Sunday Brunch: Interview with Christy Anderson, Obstetrics Nurse Extraordinaire

Christy Anderson, OB Nurse

I first met Christy Anderson, an obstetrics nurse and a dear friend, in the early summer of 2009. I was a few weeks pregnant but (having taken one of those super-expensive, high-tech pregnancy tests purchased in a Manhattan pharmacy) I didn't know it. My then-fiancé and I were driving around the US, stopping for beer and hashing out such monolithic couples' disagreements as whether or not we should have a wedding and if we did, if we should have a band, and if we did have a band, if they should play classical music or songs more germane to our generation.

But I was planning to be pregnant soon so I picked Christy's brain over a campfire and a bottle of wine(!), looking for her educated opinions about the birthing process. I like to think that, in the three years since, Christy and I have both experienced a sea change toward natural birthing processes—she, from an informed place working within the medical system; and myself from a general obliviousness and belief that it's all a bunch of hippie hoo-haw. Christy's entering a nurse-midwifery master's program in January and I keep telling people I lured a nice nurse over to the placenta-eating dark side. 

For this week's Sunday Brunch, the first of a two-part interview, Christy talks about the amazing hospital she works for (seriously, they offer prenatal yoga. how sweet is that?) and her experiences as a compassionate and fiercely hard-working obstetrics nurse. Her later interview will examine some of the reasons she is looking to further her education in the midwifery field.

Buon appetito!

– Svea Vikander

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SV: Let's start at the beginning. How did you know this was the field of nursing you wanted to go into?

Christy, after assisting in the delivery of her cousin's baby, Bree.
Let it be said... Newborn babies sometimes cry too!

CA: I didn’t immediately know. In high school I thought I wanted to be a pediatrician. I was so lucky to be able to job shadow a wonderful pediatrician. I learned a lot of great things from her but the most powerful lesson was that I didn’t want to work in pediatrics! Crying babies with ear infections all day was not my idea of a great job. However, I knew that I wanted to work with babies so my next thought was about newborn babies. This led me to do a summer job shadow with certified nurse midwife named Lori. I spent a good portion of my summer with her and fell in love with the job and the amazing process of labor. From then on I knew I would go to nursing school and one day become a certified nurse midwife. 

SV: And now that you're doing it, what's it like to be an OB nurse? What does your typical shift look like?

CA: I work 12-hour night shifts, which means I arrive at work at 7pm and leave at 7:30am. I wear one of three hats while at work during these shifts. The first would be as a charge nurse. This means I answer all phone calls and triage all patients who come in who might think they are in labor or are having some type of pregnancy problem. I am responsible for knowing what is going on with all the patients on the floor at all times, assisting other nurses with help when they have questions, and attending all births to be the “2nd nurse.” Being a 2nd Nurse means I am there to care for the baby once it is born for the first half hour. As a charge nurse I am also responsible for staffing the unit.
The second hat that I could wear would be a labor and delivery nurse. This is by far my favorite hat to wear. It is during this time I am able to really connect with my patients and help them have the birth experience that they are hoping for. This is where I am responsible for the laboring mother, supporting her during her labor.
The third hat I might wear would be as a post-partum nurse. During this time I am responsible for either three or four mother/baby couplets. I help facilitate bonding, breastfeeding, and teaching a wide range of infant and mother care practices. I also assist the families to finish some of the hospital paperwork that needs to get done so they can go home with their babies.

SV: Shift work is so hard. Especially all night. What's the hardest part about your job?

CA: Breastfeeding assistance. No matter what position I put myself and the mother in, it always hurts my lower back! So that is a personal thing. In general, though, nurses can find it hard it to make a connection with the patients. Often you only have minutes to meet the patient before almost immediately being in an emotional and stressful situation. You have to get them to trust you and make a connection as soon as possible. Sometimes that is hard to do at the end of a labor that is very intense or when patients come in thinking we are the enemy. Patients’ attitudes are often the result of thinking we are merely agents of the hospital’s policies, here to enforce practices that they would not choose for themselves, rather than as a partner in their birth experience.

