What I wish I could tell young pregnant me...
Your provider and nurses are influential for better or worse...
Specifically in the hospital setting.
With both of my pregnancies, I did not feel like I had much of a choice in who my care provider would be once birthing time came. I was with Kaiser: a big medical complex with a very large pool of midwives and OBs. I saw the same OB throughout my pregnancy, but I didn't expect to see her on the big day. The chances were slim that she would happen to be at the hospital on any given day.
This didn't phase me. I'm a very independent person, and I felt confident enough that my body knew what it was doing. I underestimated how influential the staff I was assigned could be.
I had a very long labor which I was working through without medication. It was harder than I imagined, and much longer, but I was doing it. It didn't help that I felt unsupported by the various nurses I had. My husband was great and I felt safe when I was alone with him, lights dim, in the quiet room. Unfortunately, it seemed as though the nurses that were assigned to me were unfamiliar with unmedicated labor and would come in, turn on the lights, and try to talk to me during a contraction, even, at times, when my husband told them to wait. When I got an irresistible urge to push very early, I didn't know what to do, and the nurse at that time could only tell me, don't push, which felt completely impossible. My husband did his best to advocate for me, short of asking for a new nurse. At the time, we didn't think of this, and now I let my clients know this is always an option.
Since then I have worked alongside many wonderful nurses and nurses that know how to support unmedicated labors. With my 2nd birth, I prepared afresh with added life experience and this time, I specifically prayed for a wonderful birth team. I had an entirely different, more supported, unmedicated hospital birth experience. In addition to praying for a great team, I actively worked to foster a positive environment in the room, bringing goodies to show appreciation for the nurses. I was able to hire a doula to be my constant support, knowing I could not count on the busy nurses for this.
Nurses are with you much more than your OB during hospital births, Still, your OB has a huge influence on how you give birth. One profound way I see OBs influence birthing, is at the pushing stage. Oftentimes, this is when you see your OB, just right before birth. In the hospital, the traditional pushing position is in a semi reclined position with your feet in stirrups. This is a position that has become popular due both to the use of epidurals, which make it more comfortable, and for the easy access for the attending provider to "catch" the baby. It is not the most beneficial position in terms of making the widest possible space in the pelvic outlet for baby, and is not typically a favored position by unmedicated moms following their natural instincts.
Many OBs and nurses coach pushing almost exclusively for people who receive epidurals, which impacts your ability to push instinctively. This had lead to the prevalence of coached "purple pushing" when you are instructed to hold your breath for 8-10 seconds and push with all your might as many times as possible during a contraction.
The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization, both recommend spontaneous pushing:
When not coached to breathe in a specific way, women push with an open glottis [with breath]. In consideration of the limited data regarding superiority of spontaneous versus Valsalva pushing, each woman should be encouraged to use her preferred and most effective technique. ACOG
Because stirrup positions and purple pushing are still standard practice in most hospital births, it's super important to talk to your OB ahead of time about how they support their clients during the pushing stage, specifically if you want an unmedicated birth. I am deeply touched when I see providers who support mothers to follow their birthing instincts to the very moment of birth. It should always be this way. From my personal experience and at this point in time, this is rare in the hospital setting. I was blessed during my 2nd son's birth to be supported by a wonderful hospital midwife who was comfortable with me pushing on my side as I instinctively desired.
Midwifery care is generally more mother centered. The midwifery model sees birth as a natural physiological process, that is usually best left undisturbed, whereas the medical model sees birth as a pathological event to be monitored and managed. This is why it is so special and rare to see an OB that is truly mother-centered in their care.
It is my adamant belief as a mother and as a doula that mothers should birth the way that they choose, with a caring team of professionals who not only want to keep mom and baby safe and healthy, but who also support the mother's wishes and instincts. These wishes and instincts should not be superfluous to the provider's protocols and assessments. They should all be weighed together and the decision should always be the mother's.