Chanie Fingerer from the Happy Birthway podcast joins Dr. Fox to talk about her experience as a labor nurse. They discuss how her own birth experience inspired her to go into labor nursing, her education and training, and what life as a labor nurse is like.
“Labor Nurses: Why they are awesome” – with Chanie Fingerer RN
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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics and women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy and wellness. Chanie Fingerer, welcome to the podcast. So glad to have you. How you doing today?
Chanie: I’m good. Thank you so much for having me. I’m a huge, huge fan. So it’s really an honor.
Dr. Fox: That’s very sweet. I appreciate that. So Chanie, you are a labor nurse. And you now run what you call the Yoledet Academy. And you started a podcast, “The Happy Birthway” podcast. And so you’re all over the place with this, how’s that going?
Chanie: Yes, I am all over the place. It’s good. I mean, I make most of these decisions. Like when I’m, you know, an hour after I drink a coffee and I feel full of energy. And then I sometimes question myself after that, but it’s going well, it gives me a lot of a sense of fulfillment, and allows me to kind of reach further than just my job in the hospital, it allows me to just have more of an impact on people, that I can’t just take care of patients. So very fulfilling and worth it.
Dr. Fox: Listen, I think it’s fantastic. I love what you’re doing. I think it’s very similar to what we’re doing here on this podcast, obviously, from a different angle, which is great. That way women can sort of get information from different sources who look at it, maybe somewhat similarly. But obviously, maybe differently as well, or at least from a different aspect of it. And so I think it’s all really helpful. And I’m curious if you could tell us a little bit just about your background, where are you from? How’d you get into nursing, just in general, and then how you got into labor nursing.
Chanie: I’m originally from Brooklyn, good old Brooklyn, New York, grew up there, got married and we settled down over there, and I had my first baby14 years ago, I can’t believe it’s been so long. And I was in school at the same time, nursing wasn’t really something that crossed my periphery, when I was deciding on career choices. I remember one time my mom mentioned it to me when I was in high school. And I said to her, “Ew, like, nurses work at night, cleaning people’s butts, like, I don’t wanna do that.”
Dr. Fox: I hope that’s not all you do?
Chanie: No, no. No, I mean, I will tell you, I do, that is part of my job.
Dr. Fox: Sure.
Chanie: That was kind of my ignorant impression of nursing. And I kind of went branched out into the social services arena, I was a service coordinator for the early intervention program, which is “The Birth to 3 Program” in many states, where children who are between the ages of, you know, newborn to three years old, who have developmental delays in any area, they come into this program to get an evaluation and see if they’re eligible for any services such as speech therapy, special education, occupational therapy. And because New York City, in particular, has such a strong program, and it’s just such a vast volume of people, right? It’s New York City, super concentrated, they actually have this position of a service coordinator that really I guided parents from the beginning who would call with concerns for their child and we’d go through the whole process of evaluating their child, accessing any extra resources that they may have been eligible for, such as social supports, food stamps, health insurance, Medicaid, things like that.
And then if they were eligible, they stayed on the program. And I maintain them as kind of like, “Okay, 17th caseload,” and kept in touch with them. And it was great work, very fulfilling, but kind of a very narrow reach in terms of this is not a position that’s around in many other places. This is very specific to New York City. So I knew that this was a great kind of stepping stone for me that I was gonna go and do something else. And it was just an amazing experience. But I knew it was kind of a temporary stepping stone.
So now, backtrack a little bit because I was still in school at the time when I had my first child. And just kind of pursuing a generic bachelor’s, wasn’t sure exactly where I was gonna go with it. Just got a Bachelor’s in liberal arts and sciences and started this service coordinator job like I told you. But when I was in school, I had my first child and I had a really bad experience birth-wise. I’m an information junkie. So when I got pregnant, I educated the heck out of whatever I was able to educate myself in, read every book, you know, “What to Expect When You’re Expecting” was the most popular one then. And they go by the month, not by the week. So I would like every single day just read the same month over, and over, and over again. I went through a childbirth education class, then there was really not much in the way of like, online social media supports, I don’t think Facebook was in existence then. But there were like some websites with these forums. So if you were due in March, then you can join a march moms group or whatnot. And I was in one of those kinds of forums. But the problem with that is that there was no one really running it and moderating it so you can get like all this junk science from some random mom’s telling you something that was completely untrue.
So, you know, I mean, it was nice, just to have that kind of, like, extra support. I was one of the first ones from my group of friends to have gotten pregnant to begin with. My pregnancy was pretty, thankfully, very uncomplicated. And I educated, like I said, the heck out of myself. But then when it came to actually giving birth, although everything was so straightforward, and healthy, from an objective point of view, I really was disrespected throughout the entire care that I had. My providers were not very…they didn’t really give me the time kind of and infantilized everything and glossed over any of my questions. And I mean, I educated myself, even though I wasn’t a medical professional at the time.
So when I started asking more in-depth questions they kind of got impatient with me, you know, and told me like, “That’s not for you to worry about or whatnot.” And then, when I finally went into labor, I went into early labor, I was overdue, and I had to come in for what we call non-stress tests, and NSC, just to give the baby some extra monitoring, and it was over the weekend. So it was done in the hospital, not in the doctor’s office, which was closed at the time. And I was in early labor at that time. So the doctor that was on call that day checked me and did a membrane strip at the same time that she examined my cervix, without asking any consent, or anything or letting me know, or, you know, nothing. And just said to me, “Oh, yeah, you’re gonna, you know, things are gonna ramp up now,” after the exam was done. And of course, they had all the classic after signs of a membrane sweep or membrane stripping.
