You are pregnant, and excited! You like the idea of a home or birth center birth, but think that, for your first baby, it would be a good idea to be in the hospital just in case there are any problems. After all, you don’t know yet if your pelvis is big enough, or if you’ll have other complications. Maybe with your second you’ll consider a home birth.
You’d like to have a midwife, but there aren’t any midwives with hospital privileges in your area. But you’ve found a great OB who definitely has the heart of a midwife. She even encourages you to write up a birth plan! You’ve toured the hospital labor unit, and the rooms are beautiful. Some even have large jacuzzi tubs to labor in. You’re confident you will have a lovely, home-like birth in the hospital. You’ve done your homework, and are looking forward to a beautiful experience.
Wait a minute. . .factor in your labor nurse. Or nurses. No problem, you think. The nurses have to follow whatever orders the doctor gives them, right? Right?
The conversation in the comments is very much worth reading, too. There is, of course, the expected "But I had/am a wonderful L&D nurse! Therefore this isn't true!" There are ABSOLUTELY some wonderful nurses out there. No question. At Your Cervix is definitely one of them, but she's certainly not alone. If you had one of these, or are one of these, awesome. I say that with zero sarcasm or snark - really, that's awesome. But we all know people whose births were derailed by someone who was not so wonderful.
You can have done ALL your homework, taken the best classes, and selected a truly supportive provider in OB/CNM choice, and even hired a doula - and if you get one of these nurses, you're still going to have to battle for your birth . And who you wind up getting is a total crapshoot. Having a doula IS probably your best defense here, though as discussed, if you have a nurse who is hostile to them, it can actually backfire in some rare cases, I'm sorry to say. I don't mean to diminish the importance of childbirth preparation, using a doula (obviously), or especially careful choice of care provider, but it is still true that whether you go with an OB or a CNM, they are going to be present the least amount of time. This may be different with some CNMs, but despite their best intentions, many others are just as overscheduled and likely to have to be running-in-at-the-last-minute to catch, snip & run as an OB. (Again, there are exceptions.) And in the meantime, the nursing staff can make it or break it.
Many a post or article written about the pitfalls of hospital birth results in commenters sharing their own positive hospital birth experiences. I have no doubt that these stories are true; with some, their hopes and criteria for their birth might be quite different than mine, but with some, they might be quite similar. I firmly believe the biggest factor in those positive stories is the roll of the dice that is the L&D nurses. If you're choosing hospital birth, hire a doula to improve your odds, absolutely, but be very aware of the impact they can have, and follow Birth Sense's advice in her post on how to get your best chance.