1. Freda, Margaret Comerford EdD, RN, CHES, FAAN, EDITOR

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I've been thinking a lot recently about the different generations of nurses working today. In getting ready for a presentation at an AWHONN convention about Controversies in Childbearing, I've had to consider whether the things that I think are controversial are actually controversial for younger nurses who never worked with women in labor during the 1970s, 1980s, or 1990s, and so have no idea how different things are today. I actually worked in L&D when the epidural was first introduced, when just about every birth was a medicated birth (during the age of "twilight sleep"), when Demerol and scopolamine were given to most laboring women followed by general anesthesia, with resulting total amnesia about labor. I could go on about the atrocities of the "good old days," but suffice it to say that it shocks me to hear nurses my age discuss those days as better than today!!


In the mid-1970s, L&D units opened up to spouses, and the era of "twilight sleep" ended. Women were awake but still wanted pain relief, and various forms of anesthesia (saddle block, caudal block, and then epidural) came into fashion. Of course now the epidural is the most commonly used pain relief for labor. Its use has changed; we used to wait until labor was well established (at least 4 cm) before administering the epidural, but now it is administered earlier. Older nurses question this fact, and a vocal group of older nurses and midwives bemoan the use of epidural analgesia at all. Who's right? Because "birth by appointment," rampant inductions, and increasing cesarean birth rates are common, does that mean that perinatal nursing has failed the women it serves?


I say absolutely not!! Perinatal nursing is about so much more than the technology. Yes, nursing in a perinatal setting must deal with the high tech, but we also have our secret weapon to use-high touch, intelligent nursing care delivered by well-educated and well-informed nurses of the 21st century. Despite the things we read in nursing journals lamenting epidurals and oxytocin, the reality is that only a small minority of women desire a natural, medication-free, and technology-free birthing experience. Most women have no interest in that model. They want all that today's technology has to offer them, and we are obligated to provide them with comprehensive nursing care that teaches them what to expect and supports them through the birthing process.


Intrapartum nurses shouldn't be made to feel bad about what we do. We need to speak up and answer those who tell us that childbirth should go back to what it was in some distant past, and we need to be proud of the care we give in today's technology-intensive world. Yes, inductions and cesarean births are common. Medical practice has embraced this highly medicalized version of childbirth, and our job is to help women give birth in the most satisfying way possible for them. Can nurses change what is happening in obstetrics today? Can we reduce inductions and cesarean births? I doubt it. When women choose a physician as their provider, they develop an 8- or 9-month relationship with them. They need to have trust in what their doctors tell them. We only meet the women as they are admitted to a hospital. It is unrealistic to think that we can-or should-disagree with their choices for a birth by appointment. We need to listen to the women who come to us for care, and help make their childbirth experience the best it can be, given the parameters they have chosen.


Nursing is different for today's young intrapartum nurses than it was for me. I know that sometimes it's difficult for older nurses to adapt comfortably to those changes, but in the end, our job is still the same as it always was. Whether a birth is unmedicated and vaginal, or induced or by cesarean, our only mantra should be "support the woman in her choices and give the best nursing care possible." That hasn't changed.


Margaret Comerford Freda, EdD, RN, CHES, FAAN