That was, I think, the beginning of just the violations that I felt during my entire care, I just really had a bad experience. And it’s sad, because my, everything went well otherwise. And I go into more depth about this. This is not about my birth story. But looking back with my second child, things got a little bit better. I did some more research.
Dr. Fox: Did you stay with the same doctors?
Chanie: So actually, in the beginning, I did. And then when I started asking certain questions, because I did either even further research when I started asking more questions. And, you know, I had credible sources to back up what my requests were, and the doctors didn’t listen to me and just gave me really, like, absurd answers. Like, when I asked if I can do immediate skin to skin with my baby. I mean, this was 12 years back. So it was kind of more of a newer thing. But we already knew that there were benefits. The doctors immediately said, “No.” And when I asked why, he paused for a moment and said, “Well, because maybe you’ll have a laceration, and I’m gonna have to repair it, and you’ll go out, and you’ll throw your hands up in the air and drop the baby.”
Dr. Fox: Do you think they were sort of, as you say, disrespecting you or not listening to you? Do you think that was just how they operated? How they functioned? Or was it because you were young? Or was it just because they took your questions as maybe in a front to them? What do you think it was?
Chanie: There’s so many factors that…I’m sure all of those things, a little bit of all of those things? You know, I don’t know. And the interesting thing is, is now from my experience, I see that it’s so can not be like that. Like, there’s so many amazing, phenomenal providers, and hospitals and just birth workers in general. And that’s the sad part. You know, I don’t know what it was. It’s definitely cultural in terms of practice culture, where just things are done a certain way. And maybe these were doctors who had been practicing already for decades, and were kind of used to the old way of doing things where we did infantilize woman and just told them, “This is what the doctor says, and you need to obey the doctor and do whatever it is.” And there were no questions asked. And, you know, maybe that was what it was, and they just didn’t want to change. I mean, it’s definitely less convenient to have to listen to your patients and on or maybe specific preferences or whatnot, that they’re asking for. So I don’t know what it was exactly, but it definitely was an unpleasant experience.
Dr. Fox: But you ultimately switched doctors during your second pregnancy.
Chanie: Yeah, so actually, during my second pregnancy, I had come across a midwifery group. And again, this is not demonizing doctors, I hate for someone to think that I did that because midwives are better than doctors, that’s definitely not the case. And everyone has different needs specific to their situation. But I did come across a group of midwives that I had a first consult with and really felt like, they were more open to my request. And I felt like they were, you know, they just respected me more, and answered my questions. And I felt like they gave me the time of day. So they were able to say something like, “Well, of course, yeah, we can do skin to skin, we can let the cord pulsate, do delayed cord clamping,” which again, then was not as popular as it is today. Today, it’s standard hospital policy in many hospitals.
So just, I was really happy. And my experience definitely did improve. However, unfortunately, we know that your OB/GYN provider, whoever it may be, is not the only one that affects your experience, right? It’s the hospital, whatever birth setting you’re having your baby in, and whoever you come in contact with throughout that experience. And a lot of it is out of your control. You can’t choose your nurse, and whoever it is that’s involved in your care, right?
Dr. Fox: Right.
Chanie: You know, that part still had a lot to be desired,
Dr. Fox: Meaning you like the midwives you’re seeing, but the place you’re delivering, you did not get the same vibe from your labor nurse?
Chanie: Correct. Labor, postpartum, the overall experience.
Dr. Fox: Was it the same place where you delivered as the last time, even with the different group?
Chanie: Yep. Yep, it was. And…
Dr. Fox: And it was a hospital?
Chanie: Yes. Yes, it was. It was a hospital birth. Yes.
Dr. Fox: Okay.
Chanie: We always say, “Oh, you’re a consumer.” And not we always say, but I hear this often, I guess, in my line of work, and I definitely do encourage someone who is not happy with their provider to go do the research and not be afraid to switch if it’s not working out. But we do know that there are limitations, there are location limitations, there are health insurance limitations, there are still limitations, and you don’t necessarily have all that control to choose all the factors that are going to affect your birth. You know, it was at the time what was available to me.
Dr. Fox: Plus the midwives that you liked. And these are providers that you like, and so it’s hard, right? I mean, there’s all these variables that go into it, as you said, but ultimately, one of the variables usually don’t have anything to do with that total until the day you deliver. And so if you have this either, midwives or doctors who you love, and you’re really happy with, and they’re taking good care of you. What are you gonna do? I mean, it’s like, it’s hard for you to switch to some other place. And now, the whole process starts over, and maybe you don’t like them as well. And I agree, it’s a tough spot to be in. I mean, obviously, it’d be ideal if everybody were great. And everyone did it really well. But that’s unfortunately, we’re not yet there.
Chanie: Like you said, the providers were great that I had with my second birth. And I have to say that that really did make a difference. Like, when my labor nurse gave me attitude about something, my midwife that was there with me said to her, “No, this is how we’re doing it. And that’s safe. And that’s okay. And it may not be something you’re used to, but that’s how we’re gonna do it.” But even if I got those wishes, the fact that I still felt the attitude and the lack of support for my specific preference, you know, we’re still there, it’s still just not the most ideal birth experience. And like you said, there’s so many factors that are out of our control. And it doesn’t necessarily mean that it’s the fault of any healthcare worker. Just working in a hospital, I see all the different limitations we have all of us in working just, environmental things, in labor and delivery, you just can’t predict things, right? Like I’ll have patients who came in for an external cephalic version, right, to turn the baby while they’re still pregnant to turn a breech baby head down. And in our hospital, the policy is, is not eating beforehand.
