Can I rely on nurses, midwives and doctors to offer labor support?

Hospital-based providers may have difficulty giving you the best possible labor support for several reasons:

• Background and education: Doctors' education focuses on diagnosing and treating problems and performing surgery. Nurses trained and working in hospitals where most women have epidurals may have limited experience supporting women who want to avoid or delay this form of pain relief. Midwifery education includes labor support, but hospital-based midwives may have difficulty providing it (see next two points).
• Responsibility to others, and care that doesn't involve support: Your caregivers may also need to attend to other laboring women, office appointments or scheduled procedures. Hospital or employer policies may demand that their attention focus elsewhere. Many nursing tasks (such as monitoring/adjusting equipment, helping doctors with procedures and completing paperwork) do not involve direct patient care. If you have an epidural, your nurse's attention will be on related technology, like intravenous (IV) lines and electronic fetal monitoring (EFM). In addition, many hospitals are short-staffed, which is even harder on nurses.
• Shift structure: Nurses work in shifts, so nurses might come and go throughout your labor. Doctors and midwives often rotate being “on call,” which means a new person may attend your birth. It is unlikely that you will have met the nurses.

For these reasons, clinical caregivers in hospitals are rarely able to offer the direct, continuous personalized labor support that has been shown to be so beneficial for laboring women. These factors are less likely to be a problem at out-of-hospital (“freestanding”) birth centers. They would rarely have an impact on home birth care. Read more about how birth settings differ here.