(from the Aspen Women's Health Centre, via Denver Doula)
It's nice to know not all OB Nurses are created equal.

SV: And, in your case at least, this simply isn't true...

CA: Well, no. The thing is, I can't say our hospital, St. Francis, is typical. Recently I have been reading more blogs, hearing from friends, and attending more conferences and have noticed there is something special about the hospital I work for. We are a regional hospital and usually do around 1200 deliveries a year. Our providers consist of OB/GYN’s, certified nurse midwives and some family practice physicians. Within the last year we have started offering water births with our midwives. A few months ago we began to use aromatherapy to help our patients with pain, stress/anxiety, nausea and relaxation/sleep. A large percentage of our nurses are trained in integrative health techniques such as: massage, guided imagery, meditation, music therapy and deep breathing techniques. These have proved to be very helpful for our patients. We also have a lot of our nurses trained by Gail Tully and her Spinning Babies techniques. We have a different approach from most hospitals when it comes to cesarean births. I think some of this has stemmed from a few of our nurses, personally, having bad experiences at other hospitals during a cesarean birth.

SV: That's amazing! Policy informed by people's actual lived experiences!

CA: (laughs) Yes. Another thing that has shaped this new approach is our belief in the research that supports immediate skin-to-skin contact between mother and baby. Most hospitals during a cesarean will show the mother the baby quickly if at all and then take the baby away. The mom will then see the baby again only after her recovery phase. Our hospital is very different in that aspect. If a patient is going to have a cesarean birth, myself or another labor nurse plans to be in the operating room the whole time. Once the baby is born the doctor places it on the warmer (they are sterile and need to place it in another safe sterile place). As the nurse, I will wipe off the baby quickly and if any stabilization needs to be done, it will be done quickly. Then the baby is placed skin-to-skin on the mother’s chest as long as she likes while the surgery is finished. Some mothers choose to do skin-to-skin the entire time, others choose to have us weigh and measure the baby in front of her while still in the operating room.

SV: That's exactly what maternal-issues therapist Helen Dunn recommended when I interviewed her, in terms of dealing with C-section trauma: giving the mother choices. It can help to give her a sense of control and reduce the incidence of PTSD.

Want to learn more about V-BAC, TOLAC, and the BAC-lash?
Check outICAN: International Cesarean Awareness Network

CA: It also helps to simply ensure that she has the birth that she wants – or as close to it as possible. After the surgeon is finished the mother is moved to a new bed and then mother and baby are transferred back to their room for recovery. During this phase the mother can continue skin-to-skin contact if desired or start breastfeeding. Breastfeeding during this time can sometimes be difficult as the mother is in a mostly reclined position. Nurses have been known to stand and hold the baby in a good position during this time, in order to better facilitate this first breastfeeding. I actually do not think elective primary cesarean birth is something that should be an option to people. I think it might be a while before that is a rule.

SV: Really? No elective cesareans? Why is that?

CA: I think often women make this decision based not fact or need but more of a socially accepted norm these days. Some will choose it because they don't want to push or don't want to ruin their sex life. These seem like trivial things when you look at the recovery period and increases in potential complications with next pregnancies and next potential cesarean delivery. Often times once women are educated on what it truly means to have a cesarean and what it could mean for future deliveries they realize this is not the easy way out. I think there is a time and a place for elective cesareans for those people that aren't just looking for the planned delivery to try to fit it into their schedule. I would hope that any provider that is willing to offer an elective cesarean also talks about the potential risks, what this means for future deliveries and the possibility of emotional distress that can happen between a mother an her new infant from this type of delivery.

SV: And I guess something a lot of women aren't told is that having one C-section will make their later labours more likely to end in C-sections – in fact, a lot of doctors won't do 'VBAC' (Vaginal Birth After Caesarian), they insist you have another C-section.

CA: There is a time and a place for a trial of labor after cesarean (TOLAC), which could become the VBAC you're talking about and in certain situations I would really recommend it. Sometimes, I have a hard time recommending it to friends who ask as I have seen it go really bad really fast, but that's a very small percentage.

SV: What about the commercial aspects of C-sections and birth interventions?