And we always have an operating room available in case of emergency which is probably not gonna happen but just in case we like to have everything prepared, including telling them not to eat from the morning, just in case. So what happens when you have three patients that walk in that all are scheduled for a week Caesarians, two of them who are the same provider that is going to do your version, you’re not gonna be the top priority. And unfortunately, we can’t control the fact that the other two are in labor and need to have the Caesarian, right? I mean, this is just an example that happened a few months ago that I can think of. So very understandably, the patient was really upset. Like she hadn’t been eating for hours now. She’d been in the hospital for four hours since she got there, and still did not have her version. And it’s frustrating, right? She may have taken off of work or whatever it is, but unfortunately, there are many limitations to just we’re humans, believe it or not, we’re human. I know. Yeah.
Dr. Fox: So was this experience what led you to go into nursing? You said, “I wanna do this, and I wanna do it better?”
Chanie: Exactly. I said, when I was thinking about what I was gonna do with my life.
Dr. Fox: Other than work and have two kids, you know, other than that?
Chanie: Yeah. Yeah. Well, it’s a self-fulfillment of like, “Where am I gonna take it? What am I gonna do?” Absolutely. After I actually got pregnant with my first I became obsessed with everything having to do with birth, and pregnancy, and postpartum. And babies, and I just couldn’t understand why people didn’t relate to me, like, how could you not be fascinated with everything having to do with birth? And I just became obsessed, and I became the go to for a lot of my friends, even before I went to nursing school, just asking me things and figuring things out and whatnot.
Dr. Fox: So did you enter nursing school knowing you were gonna do labor nursing, specifically, because of all this?
Chanie: Yes. Yes. And that was kind of why I went to nursing school. And knowing what I know now that was like a huge leap of faith on my part, because it’s not the nursing market is really not simple. Getting a job in a very specialized area is difficult. I’m also orthodox, observant Jew. So with my Sabbath observance that added an additional layer of challenge. And that was a huge leap of faith that ended up working out amazing. And I created it all not to myself, it’s like that God seriously, he just set up all the right circumstances for it to happen for me that way. But yeah, I went in specifically, I thought I wanted to be a midwife, that the plan was always to start as a labor and delivery nurse. And I actually am happy that I started out as a labor and delivery nurse, because I don’t wanna be a midwife. I want to have the kind of job that I have now that a midwife doesn’t necessarily have. Even though they’re involved in the patient’s care, there’s just a different…it’s a different role, being a labor and delivery nurse.
Dr. Fox: What kind of training is there? So you have to obviously complete nursing school for you to become a nurse. What additional training do you have to do to be a labor nurse? Is it just your first job is in labor? And then the first X amount of months you’re like an apprentice until you figure it out? Or is there a specific coursework you have to do to specialize in that? How does it work?
Chanie: Yeah, so it’s both. So after I finished nursing school, I took my boards, I became a registered nurse. You have to apply for a job. So you see what’s out there, you apply. And I had been in the process of moving to Connecticut, actually, right when I finished nursing school, which I went to in New York. So I was applying to Connecticut hospitals. And you don’t have to have experience prior to becoming a labor nurse or any specialty, but the training, kind of like you said, apprentice we call it orientation is definitely longer if you don’t have experience in that field. And in general, for a brand new nurse, it’s like you want 30% of what you need to know in nursing school and 70% on the job. I’d imagine that’s kind of the same for medicine and residency, I don’t know, maybe I’m wrong, but…
Dr. Fox: Well, it’s a little different because for medicine, your first job, so to speak, is actually a training program. So you do your medical school, you get your MD, and then you don’t apply for a job, you apply for a residency, which is specifically X amount of years just to train you. So you’re not really considered like, you know, you’re not practicing on your own, so to speak.
Chanie: Right. Right.
Dr. Fox; So for OB/GYN you enter knowing, “I’m gonna be here four years until I can actually take care of patients completely on my own.” Where as was with nursing, it’s sort of done on the job. You’re already working as a nurse, you’re already done. And so it’s a little bit…it’s different in that sense.
Chanie: Right. You’re already working as a nurse, but you’re still under supervision.
Dr. Fox: Sure.
Chanie: So it…
Dr. Fox: How much time is that where you’re like supervised? Is it based on the person or is it pretty standard, like a fixed amount or is it every hospital’s a little different?
Chanie: Every hospital is a little different. I think that my duration was 18 weeks, that was like the standard brand new nursing orientation. And you have a preceptor, which again, I’d liken to like an attending over a resident, right, where the resident is a doctor but still not fully able to practice independently. And of course, that’s the standard. I don’t think it’s ever shorter, because we wanna make sure the nurse is competent enough to practice on their own. But sometimes if a nurse is having some difficulty or whatnot, it may have to be extended, they have to go on leave, or whatever it is. And you’re still never…you know, in my line of work, I’m never practicing independently. Of course, there are providers that are managing the patient. But they’re all of us nurses together on a unit are always just looking at each other’s patients and always bouncing things off of each other, just to make sure that we’re giving the patients their care. But yes, once you finish that orientation that 18 weeks, then you’re officially not a baby nurse anymore.
