Can "Love" work as an advocacy skill?
“Love” is an advocacy skill that we teach in the Evidence Based Birth® Childbirth Class. It’s probably the most impactful to the overall satisfaction of your birth. When we feel safe, supported and loved, our bodies labor better and we have a more positive memory of our birth - even if it didn’t go the way we had hoped.
The Iceberg analogy is a perfect metaphor for the small amount we show the world, and what we keep under the surface that can bubble up at any time and seemingly come out of left field to those around us. We all walk into the hospital with the hope that our nurses, midwives, residents will be our strongest advocates. The statistics tell us otherwise. Research shows that in a typical shift, the RN is in your room about 30% of the time, and half of that is spent charting and attending to other tasks that are important to your safety.
I like to use the flight attendant analogy here to highlight the conflicting roles nurses have at the bedside. Flight attendants are on every plane for our safety first. That is their primary job and while our comfort and satisfaction are at the top of our list, their tasks require they always keep an eye to safety. So, when we snap because they didn’t bring our drinks in a timely manner, their frustration can show when we treat them as if our nourishment needs should be higher up on the priority list.
We have to remind ourselves that serving us drinks, or fixing the failing WiFi is not the flight attendants primary task. But that can be hard to remember when we have a great deal of our own iceberg bobbing under the water as we move through the airport like cattle and cram ourselves into a seat next to someone who takes up both armrests. Air travel can make it very easy to take our our unhappiness out on someone else - and we all know flight attendants deal with that every single day at 35,000 feet.
Nurses are no different. They have a huge list of tasks and eyes that need to be everywhere at once. They have a condescending doctor or emotionless charge nurse telling them to go in and start your IV or check your cervix. She catches your wrath when you say “not right now” and she responds with “Well, it’s hospital policy” or “Your doctor has ordered this”. Why does she do this? Well, maybe because she’ll get in trouble from the doctor or the charge nurse if you decline. Maybe because your bark isn’t as bad as the staff’s bark on the other side of those doors. Long story short, there may be more to her answer or actions than what she’s showing you, much like the size of that iceberg under the surface of the water. Just because we don’t see it doesn’t mean it doesn’t exist.
Consider what your nurse, or midwife, or resident has to deal with. They have orders coming from the top, and orders coming from “the bottom” (yup, that’s us at the bottom of this top-down hierarchy of care). These “middle care-givers” are stuck in the middle, rarely able to make everyone happy. Let’s add that maybe your midwife was up all night breastfeeding her own newborn before coming on shift. Maybe your resident has a sick relative hospitalized with COVID. Maybe your nurse’s partner lost their job and she’s pulling double shifts to make ends meet. If we knew all of those things, would we treat that person differently? Would we show them some compassion and kindness? I bet you would.
So what’s a laboring patient to do? Well, show that hands-on care-giver some LOVE. Give your nurse a reason to WANT to go to bat for you. The more we treat them like the humans they are, the more the iceberg begins to melt under the surface. The more we show that care-giver the kindness and respect we want for ourselves, the more you’ll melt hardness that can come from being treated so poorly at the nurses station. They have a calling to help others somewhere in their soul. Even if you don’t see it today, caring is still part of their nature. It’s somewhere in there, we just have to melt the iceberg with LOVE to lure them into being partner in your care. And she’ll do it because she “wants” to, not because she “has” to.
I can speak from experience. When I’m with fun clients who are kind, respectful, create a warm, home-like environment in their room with twinkle lights, lavender scents, and relaxing playlists, the more inclined the RN is to stay with you. “It’s so peaceful in here”, they’ll say. That’s what we want! Truly supportive care. Make it worth her while to give you her best. If we’re barking our wants and needs at her every time she walks in, why would she have any motivation to help you?
“Okay Jen. That all sounds good, but no way does that really work.” Um…. YEAH it does. As an RN myself, I’ll tell you that the environment I just described above was exactly the kind of rooms I had a very hard time leaving. I wanted to stay because nice patients made my shift. The demanding ones… did not. The demanding patients came in with their guns a-blazing and just assumed I was the enemy. Little did they know I was their best friend in labor, but they lost me at “Hello”. I was going to be their strongest advocate, until the partner snapped into the air to get my attention, “Nurse, my wife needs juice?” Right there, that partner showed me what they thought of me and my presence. I didn’t even have a name.
