5 Things Labor and Delivery Nurses Wish You

Knew
You Can't Really Plan Birth
No, most nurses don't hate birth plans. Well, maybe just a little bit.
"They are good in theory," says Krystal B.*, a Dallas-area RN who has worked in labor and delivery and is
now an antepartum nurse. She explains that it's great for any woman to have an idea of how she wants to
experience labor and delivery, but if you use a birth plan, it's important to stay flexible and realistic.
When preparing a birth plan, begin by talking with your health care provider, says April Boney, RN, nurse
manager for labor and delivery at St. Francis Medical Center in Monroe, Louisiana. "One of the biggest
problems we see is that parents arrive in labor with a birth plan that nobody else has ever laid eyes on,"
says Boney. "There might be something in there that the obstetrician doesn't agree with, or the pediatrician
doesn't agree with, or even something that we can't carry out due to state laws." Your health care provider
will also be able to help you become informed about the policies of the hospital or center where you'll be
birthingpolicies which affect how much of your birth plan is actually possible.
Remember that birth itself is not predictable. "Your birth plan needs to take into account that things happen
during birth that you can't plan for," says Boney. Sometimes, plans must be set aside to protect your health
and the health of your new baby.
*Asked to be identified by first name and last initial only.

You Can (and Should!) Prepare

The nurses surveyed all agree: in childbirth, knowledge is power.
"Almost any class is worth the effort," says Sara Pickett, BSN, a Chicago-area nurse. Pickett worked in labor
and delivery while stationed at the Naval Hospital in Okinawa, Japan. She also taught childbirth education
classes for two years.
Childbirth classes can help new parents get a realistic idea of what to expect from their labor and delivery.
"No matter how many episodes of ER or A Baby Story you've watched, taking a class at your chosen facility
strengthens your knowledge, both about the birthing process and about policies at that facility," says Krystal
B.
Boney recommends what she calls a "true prepared childbirth class." Often lasting four to six weeks, the
best classes are small and very interactive, and are helpful to both parents. In addition, says Boney, "Make
sure the childbirth class that you attend talks about variations in childbirththings that could go differently
from what you expected, such as having to have a C-section."
Expecting couples may want to consider taking classes in more than just giving birth. For first-time parents,
a newborn care class is often helpful. And if you're planning to nurse your baby, a breastfeeding class is a
great idea.

Be Open to Controlling Labor Pain

Want an unmedicated birth? No matter what you may have heard, "going natural" is indeed a realistic option,
according to Norma McClary, RN, BSN, and a labor and delivery nurse at Florida Hospital in Orlando. "It is
harder for first-time moms, though, because of all the 'unknowns.' They aren't always as relaxed as women
who have been through labor before."
If you desire an unmedicated birth, prepared childbirth classes are a must. In addition, McClary advises her
patients to keep an open mind. "Sometimes patients come in saying, 'I do not, do not, DO NOT want an
epidural,' and then if they decide they do want it later, they are setting themselves up for what they may
perceive as a failure."
"Don't put those kinds of boundaries on yourself," says Pickett. "That's when you get let down."
Being flexible is a good idea even if you haven't the slightest interest in natural childbirth. Unfortunately,
epidurals aren't given in the hospital parking lot! You may have to cope with a littleor a lotof pain before
you are able to receive an epidural or other pain medication. And pain meds aren't always foolproof. It's best
to prepare yourself by taking a childbirth class, where you can learn non-medical methods of coping with
pain. "Know what you think you want," says Pickett, "and then be ready for anything."

Communication is Key

"[Nurses] are essentially an intermediary between the doctor and the patient," says Krystal B. "It's our job to
carry out the doctor's orders while acting as an advocate for the patient, which can be a challenge." This job
is easier when patients are prepared, realistic, andbelieve it or notready to ask questions.
Boney recommends patients ask about anything that makes them feel hesitant. "Start by asking, 'Is this an
emergency, or do we have time to talk about what's going to happen?' Of course, if you are then told, 'No,
it's an emergency and we need to do this now,' then you know the staff is doing what's best for your baby."
says Boney. "But if your nurse says, 'No, it's not an emergency, I can explain it to you,' then you can ask,
'How is this benefitting my baby or my labor? Why are we doing this?' Ask about the pros and the cons, and
ask what would happen if the procedure in question was delayed a little bit."
Also, listen to what your nurse has to say. "Your nurse went to nursing school, and if he or she asks you to
do something, such as change positions, it won't be for his or her selfish reasons," says Krystal B. "There
may be times when your nurse comes off as abrupt, but please remember they are there to help you and
assure the best possible outcome for you and your baby."