Dr. Fox: And when did you finish your training? Like how long have you been a labor nurse now?
Chanie: So it’s coming up in June? It’ll be seven years.
Dr. Fox: Wow.
Chanie: Which is crazy.
Dr. Fox: Right. And tell us, what is a typical day like for you as a labor nurse? Obviously, no day is the same, but just on average. So our listeners understand, like, when do you get there? What do you do? When do you leave? How does the day go for you? Or a night, if it’s a night shift, let’s say?
Chanie: Yes, I used to work nights, I’m so glad I don’t anymore, I was just not a person cut out for it. I worked days, I typically worked 12 hour shifts. So from 7:00 to 7:30 p.m. Although it never turns out that way, we always get to work a little earlier. And you have to be prepared for the possible eventuality that you may have to stay longer. Because if a patient needs your care, and there’s not enough personnel, or you have tons of charting to do, after your patient care, because your patient care takes priority, then we’re always prepared for the eventuality that we may end up being in the hospital for 14 hours. And it’s something you get used to, it’s not your typical eight-hour workday, but you just, you know, you can get used to anything.
So it kind of just becomes regular, always depending on whatever’s on the board, whatever patients are there we have, I liken a labor unit to an emergency department, ICU, operating room, and I mean, surgical unit and med surg unit, all in one for pregnant people. That’s how I like to liken it. So you’re kind of, really, you’re having a little bit of everything. So triage are patients that come in with different complaints, and you’re trying to assess whether they’re gonna get admitted or not, we’ll have scheduled C-sections or scheduled inductions, which we call scheduled events. And the night before whoever the charge nurse is, whoever the nurse in charge is, they look at the board, they look at the nurses coming in and they make an assignment. So you come in and you get your assignment, we always go over the entire unit, kind of like I said, we all are working together, we’re all always watching each other’s patients. So kind of just to get an overlay of the lands of what’s going on that day. You know, and then we go about assessing our patients, right, that’s the first thing we wanna do our head-to-toe assessment, looking at any medications that they are due for. We get report from the off-coming nurse who gives us the full lowdown on the patient’s entire situation.
And working in a specialized field like labor and delivery, they’re kind of becomes like this standardized report that you get, where the number of pregnancies and how many weeks the patient is, and where they are in their labor progress, and is it an induction? Whatnot. So we like to do bedside report, really involve the patient in what’s going on, so that we’re human, if we leave anything out, the patient can always fill us in. And then the patient just is also on top of knowing what the plan is. And we make sure that the patient is on board too. And then we go about doing whatever orders we have from the provider, whether it’d be during labs, during medications, or whatnot. And depending on…it’s so varied because it can be a labor patient, it could be a C-section patient, it could be a triage patient, it could be an anti card inpatient with some complication that is in the hospital.
So it can go so many ways. It’s like, you just really never know what you’re gonna be hit with. And I think that a lot of us are adrenaline junkies, where we don’t need to ride roller coasters. We can just…
Dr. Fox: Right, go to work. Yeah.
Chanie: Yeah, we can just go to work. Exactly. And I really like that. Yeah,
Dr. Fox: I think that one of the things you said which is so true is this idea that the labor floor really is a big team mentality. And it’s I don’t wanna say more so than other units because obviously, I don’t work in other units in the hospital. But just from my experience in medical school and how reasons people will be in the hospital, this is much more like, you know, all for one in one for all if there’s a problem in one room, multiple people run in. Frequently there’s doctors and nurses who go from room to room to help out other people just because it, you know, some people at one point in their labor need more help and other people need less and than that happens all the time.
And there’s multiple people looking over sort of all of the patients at once. And it’s a really nice thing, because you get tremendous camaraderie and teamwork amongst the providers. It’s also one of these high risk, high reward situations that when it works, and everyone’s functioning as a well-oiled machine, the teamwork is amazing. But if there is dysfunction amongst the team, this nurse doesn’t get along with this nurse, or the doctor or nurse have a conflict, or whatever it is, then it can really go bad. And that’s why those skills of teamwork and working with others are so critical. And somewhere like the labor floor, and there’s so much personality involved with this, it just makes it also really interesting to work on top of the medicine, there’s all of that interpersonal amongst the staff. And then also, like you said, with the patients like, portray the ones in labor. They’re awake, right? They’re not like deathly ill usually, they’re awake, they’re a part of this, they hear what’s going on, they see what’s going on, they’re either afraid, or excited, or both, they’ve got someone in the room with them, usually whether it’s their partner, or a parent, or a friend, or a doula, or all the above.
And there’s so much layering of what’s going on there that, you know, the medical, the social, the psychological, the interpersonal, that it’s just so unique each day with each person. At least that’s what I find. I imagine it’s the same as a labor nurse.
Chanie: Oh, yes. I so agree with everything that you’re saying, the part about the collaborative care being so important, it is so crucial, especially for timely care for a patient because everything’s great until it’s not, right, in our fields where things can be going great. And then there could just really be an urgent need for intervention. And I think that we also kind of have this dance routine that we already all know together, like, I can just say, “Okay, we’re gonna reposition and put oxygen on and like you as a doctor would know exactly what I’m talking about, and exactly what I think is going on. You know, just having these code words and just knowing the routine and someone saying, “I’m gonna open up the back.” Which means, “I’m gonna open up the operating room,” when you can work, right, interpersonally, it’s priceless. I think it really can affect the quality of a patient’s care.
