Speaking of Communication...

Some people are just more skilled at (or creative about) it than others.

I am a very concrete thinker, and that comes across, sometimes too bluntly, in my communication style. Tact is not one of my finer skills...and that gets me in to hot water when I'm working with friends and families of laboring mothers.

We have a "three visitor" rule where I work...by policy, we allow only three people in the room during labor and birth. We're a major high risk referral unit...that floor is absolutely hoppin most of the time, and with a lot of our patients, it means we have to move fast at times...and there are a lot of us in the room doing it...so we can't exactly have everyone from Great Grandpa, down to big sis's latest newborn progeny in the room...either someone's gonna get trampled, or precious minutes are going to be lost that can mean the difference between a good or poor outcome. BIRTH IS NOT A SPECTATOR SPORT. For those whose hackles I raise when I say this, let me tell you that, at nearly every labor I have attended where a huge conglomeration of family and friends hung around during labor, most, if not all of the crowd were gone...vamoosed...as soon as Junior or Juniorette made his or her way past Mom's perineum...seriously...most people seem to just want to get a goggle at the emergence of this little alien from the mother's body, and then the show's over...they are out of the room before Mom is even out of stirrups (yes, they use them where I work, I hate it, but it's just how they do it), leaving her and her partner (if there is one...I have often see a family leave a mother totally alone) still dazed about what has happened to them. So, I don't think I'm being unreasonable when make that statement...because, more often than not, that's exactly how the onlookers are treating the situation.

It's also difficult to enforce this policy when Mom is sick. For example...when Mom has preeclampsia. The high blood pressures that a mother can experience with this illness can deprive her brain and nervous system of oxygen...when we treat a mother for preeclampsia, we're only buying time until we can effect a cure the only way that it can be effected...by ending the pregnancy (more specifically delivering the placenta, which is where current thought leads us to believe the problem originates, and of course, if the placenta is coming out, so is baby). In the mean time, Mom is at risk for seizures; so we keep the lights and noise down in the room, so as not to add to the problem of an already overstimulated nervous system. It doesn't help things when there are half-a-dozen or more family members, some of them with cranky toddlers in tow, coming in and out of the room, talking and laughing, eating, schmoozing, switching on the lights and television, and in general, acting like they are at a social event.

Over and over again I've explained to families, as gently as I can, why we need to keep the room clear of debris and extra bodies, so that, if need be, we can move fast...or so that we can keep Mom calm and resting. Things will quiet down for a while, and then, little by little, people tend to drift back in, and the noise level drifts back up. What gives? How many times can I explain things? How many signs do we have to post? Do they not believe that the risks I am pointing out to them exist? Maybe it's one of those "for other people not us" frames of mind. I can only guess. Anyone have any suggestions for Nurse Ratched here? I think I'm being nice when I explain. I try to be!

But those are my complaints. Patients and their families have legitimate complaints as well (doh). Sometimes they just aren't "meshing" with their nurse...or worse, the nurse is being a "b*&%$"...it's been known to happen...we all have our bad days (nights), and some of us seem to just hate our job, pure and simple (why these people stay in the job, I'll never be able to understand...I mean, nurses are among the most employable workers I know...there has to be something out there that they would rather do). There have been times on our floor when a Mother or family will ask (pleasantly or not so pleasantly) for another nurse; and we try to accommodate them...but it's not always easy...and sometimes we, probably because we've been asked in a way that we've allowed to get our defenses up, will allow ourselves to believe, and attempt to convince the family that, this just isn't possible (due to staffing, etc).

C. to the rescue...some people are just gifted in this way. Her advice to her Doula clients when a personality conflict (or worse) comes up...send someone out to the nurses station, ask to see the charge nurse, and with a smile and complicit sort of tone, say "I'm sorry to have to ask this, I know you are busy...but...this is so awkward...our nurse looks exactly like (my ex wife or, my abusive mother-in-law, etc.)

Of course, while C. is suggesting this, everyone in the room is roaring with laughter...but how could it not work? I'd move Heaven and Hell to relieve my laboring mother of her current nurse if I thought this was the situation.

Like I've said...some people (unfortunately, not me...I'm still [hopefully] evolving...are just plain gifted.

If only we could all be.