Poop Happens
If you've never given birth before, you may be feeling a little inhibited about labor. But don't worry; your
nurse has seen it all. Pooping on the table? Yes, it could happen to you! "If that happensand it happens a
lotit just means you are pushing the right way," says Pickett. "It's no big deal, and most women don't even
realize they've done it," adds Krystal B. In fact, once you're in advanced labor, you're probably not going to
care who is in the room, what you say, or what you do.
Most labor and delivery nurses are pretty tough. "They are used to being screamed at, yelled at; that is just
a part of childbirth," says Boney. And if you do or say something that you really have regrets about later?
"Don't be afraid to apologize," says Pickett. "Nurses are human too."
Finally, keep in mind that no matter what happens during your labor, in the end, it's the outcome that's really
important. "To your nurse, your healthand the health of your babyare the first and foremost concerns,"
says Pickett.

12 Ways to Relieve Pregnancy Back Pain

Approximately 70 percent of all women experience some degree of back pain and pressure during their
second and third trimesters, according to a study published in 2004 in the journal Obstet Gynecol.
Strengthen, soothe, and support back muscles with these 12 medication-free strategies for back pain
relief.

Note: Before trying any of the methods outlined here, first check with your obstetrician or midwife.

Good Posture
Why it works: A bulging pregnant belly shifts your center of gravity out from your body. Often without
realizing it, you let your lower back be pulled forward into a swayback posture, making back muscles short,
tight, and painful. Standing up straight allows muscles to naturally lengthen and stretch, making good
posture one of the easiest "exercises" for easing lower back pain.
How to do it: Arrange your different body parts in perfect alignment from the top down. Roll your shoulders
back and lift your rib cage. Position your head so your ears are in line with your shoulders. Contract
abdominal muscles (feels like drawing your belly button closer to your spine) and flatten your back to
position hips. For better support and balance, stand with your knees slightly flexed. "Maintain this position by
imagining a cord pulling you from above," says Amanda Larson, a physical therapist and prenatal yoga
instructor in Portland, Maine.

Lower Back Extensions

Why it works: Abdominal and back muscles normally work together to support your body's midsection. As
abdominal muscles become increasingly lax in order to accommodate a growing uterus, back muscles
compensate by working much harder. Lower back extensions safely strengthen back muscles during
pregnancy, making their tough work a little easier (and less painful for you).
How to do it: Get down on your hands and knees. Larson recommends placing an exercise mat
underneath you for comfort and support. Keep your elbows slightly flexed (not locked) and your back
straight. Extend your right arm out in front of you at shoulder height. Extend your left leg out behind you at
hip height. Contract your abdominal muscles. Hold this position for five counts, advises Larson. Repeat
10 to 20 times on both sides.
For best results, start performing this exercise early on in pregnancy.

Prenatal Yoga
Why it works: Prenatal yoga is a relaxing way to tone parts of the body most affected by pregnancy,
including the back. "Almost every yoga posture I teach engages back muscles, providing a gentle but
effective workout to stretch sore muscles and strengthen the lower back," says Larson.
How to do it: Can't make it to class? Get pain relief fast with child's pose, a very basic yoga position. Kneel
on the floor with legs spread apart. Sit back on your heels. Tuck your chin down to your chest, and with arms
extended, bend forward until your forehead, forearms, and elbows are resting on the floor. Your belly should
easily fit between your legs. If not, spread your knees wider. Hold this stretch for up to one minute. Breathe
naturally. Adds Larson, "This position promotes relaxation and can instantly relieve lower back tension."

Pelvic Tilts
Why it works: Pelvic tilts (also called "pelvic rocking") strengthen abdominal muscles, relieve backache,
and help improve posture. "Abdominal muscles do relax somewhat during pregnancy, but keeping them
toned can still go a long way in alleviating back strain," says Larson.
How to do it: Get down on all fours. Keep your elbows slightly bent and back flat (visualize your back as a
coffee table). Contract your abdominal muscles and rotate your pelvis so your tailbone is pointing toward the
floor. Hold for a count of five and then release. Repeat 10 to 20 times. Pelvic tilts can also be done lying
down on your back (until the 20th week of pregnancy) and leaning against a wall, using the same basic rock
and hold motion.

Swimming/Water Exercise
Why it works: Take a dipand take a much-needed break from back strain. Because water supports your
weight, swimming and prenatal water aerobics classes relieve pressure from your back and joints while still
giving you a great whole-body workout.
If you just want to give your aching back a break by floating around the pool in your cute maternity bathing
suit, that's OK, too.
How to do it: Some hospitals have their own fitness center swimming pools; your health insurance might
completely or partially cover the cost of pool access at these facilities. Check your insurance policy to see if
you qualify for a discount at health clubs or YMCAs in your area offering prenatal swim classes. If not, many
health clubs offer a lower monthly rate for pool-only privileges.

