"I really felt they took my needs into account," she says.  "My case room nurse was wonderful.  She spent people out of the room when she felt I needed rest, and she respected my wishes about managing the pain.  She asked and she listened."

In response to patient needs, the Grey Nuns has modified its approach to epidural use, a procedure that traditionally immobilized the patient as it blocked pain in the lower half of the body.  Anesthesiologists now offer epidurals that allow women to retain some sensation and movement.  "The fact that I could still feel something, but the pain was gone, was great." Says Jennifer, who opted for the procedure in the wee hours of the night.  "It would scare me not to have some control or connection to what was happening in my body."

Caritas has also begun to integrate midwives into the hospital labour and delivery team.  Last year the Misericordia participated in a regional pilot project for patients who wanted to be attended by a midwife, but wanted the security of a hospital setting.  Of the 53 women registered, seven delivered at the Misericordia with a midwife in attendance.  The program will expand to the Grey Nuns in the near future.

Caritas' approach to labour and deliver continues to change as womens' needs change and evolve.  Prenatal classes for couples are scheduled to meet the needs of busy lifestyles.  At the Misericordia, tours are offered to pregnant teens to help prepare them for childbirth and provide them with information to help them have a safe delivery and healthy baby.

At the Grey Nuns, which serves a diverse ethnic population, a multicultural health broker helps to ensure culture and tradition is respected in the birthing room and postpartum.  The health broker acts as a liaison between patients, families and caregivers when the mother enters the hospital and before she goes home.

"Labour and delivery practices have changes so much since I started nursing," Heather marvels.  "Not only do we have fathers in the delivery room, we have whole families."  Heather notes a growing tendency to view birth as a natural process, rather than medical event.  As the birth progresses, parents are consulted and included in discussions.  "Our guidelines are simple," she says.  "If it's safe for mom and baby, we'll accommodate them as best we can.  This, after all, is their moment."