I’m going to give you some pointers to show some LOVE to that nurse, or midwife, charge nurse, or resident. Anyone who can be that middle caregiver between us and our providers are often trapped in no-win situations. Just try these suggestions. I’ve seen them melt the most frigid of nurses. I’ll admit, as a doula, I’ve traveled around my region to find some that I’m ashamed to say have the same letters behind their names as me. You won’t win them all. Some have been beaten down beyond repair and will simply not melt. That iceberg is just too deep. For the most part, your nurses and direct hospital care providers (like midwives and residents) have their hearts in the right place, but maybe are just having a bad day, or week, or year (2020 has scarred us all a little bit).
Try these suggestions. I promise they work because I see it myself with every birth I attend:
Learn your caregivers’ names. If they didn’t properly introduce themselves before they started talking at you, “I’m sorry, I missed your name. My name is John and I’m Sarah’s husband”. Model the behavior you want for yourselves.
Once you learn their name, address them by their name, not their role. We don’t want to be referred to as the “Gestational Diabetic in 31” and they don’t want to be “Nurse” or “Hey”.
Partners - make eye contact when a provider comes into the room. Stand up if you’re sitting in a chair far away from the bed (because she has an epidural and doesn’t need your hands-on support), and stand next to your laboring partner and make yourselves part of any conversation that needs to happen.
Say please and thank you. Duh, but it needs to be said. And be corny - I say this with every new caregiver who enters the room, “Hi, I’m Jen and I’m Sarah’s doula. Thank you so much for taking care of us today.” Not hard, not fancy, but thanking someone for something they haven’t done yet makes them want to meet your expectations
Gifts of service. This can be as simple as your doula cleaning up all the dirty linen from the floor after a position change in bed, or asking your nurse, “I’m going down to the cafeteria. Can I grab you anything?” Or “My mom is bringing Chipotle to the hospital lobby. We’d love to treat you to lunch if you’re interested” She’ll always say “no” and it IS the thought that counts.
Bring treats. Bake some muffins or cookies as an early labor project and bring a plate to the hospital for the nurses to share in the lounge. The fastest way to a nurses heart is through her stomach. Trust me on this one. Whatever you make will go. Or bring in individually wrapped, store-bought treats to keep in your room with a big sign to every caregiver to take one on the way out. You’ll have nurses clamoring to take care of you just for a cute cookie.
Ask your caregiver about themselves. This doesn’t have to be invasive. A super simple one is, “Do you have any kids?” or “What were your labors like?” I also make note of accents and love to ask people where they are from. Whether it’s a NY dialect or a German accent, get them to talk about themselves. Research shows time an again that we endear ourselves to people who care enough to ask us about ourselves.
Use touch to humanize the process. Yes handshakes or a touch on the arm are a thing of the past, but I’ll make a joke and shoulder bump that RN standing right next to me as an exclamation point. It’s that human connection. It shows your desire to share this experience with her in a meaningful way. Trust me when I say L&D nurses have a really good sense of humor. If you have a funny bone, use it. It’ll put everyone at ease, including the birthing person.
Write a thank you note. Take notes of every nurse and midwife you met. Every resident who was involved in your care. Write them a note (with names) about how they had a positive impact on your experience. Will this help your situation? Nope, your birth is done. But that nurse just came on shift after having a fight with their partner and they’re grumpy. They see your card with her name sitting in the lounge, and you just gave her the perfect hug when she needed it the most. Guess who will benefit from that - the patient who she’s about to meet to help them birth their baby. She could have entered grumpy, but now she’s entering with a smile and the person after you benefits. This is a prime example of paying it forward.
We’ve gotten away from human kindness. I challenge you to “Go high when they go low”. You won’t win them all but what have you got to lose? You get what you give. I have watched nurses step in and advocate for my clients in ways I never though imaginable, all because we gave her a cookie, or kindly asked, “We can see how busy you are. No rush but when you have a free moment, can my wife have some juice?” It’s so easy. Try it. I can almost guarantee you’ll get so much back in return.