Acupuncture
Why it works: A mainstay of traditional Eastern medicine now commonplace around the globe, acupuncture
places thin, sterile needles at specific "energy points" in order to activate the body's own natural pain relief
system. How effective is it? In a 2007 study published in the journal Cochrane Database of Systematic
Reviews, it was discovered that 60 percent of women who received acupuncture for both back and pelvic
pain reported less intense back pain, compared with 14 percent of women who did not.
How to do it: Find an acupuncturist experienced with treating pregnant women or ask your doctor to refer
you to a medical acupuncturista physician trained in the art of acupuncture (bonus: your insurance might
cover visits with a medical acupuncturist). Expect the acupuncturist to insert needles into your skin that stay
in place for several minutes to an hour. (Does it hurt? No more than a slight pin prick, say most acupuncture
patients.) Pain relief can be immediate or take several visits to achieve.

Chiropractic Care
Why it works: Chiropractors adjust misaligned joints, especially in the spine, to relieve nerve stress and
promote healing throughout the body. Does it work? According to medical researchers in Sweden,
chiropractic care is extremely effective in treating pregnancy-related back pain. And a 1998 study published
in the journal Obstetrics and Gynecology found that 70 percent of pregnant women receiving chiropractic
adjustments achieved long-term relief from pain.
How to do it: Chiropractors use hands-on pressure to gently adjust spinal misalignments. Seek out a
chiropractor experienced with treating pregnant women or look for a member of the International
Chiropractic Pediatric Association, a certifying organization for chiropractors specializing in prenatal and
children's care

Lumbar Support Pillows

Why it works: Does your desk job require you to sit for hours? Good posture is just as important while
sitting down as it is when you are standing upright. Keep your head and shoulders in line and use a lumbar
support pillow (a small pillow specially designed to fit the lower back) to keep your back properly positioned
and pain-free.
More tips for the office: Lumbar support pillows can be purchased at most medical supply stores or online.
Also consider picking up a footstool to keep under your desk, as leg elevation while sitting can also ease
back pressure.

Supportive Sleep Environment

Why it works: When backache persists after you are in bed for the night, shift your body into a more backfriendly position. Sleeping on your side and using strategically placed pillows for support can provide relief
from aches and pains, and help you get some much-needed rest.
How to do it: Lying on your left side, keep your neck in line with the rest of your spine by using a firm pillow
for your head. Place another pillow between your legs to relieve pelvic and back pressure. Finally, tuck a
small pillow beneath your tummy to prevent a heavy belly from pulling your back forward as you sleep.
According to research conducted by Dr. Darryl B. Sneag, AB, and Dr. John A. Bendo, MD, using a wedgeshaped pillow will yield the best results.

Angry Cat Stretch

Why it works: It's not just your lower back that can cause you pain during pregnancy. As your breasts
become fuller, added weight in the chest area can pull at your upper spine, creating painful, pinching
pressure. The "angry cat stretch," another movement borrowed from prenatal yoga, relieves upper back
tension.
How to do it: Get down on your hands and knees. Keep your back straight. Gently drop your head and
round your back (like an angry cat). You will feel this stretch in your upper back. Hold for about 10 seconds
and then return to your starting position.

Maternity Support Belt

Why it works: These thick elastic bands worn around the hips and under the belly cradle and support lax
abdominal muscles. Especially helpful if your job requires you to stand for long periods of time, wearing a
maternity belt can improve posture and decrease lower back pressure. Some women say they can't get by
without one!
Which one to buy: Maternity support belts come in all shapes and sizes. Keep it simple with a single band
slung around the hips or choose a model with bust and shoulder straps for all-over back pain relief.

Regular Physical Activity

Why it works: Pregnancy-friendly workouts such as brisk walking, riding a stationary bike, and prenatal
aerobics can tone and strengthen the entire bodyincluding the back. Another important reason to exercise:
It burns calories. Because packing on excessive pounds during pregnancy contributes to back pain, regular
physical activity lets you eat for two while still keeping gradual pregnancy weight gain on track.
How to do it: Be sure workouts always include five- to 10-minute warm-up and cool-down periods. Warming
up is especially important during pregnancy because looser joints and tendons are more susceptible to
injury. If you are walking, start off at a slow pace to gradually increase blood flow to muscles and prepare
ligaments and tendons for the work they are about to do. At the end of your workout, ward off muscle
stiffness and soreness by gently stretching back, arm, and leg muscles