Vintage shot of Ina May Gaskin
in The Business of Being Born

CA: Many people have seen the movie The Business of Being Born and I have to be honest – I only watched it for the first time last night! As this movie insinuates, a lot of hospitals are keen to induce their patients, give them epidurals and offer elective cesarean births or at least push towards cesarean birth when it is convenient for the doctor. This, however, is not my hospital. We now have a policy on the induction of labor, which reduced our induction rate significantly. We use pitocin conservatively. As more of our nurses become competent in the above techniques, we are having more and more “natural” un-medicated vaginal births. That being said, we are still a hospital and have certain policies and procedures that some may consider controversial. But we have a much more holistic approach to labor and delivery than other hospitals.

SV: I remember when we first met, you said that you'd seen a doctor write 'birth plan' on a patient's record, under the reason that a labour had failed to progress. What are your personal feelings on birth plans?

CA: Birth plans are very interesting. It is my recent opinion that they should be called “birth preferences.” The semantic of birth “plan” means your labor will be this way and you will not stray from it at all. Sometimes that is fine but sometimes it needs to be a little more fluid. One of my favorite quotes from a fellow co-worker is, “I have read your birth plan and it is so very lovely and I will do everything in my power to have it the way you prefer. However, sometimes we make plans and God laughs.” I think this sums up a lot because we can plan all we want and sometimes things just don’t go the way we were planning them to go. I think the best thing to do is have an idea of how you want things to go and inform your provider and nurse of these things. A written plan may not be necessary.

SV: I guess that makes sense if you really trust and feel connected to your care-providers. What about rooming in?

CA: Rooming in is great, it facilitates on-demand breastfeeding and attachment. We promote it but also offer the nursery at night. More often than not, parents take advantage of the nursery. I think they think I only have one or two nights that I might be able to do this so I might as well do this after having had such a long labor. If I had to guess, at our hospital at night maybe about 70% or more of parents send their baby to the nursery, to be brought back when the baby is ready to nurse.

Christy, during The Night Eight Babies Did Not Room In

SV: Have your ideas about pregnancy and childbirth changed over the course of your education and career?

CA: Yes, looking back over the last seven years, my thoughts have changed quite a bit. When you start a career like this there is so much information to learn that it is easiest to learn the black and white parts of the job. The more mechanical things, such as electronic fetal monitors, starting IV’s, epidurals. As I became more proficient in these areas, I started to work on really understanding and being able to support natural childbirth. I have always loved it and I’m in awe of it. I am the first to volunteer to take natural birth patients when they arrive. I am just truly amazed by the human body and how it works. I have seen so many of them now that I can actually hear when a woman is ready to give birth. I love that even though every woman is different the body is so similar that at the end of labor you can just hear when a woman is going to deliver. It isn’t always necessary to do an exam... you can just have a sense of it.

SV: That's amazing. I remember when I was in labour with Sweet Baby James, the labour progressed much faster than we expected. Zu called my mom to ask her to get the car ready in an hour or so. She told me later that she could hear me having contractions in the background and she 'just knew' that I would have the baby very, very soon so she went to get the car started right away! (she forgot the keys and had to backtrack to her place in the middle of a Montreal February night, but that's another story). That kind of primal knowledge really is incredible.

CA: Exactly. And that's what I want for my own births. When I first started I thought for sure I would want to have an epidural when I have a baby of my own. As I have grown in the profession and my own learning I think I’m going to trust my body to tell me what I need.

SV: What kind of a birth do you hope to have? Where would you hope to give birth?

CA: I hope to have a very open mind in this situation. I would like to keep my mind and body healthy and continue to practice yoga in preparation. I would like to think I would be able to have an un-medicated water birth but I am going to try not to have any expectation on my birth and just see what my mind and body need at that time. I feel very safe in the hospital that I currently work. I work with some wonderful midwives that I would like to provide my care. I think I could have the birth I hoped to have with them with the medical backup right there if needed. Not to mention to have all my wonderfully supportive co-workers there to help me through it.

SV: That sounds great. I'm sure that your experiences from working in labour and delivery will inform your birth, and your birth will then inform the further work you do.