pushing for what seemed to be about two hours at that point, and as the tiny nurse was showing a family member how the head came down and receded with each push –while the baby was still inside - she casually says, “Oh, that’s turtling.” Uh, no it isn’t. Turtling is when the head is born and then is pulled back up, mooshing back against the perineum. Said more clinically:

“Once the shoulders impact at the pelvis inlet, the fetal head which has already left the pelvis, often recoils tightly against the maternal perineum. This is termed the ‘Turtle sign’…”

photo by Kristina Kruzan

The woman did, later, have a shoulder dystocia, but the turtling had not happened yet. I wonder what the other nurses –and the tiny nurse’s supervisor- had to say about her clinically incorrect remarks.

The third was when a mom was on hands and knees and her sister made a snickery comment about her being “doggie style” and Nurse Linda pipes up, “We prefer to call that knee-chest.” Excuse me? No “we” don’t; we call it hands and knees.

I acknowledge I’m not like a lot of Natural Birth Advocates (NBAs) who refuse to watch these types of shows. Besides watching as an informal continuing education, they are what many pregnant women watch and I like to be able to answer questions regarding what they’ve seen on them. Bloggers and commenters have begged for a realistic (not reality!) show about homebirth, but honestly? I don’t think it’s dramatic enough to show. And don’t we like it that way?

References (2)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    Response: copysniper
    - Navelgazing Midwife Blog - Thoughts on "One Born Every Minute"
  • Response
    - Navelgazing Midwife Blog - Thoughts on "One Born Every Minute"

Reader Comments (14)

I'm a new doula, with a passion for natural childbirth, and I want to work in hospitals, not only because that's where the clients are, but because I believe very strongly that a woman birthing at an understaffed urban hospital needs me a whole lot more than a woman having a homebirth with a midwife (etc.)

I also want to stay within my scope of practice, which means no heart tones. In your opinion, does holding the fetal monitor on the mama's belly count?

Do you have any other suggestions for making nice with the LD nurses? I don't think of them as the enemy, and I know they're over-worked and drowning in charts. What can I do to help them while I'm helping the mom? (I'm fine with changing chux pads and other grunt work like that.) Thank you!

February 14, 2011 | Unregistered CommenterJennifer

Interesting...maybe home birth is better for you tube.

I think my CNM was a lot like you in the making harmony bit. I wanted to drink water, the triage nursie said, "no, anethesia doesn't like you to drink." Uhm, I wasn't planning on getting anethesia, so I didn't care what they thought. I was planning on a hep lock only and didn't want to go water free for 3 or more hours. (I was also angry because the triage nurse lied and said she'd called my CNM and had to have an internal exam before the CNM would come to the hospital. After I stupidly consented, the CNM walked in...nursie apologized). Anyway, I was agitated and my midwife could tell. She smoothed things over and told me if I wanted water don't ask, just drink. Don't mention things outloud, just do what you want. She held the monitor on my belly and I rocked beside the bed as baby had some decels, but nothing too scary. She wanted to let me rock. She let the nurses know that becasue I was moving the HR looked like decels and was getting lost a bit, but it was my movement so they needn't worry. I was upright and mobile, the nurses had little to do but set up and wait until I pushed. Everyone had a good attitude. So yes, your suggestion not to be combative is priceless and ever so helpful!

February 14, 2011 | Unregistered CommenterDawn

Hmmm... "How to Be a Doula the Nurses Like"... or "How Helping the Nurse is *Really* Helping Your Client"... or "Truce! Doulas & Nurses CAN Agree."

Hmmm... *laughing* I can hear the screams of horror even from here.

February 14, 2011 | Registered CommenterNavelgazing Midwife

Oh Barb, If you only knew how many times I have said the following: "As Barb Herrera says, 'If you buy the hospital ticket, you go for the hospital ride'." It's just another reality birth show. Ratings driven obstetrics at its worst. Reminds me of some of the finest episodes of The Twilight Zone.

February 14, 2011 | Unregistered CommenterErika

I was taught in my DONA doula training that it is out of the doula's scope of practice to touch the medical equipment. I was taught that the mom can touch the monitor, but the doula cannot, unless the nurse specifically grants permission.
I chose not to get certified by DONA because, to me, the scope of practice seems to be limited past the point of common sense, but that may be why the doula on the show didn't help mom with the monitor...

February 14, 2011 | Unregistered CommenterRaeanne

Jennifer & Raeanne: You both ask a question I've just begun to hear because I'm getting back into the doula world. It's the one about touching the monitors. So funny, I didn't hesitate to learn when the nurses offered to teach me way back when. And then, of course, using a doppler all those years, I'm not the least bit worried I can't find a fht. (In fact, that's one of my best midwifery skills -finding fht's, even early or with wonky babies.)

So, scope of practice... yeah, I think the DONA thing gets fuzzy, but, to me, it isn't clinical at all because you aren't diagnosing at all... you aren't initiating something that goes from zero to equipment. To me, you are serving your client... facilitating her having a more physiological labor.

I definitely don't think you should do it until you have been taught/shown how to hold it and to *know* what you are listening for; this isn't a new doula skill (imo), but one that comes with, "Crap, the monitor moved again because she's wiggling around and that nurse is going to come in and complain about her moving" situations.

NOTE that losing the fht's is NOT a maternal issue, but an equipment issue... and I am *clear* with that distinction with clients who've begun to feel bad about moving when the nurse sighs or tsks about having to adjust it again; I nip that bad feeling in the bud.

I don't know about asking to learn... that's probably not the best way to approach it... but, maybe when the nurse is adjusting the monitors/belts for the third time, saying something like, "I wish I could help by holding the monitor on the baby for you," and seeing if she offers to show you how.

