Sunday Brunch with Christy Anderson, OB nurse extraordinaire - Part II

Christy Anderson and a really amazingly adorable baby

Ladies. I present to you... Christy Anderson. Yes, she was over for brunch last week. But her interview is our third-most-popular post of all time, so I thought y'all might enjoy hearing the rest of what she had to say.

Christy Anderson is an obstetrics nurse with over seven years of experience in assisting women deliver their babies. She will soon enter a midwifery training master's program and is going to be pretty much the sweetest, most compassionate and no-nonsense midwife you could have.

Over last week's Sunday Brunch, Christy shared with us her experiences working at St. Francis Medical Centre, a mother-oriented hospital in Minnesota. This week she discusses the need for patient advocacy and her daily, woman-to-woman work in counteracting society's misconceptions about birth and the female body.

Gero apetito!

– Svea Boyda-Vikander
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SV: In the first part of this interview (click here to read) we talked about some of the amazing (well, they should be standard practice so maybe I should say, unusual?) policies your hospital implements. I'm wondering what proportion of women feel good about their births on leaving your hospital?

Water birth is amazing.

CA: When surveyed, most mothers, around 91%, would recommend our hospital to other women. I think most women have positive thoughts about their births with us though of course this is only a guess. I think introducing water births significantly increased the percentage of women who have positive experiences. If I had to estimate maybe something like 10-15% of women are disappointed in some way of their birth experience. Sometimes that has to do with having very rigid expectations of exactly how their birth will go, or not being open-minded about the fact that birth is unpredictable.

SV: Is the idea that it will go according to a plan the biggest misconception about birth that you've encountered?

CA: Not really. The biggest misconceptions are in regards to pain. Our society tells women that this is an extremely painful event and that it will be just horrible and that their bodies might not be able to do it. In reality, it is something that while intense and requiring a lot of concentration and effort, will not last long compared to the length of their life. Not to mention it can be one of the most empowering moments of their life. There are many ways to manage the intensity of pain through non-pharmacological and/or pharmacological options.

(ed. note: The book 'Water Babies' pictured above describes the work of Igor Tjarkovsky, a Soviet crazy-man who thought babies should spend most of their time in the water. Strange and all, but we have to give him props for bringing water birth to the West.)

Sims, the good doctor, is depicted
preparing to perform forced, unaesthetized
reproductive surgery on a female slave.

SV: I think Obstetrics medicine itself has a lot of these misconceptions embedded within it. Maybe this reflects its spotty history – for example, the man commonly credited as “the father of gynecology” performed forced unanasthetized hysterectomies on slaves in the American South. I wonder how this past has influenced the field today.

CA: It can change from patient to patient and hospital to hospital. In fact, patients have a lot more rights than they are familiar with and actually advocate for. I've seen patients work in partnership with a midwife a little more often than I have with a doctor. Perhaps this has something to do with the power dynamics from the history of medical care, as you said. Often patients with a doctor as provider will just do anything and everything the doctor says without any questions. This is very frustrating when the patients don’t even know how to advocate for themselves. Sometimes the patients don’t like or trust their provider but have no idea that they can transfer care to another provider or clinic.

SV: What are some of the most common mistakes women and their families make in preparing for birth?

CA: Over-preparing for birth, self-diagnosing via the internet, thinking that losing your mucus plug means you should rush to the hospital, and coming to the hospital too soon. An educated patient is better than an ignorant one but it’s important to remember that experiences written in books are just one of many paths or outcomes that can happen in labor. Sometimes, a woman will lose her mucus plug minutes/hours/or weeks before birth. This is normal. Most often it means just that: you lost your mucus plug and you will eventually have your baby! Whereas having your water break is a sign of imminent labor, this distinction is often lost on first time mothers. 

Lying on your side? Not if your bathtub is this bathtub.
But who owns this bathtub?
(I want this bathtub!)