And there is definitely, I think, somewhat of a complicated relationship between nurses, midwives, residents, and doctors, attendings, like you said, it can be great. And then sometimes there can definitely be some tension. Which I do feel is highly dependent on the culture of each individual hospital, and how things run. It’s hard because the nurses role has evolved from when Florence Nightingale which we like to call the first nurse started the entire profession of nursing. Where it used to be, I think, as you know, not so far back, I think the ’60s, the ’50s, the ’70s, maybe even where the nurses role was to obey the doctor’s orders without question. And that was a good nurse, they did whatever the doctor ordered.
Today, the profession has evolved into, we’re supposed to be a patient advocate, we’re supposed to be questioning whether everything is safe, we’re supposed to be kind of like an added layer of checks and balances. And we’re supposed to know what medication the patient needs, what the indication for the medication is, what dosage is appropriate, whether it’s contraindicated with other medications or allergies, or the patient’s condition. And if we administer a medication that is contraindicated, are nurses held equally liable? As a provider, we can’t just say, “Well, we obey the doctor’s orders.” And just the plan of care in general. So I think it’s kind of like, there’s a lot of work to be done in this area, because we haven’t really addressed that on a global level, how the nurses role evolved, and how that can affect the provider, the doctor, midwife nurse relationship, it can be complicated.
Dr. Fox: But it’s not always a bad idea to have some push and pull with these things. Because there isn’t one way to do it. And it’s rarely a situation where one person is right and one person that’s wrong. It’s usually like one person wants to lean a little bit towards the more conservative side. Yeah, and other ones that lead the other direction. And ultimately, it’s about communication, and working it out, and making sure that everyone’s on the same page. And I don’t know, I guess where I work I’m pretty pleased with the culture and how it’s been and I’ve been there a long time. And you tend to know people and a lot of it is just trust when you work with people. And it’s the same people there every day, the same group of nurses, obviously, not the same person, because everyone takes certain amount of shifts a week, but the same number of nurses, the same number of doctors, the same residents, and you get to know each other and you understand people’s personalities and how to work with them. Like in any industry, obviously, the stakes are higher in medicine, potentially. But I do think that it really…like I said, if it goes right, it’s an amazing thing. And if it goes wrong, it’s very obvious. What do you…if you are giving…and I know you do. Giving advice to women, what should they expect from their labor nurse?
Chanie: Okay, great question. Because this is…
Dr. Fox: Thank you.
Chanie: All your questions are great. But…
Dr. Fox: From podcaster to podcaster, that’s a great question. All right, I’m ready.
Chanie: So I mean, this is what I do. And this is why I started my account and my podcast. And like you said, as a nurse, I do have a different perspective versus a provider, because our roles are different. So I like to say that you just…some people will call me and ask me for recommendation of a provider or hospital because I’ve worked in several, and depending on their specific needs, what would be best for them. And I always tell them, you know, “I can tell you the best provider in the world and the best hospital in the world.” Which beside the point there aren’t best in anything. And then just pray that the day that you go into labor or have your C-section, or whatever it is, that everything stacks up in your favor, because there could be…the Lego bus could just pull up at the same time that you’re in labor, and your nurse may have another two patients that they’re running between. Or you can be one of several patients on a unit and the nurse will be able to dedicate more time to you.
And I really want people to know that if your nurse is not able to be there with you as much as you’d like, it doesn’t necessarily mean it’s because they don’t care about you. A lot of times, it’s just the realities of the job is that we’re kind of splitting ourselves up between patients. And a huge part of our job is giving social emotional support, and coaching, and helping the patient, and the support people help support the patient. And the job doesn’t end after the patient gets an epidural because now we have even more responsibility to reposition the patient and help that baby’s head get down and dilate the patient. But it’s not always possible because of our other responsibilities. However, hopefully, you’ll be in labor, you’ll be in the hospital, whatever, whichever way you’re gonna give birth on a good day. And a huge role of a labor nurse is education.
Like it’s 50% of my job. And I find for myself personally, I love when patients ask a question, I highly encourage it, it keeps me on my toes. And I make sure that I understand and know the reasons for what’s going on. And I think that it really reassures the patient and helps them be calmer. A very big part of our job is watching the baby monitor, right, the strips on the baby monitor, the baby’s heart rate, the mom’s contractions. And I kind of actually do small, very general overview what it is that we’re looking for on the monitor, because a lot of patients will just keep saying like, “Is my baby okay? Is my baby looking good? Is my baby okay?” And once I give them a small kind of gloss over, they just feel calmer. They see, first of all, it’s not necessarily black and white situation where either your baby’s okay, or your baby’s not okay.
There are a lot of things that we’re looking for and a lot of pieces of the puzzle that it tells us that we’re putting together. And it just kind of reassures them that when they know what it is and what’s going on, when they understand like a contraction pattern and what’s a normal contraction pattern and what’s not and what’s a normal labor curve and what’s not. Like I tell my patients things like before they get their next cervical exam, if they’re in early labor, I’ll tell them, “Listen, you don’t even have to change cervical dilation numbers if your effacement is which is how thin your cervix is. If your effacement goes from 60% to 80%, that’s like a great progress even if it’s been a few hours. But if you’re in early labor week, that’s still great progress. So don’t underestimate that. You know, things like that are really part of a nurse’s job. And I think that it can make or break the experience and that’s why I started to do what I do.