And don't you all unhook the monitors so she can go to the bathroom? Or do you tell the nurse she has to go and wait for her. This could get tiresome for a nurse if you (the doula) is trying to get the mom OFF the monitor and moving around a lot... not that it's a comment to not get her off, but this might be the #1 way to help the nurse. The plug thingies are color-coded, so it's impossible to put them in the wrong hole (and the pins tell you which way to connect them to the machine). This is the easiest "skill" to learn and ask about. "I'm sorry to ask you to unhook her again... would it be easier if I unhooked her and then hooked her right back up after she pees?" If the nurse looks at you like you're a nut, apologize and say, "I'm sorry... I just wanted to be helpful. No problem... I won't touch the machine." But, I suspect you'll find the nurse relieved and LOVE you for it (I always have). I *never* touch the machine without asking, though. Well, except for turning the darned thing down. I do do that without asking. ;)

But, once you know how to unhook and hook her back up, with each new woman you can say, "I had a great nurse show me how to unhook her and hook her back up to go to the bathroom... would that help you if I did that, too?" Her answer will help you know where you stand and how much leeway you'll have with keeping her in the bathroom.

Oh, and PLEASE don't pepper the nurse with questions when mom is being admitted... the monitor discussion happens later, when things have settled in.

Is this helpful? Hrm. I really should write a piece about this, huh. ;)

February 15, 2011 | Registered CommenterNavelgazing Midwife

That was really helpful! I have my first doula client next month and I need all of the advice like this that I can get (as far as communicating with the staff). I'm certifying through ToLabor, and they aren't quite as sticklers as DONA, but they still do talk about always asking before touching the equipment. It's a good reminder. I like the suggestion about asking the nurse to show me how to put the monitor on correctly. THanks!

February 15, 2011 | Unregistered Commentersara

I would love to read a post from you about doulas getting along with hospital staff - I think that would be very interesting!
And - aren't you glad you found Kristen's blog? She is a fabulous writer!

February 16, 2011 | Unregistered CommenterNicole

Yes, please do write a piece about keeping the nurses happy! I would LOVE to read it. :-)

February 17, 2011 | Unregistered CommenterDiana

I genuinely like the show but I've heard some people say that they don't think it gives an accurate depiction of labor. There's only so much that you can condense when you have 45 minutes of time. I love the show and I've just had a godson born this January and the screams are no joke! I work and subscribe to .

(Barb here. No spam, Danielle. Not even with comments cushioning them. And sad your godson was born with screams... that isn't true for everyone. No spamming, chica!)

March 7, 2011 | Unregistered CommenterDanielle

I know enough about the equipment that I'm comfortable unhooking it, and helping hold it in place to get a good FHR trace (I had at least 20 NST's in my last pregnancy due to a problem with my baby, so I used that time to ask the nurses all about the monitor and learn how to read the strip, hook/unhook, etc). I don't have a problem helping clients with those things, because, like I said I didn't certify with DONA so I don't have their scope of practice hovering over me.
But, I usually still will just tell the mom that she can unhook if she wants to go to the bathroom (or have her ask the nurse early into the game if that's ok), so that it's obvious that it's her decision and not me being a pesky, interfering doula... (the hospital I've attended births at is not very natural-friendly, so I'm extra conscious of how I'm perceived there).

March 7, 2011 | Unregistered CommenterRaeanne

"I don't know about asking to learn... that's probably not the best way to approach it... but, maybe when the nurse is adjusting the monitors/belts for the third time, saying something like, "I wish I could help by holding the monitor on the baby for you," and seeing if she offers to show you how."

This, yes. The very first birth I attended as a doula was with a mom who was hoping to have a VBAC so of course, she was required to be on the monitor at all times. But she was also very active in early labor, walking a lot, dancing with dad, etc.

After the nurse had been in the room every 5 or so minutes for almost an hour to readjust the belts this is exactly what I asked her. She lit up and said 'that's a wonderful idea' since the only issue was that they were getting lose, and bumped during movement.

And in future labors I have done the same and waited for it to become a matter of holding the monitor still just long enough to trace the baby to make the nurse happy.

Sometimes, it doesn't matter how sweetly you offer your assistance in this matter, or how kindly you do *anything*, some nurses are unpleasant. We had one yesterday that was more than clearly put off by the fact that there was "a doula in there with her".

March 9, 2011 | Unregistered CommenterAutumn

This show pissed me off so much. I did sit there screaming and yelling at the tv... but you make a good point--- you choose to birth int he hospital and not have someone to speak up for you (doula for instance) then you choose the hospital ride. I don't know why I keep watching these shows!

June 5, 2011 | Unregistered Commenterhillary

I've been to a few hospitals recently (Washington, DC area) which are now requiring doulas to sign a form upon entry -- one point on the form is always that the doula is prohibited from touching any of the equipment in the room. A different issue....but one hospital's form even states that "the doula may not say anything which contradicts or disagrees with the attending physician." I personally have never had an altercation with staff and work really hard to create a collaborative atmosphere, but honestly signing a statement like that feels degrading to the doula and ultimately dismissive of the mother's ability to make informed choices.

Anyway, I bet that the doula in the show was very purposefully NOT touching anything. DONA seems to be cracking down on any "blurred lines" these days, too. According to DONA, a doula is not supposed to be involved in any type of monitoring. Honestly, I believe this is really a result of concern about liability issues, because as you have pointed out, helping hold the monitor can truly be a win for everyone in hospital situations.

March 13, 2012 | Unregistered CommenterElizabeth

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