 Often women are not well-educated on when to arrive at the hospital. They can stay home as long as they are comfortable. Our suggestion to patients is not to come to the hospital until their contractions are 3-5 minutes apart (timing from the beginning of one to the beginning of another), where each one lasts about 60 seconds, when this has been going on for over an hour and the mother has to stop and breathe through the contraction. If this is going on, it's good to get into the tub at home and get as much of your belly submerged as possible. This often involves lying on your side in a traditional tub. If the contractions get better and go away, this is just early labor. If they continue and get worse you are probably in active labor and ready to come to the hospital if you wish.

SV: Can you share a particularly heartwarming or funny anecdote from your work?

Crowded waiting room, 1950's style.

CA: I picked up an extra shift for a Friday night. I showed up at 11pm and they told me there was a patient waiting in the family lounge for a room to be cleaned. I checked and it was ready so I went to get her. Once I looked at her and then at her chart I realized that she was only 16 years old. Not only that, but the ENTIRE family lounge was full with her family and friends. I went to the room with her and we went through her admission. After that we had a long discussion on what her preferences for birth were. She preferred to only have her mother, sister, and father of the baby (fob as we call him) in the room with her. She preferred to have an un-medicated birth if at all possible.
 Upon hearing this I knew I needed to get these people involved in her birth process to help me support her because at this time she was only 4 cm dilated but in active labor. I was able to show her mother and the father of the baby how to massage her while she was on the birthing ball. After a while we changed positions and she walked the halls for a while, squatting when having contractions.
 I could tell she was progressing and now starting to work harder with her labor so I suggested we get her in the bathtub. She spent some significant time in the tub with the lights low, some flameless candles on, quiet music on, lavender essential oil on a cotton ball near her and her family next to the tub with her supporting her through each contraction. After a while she wanted to get out of the tub. At this point she was 8 cm dilated.

In case you were wondering what 4 and 8,
and 9.5cm dilated looks like!

She got into the bed and I showed her family how to push on her knees to help release some of the back pain she was having. She began to involuntary push at this point and had progressed to 9.5 cm dilated. The little bit of cervix that was left was on the anterior side so I had her flip to her hand and knees. In this position she started to get a bit nauseated, she vomited, her water broke and she was fully dilated.
She pushed about 20-30 minutes to deliver her baby boy over an intact perineum. She had complete control while pushing and listened so well to just breathe when her body was stretching. I have never been so proud of someone in my life. She delivered at about 3:30 in the morning so in only 4.5 hours she dilated 6 cm, and pushed her baby out. She did it just the way she wanted to, with her family all there and supporting her. It is amazing what a woman/teenager can do with the right support! I feel so good about being there for her and showing her she was able to do it.

SV: That's a great story. I have goosebumps. I feel this is the kind of birth experience we should all have access to – but when you're part of a marginalized population (being a young mother, for example), so much choice is taken away from you. To sum up, what has working in this field taught you?

Little children are so good at surrendering.
The average grown-up needs a little support.

CA: Patience, how to work well with others, the amazing power of the female body, that the mind might trick you while in labor. Just at the point when you feel as though you can’t go any further or any longer, this is when you need to continue as you are getting close to the end. Often, if I can get a patient to believe me when I tell them this, then surrender and go with the process, they will deliver quickly. It's a beautiful process and I feel honored to be a part of it.

SV: Thank you so much for sharing your education and experiences!

August 6-12th: OB Nursing, Extended Breastfeeding, Petting Zoos

New this week...

OB nurse extraordinaire (and future midwife-in-training) Christy Anderson discusses the forces that brought her to the placenta-eating dark (crunchy) side. Her Sunday Brunch interview has been so popular, she's coming back next week to talk more babies, birth, baby-friendly hospitals, and how she can just tell a woman is in transition.

In honour of World Breastfeeding Week, Svea collects 11 of the most popular objections to extended breastfeeding and applies them to herself. Breastfed until over the age of 3, she has undoubtedly become the friendless misogynist perv these concerned citizens predicted.

It's a flashback to the 1980s on Too Hot For Stroller, where a young mama takes her kiddos to the petting zoo, managing to look awesome while keeping her baby from the nuzzling mouths of sheep.

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.