Another job of a nurse, like I said earlier, is to really help that baby get out. And when a patient has an epidural, our job doesn’t stop. We’re not supposed to be sitting out in the nurse’s station just charting on the heart rate and having the computer open and just click, click, click on the computer. Our job is to reposition the patient, because that actually helps the baby’s head get into a good position, you know, ready for launching by changing positions frequently, and helping the patient, right? Because the patient is really not very mobile on their own using things like the peanut ball. Do you know about the peanut ball?
Dr. Fox: I do.
Chanie: It’s a wonderful tool. So using things like that, having all of those tools up our sleeve, I really feel like a nurse has such a huge influence in the labor progress of a patient. And we know that if the baby’s head is not engaged in an optimal position, it can make the labor process longer, it can make the pushing process longer, it can sometimes be the difference between the baby coming out from the vagina and having a C-section. So these are major things that a nurse is responsible for. And add to that, we’re also responsible for the medical management of the patient. So we have orders from the doctor or the midwife. And that’s actually one of the first things I do also, when I start my shift is we check what the orders are, what the medication orders are, is it an induction and the patient’s supposed to be having Pitocin? And how much Pitocin is the patient supposed to be having? Does the patient have a condition like gestational diabetes, which would necessitate taking blood sugars? Does the patient have Group B strep, which would necessitate giving antibiotics at certain intervals? You know, things like that, that’s also part of our job.
And I wanna say something that I think really can help people with their expectations of what to expect from nurses with labor, the patient, nurse ratio tends to be a lot smaller. So there are many times when I will just have one patient and really give that patient 90% FaceTime. And then after they have their baby, and they have such a wonderful, lovely experience, they are transferred to the postpartum unit. And suddenly, they’re not seeing their nurse for hours. Or even if they’re seeing their nurse once an hour or whatnot, they’re still not getting that same length of FaceTime. And a lot of patients don’t have that expectation, they don’t realize that it’s gonna be different once you get to postpartum, you’re expected to be more independent. And especially as time goes on, you’re expected to be more independent to care for your baby and learn how to care for your baby. But your baby’s gonna hang with you if everything is well and good with them.
Dr. Fox: Right. For 18 years and potentially longer if they don’t move out. One of the things you mentioned about education and about talking to the patients about, you know, their cervix, and the exam, and the heart rate, is so important. And I think that one of the ways to make that really successful for the patients is when the doctor or midwife and the labor nurse are on the same page. So I frequently before I examine a patient, I’ll talk to the labor nurse, I’ll say, “Hey, listen, my plan is to examine her. If she’s so many centimeters, let’s get ready for delivery. If she’s so many centimeters, we’re gonna start or change the Pitocin and do something else. We’re gonna do something else.” And sort of so everyone knows what to expect.
And so the communication with the patient is congress, like from what you’re telling the patient, from what I’m telling the patient, so she, the woman in labor, does not get mixed messages or confused about what’s happening. And again, this is part of that sort of like team mentality. But it is really important because sometimes if we don’t speak to each other, and it doesn’t mean that my plan’s right and your plan is wrong, or vice versa. It’s just if you’re telling the patient, “Oh, if you’re four centimeters,” he’s probably gonna wait three more hours. Whereas if I’m thinking, “If she’s four centimeters, I’m gonna do a C-section.” Like whatever it is, that’s not a good idea for the patient to hear different messages. So that communication is critical.
So I think one of the things women should expect from their labor nurse and from their provider, whether it’s a doctor or midwife, that they talk to each other, that they’re on the same page, that they’re communicating. And usually, it’s pretty obvious because you’ll see them interact, you’ll see the rapport, you’ll see that they’re chummy, that they know each other, that they’re able to talk about things easily. Whereas if you never see them together, that might not be a good sign.
Chanie: We call that bedside huddle at my job, where I really prefer when we do that all together in front of the patient, you know, exactly so. And I always saw the patient when they asked me for the plan, if it hasn’t been concretized, we say, “Well, the doctor’s gonna come in and tell you,” when it’s maybe not what the patient was hoping for. I’m so happy I’m not the doctor that has to bear the bad news.
Dr Fox: Well, we also get the glory, so it’s all good. What should women not expect from their labor nurse? I mean, what are the things that, you know, you’re mentioning something like about postpartum care? What are the things that you’ve noticed in your career, and in your education piece where women think they’re gonna get something from their labor nurse and you’re like, “Oh, no, that’s just not reality that doesn’t happen.” What are the things that they should know about? You were saying that you’re able to give 90% FaceTime to a lot of women. But I imagine there’s times where you’re not, like you have two people that you’re taking care of. And then it’s 50% FaceTime. And a lot of women, I think, expect their labor nurse to be their labor doula. And sometimes that can happen, but sometimes it can’t. And I think that that’s sometimes a false expectation that women have coming to, whether it’s a hospital or birthing center, or whatever it is.
