Labor & Delivery Nursing
Discover the thrill of new life, again and again
Looking for a nursing job where almost everyone is happy and healthy, where you can serve two patients for the time of one, and where most of your colleagues stay for a long time? Labor and delivery nursing might be just the spot for you. Whether you find a job in a small community hospital where the deliveries are under 100 a month, or you work in a large public facility with dozens of high-risk mothers, nothing beats the thrill of new life.
That’s what keeps nurses in labor and delivery. It is not unusual to come across practitioners who have spent 25 or 30 years in this specialty. They get their initial exposure during their student years and understand immediately that this is the place for them.
The Importance of Education
Take Debbie Miller, RN, from Glendale Memorial Hospital. She has been the supervisor of the labor and delivery unit for 12 years and says after 30 years of obstetrical nursing, “I still love coming to work…It’s a happy place and I can still get teary-eyed at some deliveries, especially if the dad is very involved.”
Glendale is designated as a “baby friendly” facility, so the staff encourages maximum parental involvement, including breastfeeding as soon as possible after birth. The baby-friendly tag is part of an initiative by UNICEF and the World Health Organization to increase the support of new parents during the immediate post-partum period. To achieve the designation, the hospital is required to educate its staff (18 hours for nurses) so that everyone can assist new moms in adjusting to their infants. Beyond that, Miller is a certified lactation nurse and certified childbirth educator.
What education is necessary for work in labor and delivery? Most units look for someone with at least a little background in medical-surgical nursing, although it is not mandatory and many successful nurses have come straight from graduation. According to Miller, it is even possible to become a good labor coach without ever having given birth because most women instinctively feel compassion for another woman in labor. Glendale Memorial certainly looks for some experience and they provide a very thorough orientation lasting about six months.
The Mother-Baby Relationship
Josette Medina, RNC, is a delivery room nurse at Hoag Memorial Hospital Presbyterian in Newport Beach. The unit handles about 450 deliveries per month and employs about 90 nurses, full and part time. Orientation is flexible, lasting from three to six months, depending on how much experience the nurses bring and how quickly they acquire skills. Here, too, a preceptor learning experience predominates. Hoag is a baby-friendly designated hospital as well and its labor and delivery nurses all receive the requisite training in breastfeeding. Most nurses with advanced lactation certification work on the mother-baby unit or the postpartum unit. Through community outreach efforts, Medina says that attitudes about breastfeeding have changed dramatically, and many patients pass by other hospitals to be cared for in an atmosphere that promotes it.
Labor and delivery nurses also care for antepartum patients at Hoag. Here, women with conditions like preterm eclampsia or preterm labor, to name just a few, may spend several weeks in the hospital before they deliver.
What does Medina find most challenging? Maintaining an atmosphere that respects the uniqueness of this life-changing event while still dealing with clinical issues that can be extremely critical. An inpatient obstetrical nurse serves as a labor coach and support, but also needs to provide highly skilled nursing care to both mother and baby. What happens during birth can have long-lasting impact on the mother-baby relationship, and it is very important to minimize disruption in the process.
And what does she think all candidates for this specialty should appreciate? That this is an intensive kind of nursing. “We manage labor and delivery, we don’t control it,” she says. Not every personality can deal with surprises that come through the door at any time, day or night. “I often think it is the same sort of personality that likes emergency nursing.” Nothing is predictable, and labor that starts out normally may have unexpected developments, not all of them pleasant. And even though there is 24-hour medical and anesthesia care at hand at Hoag, nurses in this specialty work with great autonomy and independence. They need good basic nursing skills and a highly developed ability to make critical nursing judgments.
Caring For Two Patients at Once
Sandra Partida, RN, of Providence Holy Cross Medical Center, also speaks of the “busy ER feel” of obstetrical nursing. Her mother was a labor and delivery nurse in Mexico, and ever since Partida was in high school she knew this was the type of nursing she wanted to do. And she has not been disappointed. “It’s exciting and I have learned so much.”
She came to the hospital right after graduation from Pierce College with an associate of arts degree. Her orientation included — and this is unusual — a six-week course geared toward nurses planning to work in intensive care units. Only after that period of classroom work did she begin her six-month preceptorship. During that time she gained proficiency in fetal monitoring and baby resuscitation. Knowing and understanding the particular stages of labor and how they manifest is part of the learning process that takes time.
One of the few baby-friendly designated hospitals in the San Fernando Valley, Providence Holy Cross runs about 250 deliveries each month. There is a self-contained operating room for caesarean sections, and labor and delivery RNs do the circulating for these surgeries. They also care for patients in the antepartum beds; and because of the level II NICU, few patients require transfer. Much as in an ICU, most nurses can care for two mothers at a time until delivery is imminent. Then the ratio is one to one.
Like the other labor and delivery nurses, Partida is very conscious that she is caring for two patients, mother and baby. And although most patients are healthy, some are not, and they require special vigilance. No one can predict how placenta previa will evolve, and diabetes can be particularly unstable in preterm mothers. And Partida mentioned what no one likes to consider — that things can go wrong. She finds this the most emotionally draining: when a baby is born with catastrophic impairments like anencephaly or when there is a “fetal demise.” Out of the ordinary, yes, but not rare; and anyone considering this field should know that it can happen.
Still, as Partida points out, the upside is that you are always tested as a nurse. “There is lots of critical thinking required; you don’t know what will happen 30 seconds from now, and you also always have the challenge of the whole family.”
Advancing Your Practice
Advance practice nursing is not common in most labor and delivery rooms. Although Glendale Memorial has several midwives and Hoag has some nurse practitioners, they do not practice as such within the labor and delivery suite. Nurse anesthetists and midwives would be the most common. Most advance certification comes through the professional society of obstetrical nurses and includes lactation consultant, child-birth educator and inpatient obstetrical nurse.
10 Requirements for Baby-friendly Breastfeeding
1. Maintain a written breastfeeding policy that is routinely communicated to all staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast milk, unless medically indicated.
7. Practice “rooming in” — allow mothers and infants to remain together 24 hours a day.
8. Encourage unrestricted breastfeeding.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
Elizabeth Hanink RN, PHN, BSN, is a freelance writer with extensive hospital and community-based nursing experience.