Chanie: Oh, yes, so read. So when someone has a specific vision for their birth, say, someone who has this vision that they do not want to have any interventions, or they want to have as low intervention of birth as possible. If you are really committed to that vision, that plan, you need to plan your support team, and not expect to be able to get that 24/7 support from the nurse, you may look out and get that. You also have to understand that like all humans, different nurses have different kind of personalities and the kind of force that they vibe with more and some nurses maybe have more coping skills, on medicated labor support skills than other nurses, as well. You really cannot depend on a nurse to give you full continuous support. But I really do love that part of my job. And I really do try very hard to give as much of it as I can. But at the same time, sometimes what happens is, is I’ll have two patients and one patient says that they don’t wanna be med, you know, they wanna have Medicaid at birth. And I help them do all the things that we can do in order to promote that. Because if they’re just laying in bed on the monitor, their pain is gonna be a lot worse, their labor may potentially be longer than it should be. So we’ll do all the things.
And then my second patient, it will be time for them to push. And with pushing, we always do one to one, the nurses there at the bedside, we can’t split ourselves into two. So a different nurse will take over. And then after three hours of pushing and a delivery, I’ll come back to the first patient who was epiduralized because the nurse that took me over just didn’t have that same philosophy or whatever, you know, coping tools in her back pocket. So I see that happen all the time. If you’re really committed to a certain vision, you need to plan for a doula or some kind of taking a course. So that whoever’s with you, as a support person, your partner, whoever it is, and now with COVID, it is even more of a challenge. Because a lot of places just allow one person with you.
So if that’s gonna be your partner, even if your partner wasn’t planning on being your coping support person, which they’re not always able to, let’s be real, not everyone’s cut out for that kind of thing. But reading a book and taking a course so that they know how to help you cope through labor. So yes, and like I said, if the labor bus pulls up, we’re just not able to do it. So yes, I love doulas so much. Sometimes they’re phenomenal. Sometimes I’m teaching them more than they know. So that’s actually fulfilling experience. Because when they get, like when their eyes light up, like, “Oh, that’s cool. Oh, I never knew that,” then I just know that they’re gonna take that on to their next client. So that’s really nice.
So yes, it’s really important to know that the nurse is not going to always be there 24/7 with you. And even people who plan on having an epidural, the support doesn’t stop there. Like I said, the repositioning, which can be so valuable, the nurse may not always be available to reposition as frequently as they’d like. And if you have that support person that knows or things and all the tricks, then you’ll be able to get it through them.
Dr. Fox: What you’re saying makes a tremendous amount of sense. And I think it’s so helpful to women who are either pregnant and coming up in delivery or not yet pregnant and thinking about it. And I wanted just in our last few minutes to shift gears. And tell us a little bit about Yoledet Academy and “The Happy Birthway” podcast, what you’re trying to do, how it’s been. And obviously this is a way that our listeners can hear more of you. So not just an hour, but they can hear hours, and hours, and hours from you. So tell us about those.
Chanie: Yeah, so I mean, I love providing education, I’ve always had an innate talent for being able to give over information and breaking it down in simpler terms. And I opened this Instagram account called yoledetacademy and the reason why I called it that is because Yoledet actually means woman who gives birth in Hebrew. And to me, it’s really interesting that there’s no direct English term as the translation Yoledet is one word, but here we’ll call it, you know, I mean, in medical terms a…or whatever.
Dr. Fox: Yeah, parchment.
Chanie: Parchment. Exactly. But that’s how seldom we use it. But I mean, at least among the nurses, but there’s no like, regular term. So that’s why you just kind of spoke to me. I just love that there’s an actual one term used to describe a woman who’s giving birth.
Dr. Fox: Right. It’s interesting, because like, that happens all the time where a doctor will say, like, “I delivered her,” and so I’ll say, “No, she delivered.” And it’s like, because deliver is not the right word. You know, it’s like a weird thing. Like, it’s the Hebrew word really says, like the one who births, you know, which is really the proper terminology rather than deliver. It’s the birth.
Chanie: Yeah. Yeah. We attend the birth, right. We attend the birth and we assist the birth. Yeah, exactly. We attend the birth, we assist with the birth. But yeah, exactly, it’s the woman who births, right. And so the goal for my account is just to provide straight up prenatal education from preconception all the way through postpartum and beyond, because we know the postpartum period doesn’t really last six weeks, it last a lot longer than that. A newborn education, I actually teach a newborn care class in one of the hospitals that I work at. So that’s the main goal. But also to kind of sub-specialize, I address a lot of special needs that an Orthodox Jewish woman will have due to the fact that allergies was…they’re so far-reaching into every aspect of our lives, including the area of childbirth and spirituality around it is also very strong.
So that’s kind of like a sub-specialization of my account. I also do talk a lot about just being a nurse, kind of a lot of the stuff that we talked about now, when people are asking me who are considering becoming a nurse, or people who are nurses, looking to get into this field, etc. So we talked about that, too. So I have a lot of followers that are not affiliated at all with Judaism, they’ve learned the same perinatal education. It’s applicable to everyone. And they actually, like they find it interesting to learn about Judaism, and the practices. And I actually do this all the time with my co-workers, where I don’t live in a heavily Jewish populated area.
So we have a trickle of Orthodox Jewish patients that come in. And some of the practices may seem really weird, and strange, and even sometimes concerning, but once I give context to my co-workers, they’re kind of like, “Oh, okay, but that makes so much more sense.” And now we understand what’s going on. So I do do that a lot also on both platforms. And I do have people who are just amazing health care providers who are looking to become more culturally sensitive, because they care for this population.
So that really also gives me a lot of fulfillment. Unfortunately, in the media, Judaism is not always portrayed very accurately. So I kind of really like to bust a lot of myths, like we don’t do with a hole in the sheet and we use contraception, you know. So things like that. And “The Happy Birthway” podcast is kind of an extension of that. I feel like there’s very different content that you can provide on a podcast, as you’ll probably concur with me than you can on Instagram. And I feel like both have a great purpose. I just love interviewing, I love storytelling. I love taking people’s birth stories and kind of using them as a offshoot, like to educate at the same time. And sometimes even opening someone’s eyes to what happened kind of like when they’re processing what happened at their birth. And when I explained some behind the scenes of what was going on, for example, someone said that they were supposed to come in for induction at 8 a.m. And then they kept calling them and extending the time and telling them to come later, and later, and later, and they were getting frustrated. When I explained to them that, “There wasn’t enough staff to safely take care of you and we wanted you to be safe.”
Dr. Fox: Right. And better wait at home than wait in the chair at the hospital also.
Chanie: Oh, yeah, 1,000%. Absolutely.
Dr. Fox: That’s a kindness of the labor floor to call them because it used to be you just show up and wait for 12 hours, like literally sitting in a chair. Like you’re at an airport and your flight’s delayed. It’s crazy.
Chanie: Yeah, that’s great. You make us the hero. Exactly.
Dr. Fox: Would be great if the airline did that. They said, “Yeah, stay at home, don’t worry. We’ll call you when it’s time to come in. It’d be great.”
Chantel: Yeah. Yeah, that’s right. See, we have such great customer service. But yeah, no. And sometimes we tell the patients actually, like as soon as a spot opens up, we call them, we say, “Get over here, like as soon as you can. Do not delay before someone else walks in before you.” So, yeah.
Dr. Fox: Yeah, I’ve started listening to your podcast. I think it’s terrific. I think that anyone who listens to this podcast and enjoys it, I think there’s a very high chance they’re gonna like your podcast as well. Again, it’s a lot of similar themes, but from different angles, which I think really gives people a sense of the flavor of what goes on, that there’s so many different topics or concepts, and there’s different ways to look at. There’s the medical side, the nursing side, sort of the personal side, the psychosocial side.
And I think that the more ways people can hear it presented, the more they’ll get a sense of what to expect and what not to expect, and maybe make the process more fulfilling or potentially less stressful, or maybe even a situation where they get enough or more education to actually improve their outcomes. They realize, “Oh, maybe I do need to look into something else. Maybe I do need to see a different provider, maybe I do need to ask about a certain intervention, if it’s available.” I mean, it doesn’t frequently happen. But it could and that’s important.
Chanie: Yeah, yeah. And thank you so much. That’s like coming from you. I love your podcast so much. And I respect the work that you do. So thank you so much. That’s like a really huge compliment to me on my little fledgling podcast that I started a few weeks ago.
Dr. Fox: We’re all fledgling in life, were just treading water trying to stay afloat. No, but it’s true. And again, I think that it’s just people who are in this world, and, you know, someone who’s pregnant, let’s say, for the first time, or she had something happened last time, they’re entering a world they don’t know, they don’t understand. They’re not a part of, and it’s very scary. It’s like anything, when you go somewhere new, and you don’t know what to expect. And you don’t know sort of what the culture is, what the rules are, what happens. It’s frightening. And I think that what you’re doing, and hopefully, what we’re doing here is trying to just give a window into that world that makes people feel like it’s more accessible to them. And it’s not this dark, scary place. But there’s people in there, and there’s reasons we do what we do, and a better understanding, as always, in my opinion, made the experience better for people in terms of going through it either for the first time or the 12th time, whatever it might be.
Chanie: Yeah. Yeah, so true. And it’s so true that I find a lot of people who are having their baby, it’s their first encounter with the healthcare system at the hospital, you know, being in a hospital, being hospitalized. So yeah, very much so especially for someone like that who’s never even been to a hospital can be really scary. And I think people are afraid that if they know…they don’t wanna know too much, because they don’t wanna know about everything that goes wrong. But when you learn, you see about everything that really goes right, and that things can be wonderful. And if not, then you’ll still be in great hands, and skilled hands. And you’ll be less scared, because you’ll know what the treatment might be. So you’ll feel safer.
So yeah, and like you said, the multidisciplinary approach to the care, like seeing it from all the different disciplines, all the different sides, the doctor side, and the nurses side, I think is great, too, because they’re different. And both play such a major, major role in somebody’s care. And I have to say, well, also just one thing I wanted to add is that, I also do, like we said, you don’t have a choice, who your nurse is gonna be that day, and I do teach people how to advocate for themselves in a respectful way that will breed a cooperative, collaborative relationship with the nurse, versus an oppositional and defiant kind of relationship with their nurse, which only stands to benefit them. But if there are kind of opposing views, I really love to also teach people how to overcome that and get the care that they’ll be most satisfied with. So.
Dr. Fox: It’s amazing. That’s amazing. Well, Chanie, thank you so much for coming on the podcast. I’m certain we’re gonna be speaking many times moving forward in the future. So this is just the beginning. But thank you for coming on. Thank you for doing what you do. For our listeners. your Instagram is one word, yoledetacademy. That’s Y-O-L-E-D-E-T Academy, and your podcast is called “The Happy Birthway” podcast, like birthday but a W instead of the D. Thank you very much.
Chanie: Thank you, Dr. fox. I’m looking forward to having you on my podcast.
Dr. Fox: And the tables are turned. All right. Thanks a lot.
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