Labor & Delivery Nursing: Interview with Michelle Tibbs, RN, BSN, BSW
Caring for a laboring patient and her family during the miracle of childbirth
Michelle Tibbs, RN, BSN, BSW
St. Jude Medical Center, Fullerton, Calif.
Tell us about your nursing career.
Nursing is a second career for me. My first degree was a bachelor of social work from the University of Wisconsin- Madison. I spent 15 years working for city government and nonprofit agencies.
When I was in my mid-30s, a nurse coworker encouraged me to return to school to pursue a nursing career. We were working at a nonprofit clinic that provided free prenatal care to indigent women and I wanted an expanded role. Her words of encouragement emboldened me to go back to school to obtain the degree that I had first considered almost 20 years earlier.
After graduation, I went to work for St. Jude Medical Center in the postpartum unit. I was quick to declare my desire to be a labor and delivery nurse and the RNs in that department supported me in the process of transitioning from PP to L&D. I was trained by Shirley Husted, RN. All of these years later, I can still hear some of her training mantras rolling around in my head when we have an emergency.
What is it that draws you to this particular specialty?
I knew that I wanted to be a labor and delivery nurse within the first 30 minutes of my first L&D clinical rotation. I was immediately hooked on the hustle and bustle of a busy unit, the adrenaline rush of an ever-changing work environment and the unpredictable ebb and flow of the workday. I loved the teamwork that I witnessed and I had amazing instructors and preceptors who shared their enthusiasm and absolute reverence for the work that they did.
I have always been fascinated by pregnancy. The thought that the joining of two little cells can result in the development of this miraculous little creature is just phenomenal. The concept of a baby lying skin to skin on mama’s chest moments after being inside her uterus, dependent on a cord and placenta, but now an independent human, is simply miraculous.
Please share with us the challenges of your specialty area.
We live in a world of everyday miracles. We expect them. We expect life, first breaths, 10 perfect toes and 10 perfect fingers. It is with great awe that we can say that this is an everyday occurrence in our little corner of the world. We are grateful that this is generally joy-filled work.
The sad reality is that we deal with profound losses, as well. Although the incidence of fetal demise or neonatal death is very low, the challenges of helping couples face the death of an unborn or newly born baby are very difficult. No woman is prepared to give birth to a baby that will never take its first breath. No family is ever completely ready for the delivery of a baby with birth defects. No nurse has the words to make everything okay. It is our job to help these couples endure the early hours of their losses, to make them feel safe and give them the information and encouragement they need to make it through, hour by hour.
What about your work feeds your spirit and keeps you coming back?
My challenge is to walk into the room of a laboring patient, understand the mother’s unique needs and her goals for labor and then develop an instant rapport and intimacy with this woman and her family so they trust me to guide them through one of the most important and memorable days of their lives. It takes a good intuition about people to make that sort of immediate, trusting connection.
The diversity of our culture makes this an even greater challenge. Can you imagine the experience of a recent immigrant who arrives in this new culture to labor and give birth in an unfamiliar setting, with extended family half a world away?
I recently held a newly immigrated Chinese woman during her epidural placement, murmuring words of encouragement and brushing away tears. When we were done, she reached out for my hand and said, “You make me miss my mom even more. Thank you for helping me.” If this middle-aged Caucasian woman, speaking a language the patient just barely understands, can offer that kind of comfort through touch and tone and genuine presence, then I am content.
What I love are pregnant women and pregnancy. I have great respect for each woman who enters into labor and delivery with such different expectations and I like to honor those expectations to whatever degree possible.
My day is complete when I assuage fear, empower a patient to labor in the way that she planned, offer encouragement and guide the couple through to the delivery of a healthy baby. When I see a new dad crying in joy and relief, I am moved. When I see a new dad look at his wife and tell her, “You were so tough, you were so strong,” I am moved. When a new family hugs me close and tells me that they are forever grateful for the coaching and encouragement, I am moved.
Can you share a story about your work that illustrates what you love about it?
My weeks are peppered with stories of long labors, tough decisions and pain. It is just human nature to remember the dramatic story with the heroic or sorrowful ending. The emergent delivery keeps the adrenaline pumping, but it is the peaceful delivery that unfolds in the way that the couple had planned for that I love.
Just a couple of weeks ago, I cared for a couple who had a simple birth plan. They had realistic expectations of what labor would be like and they were well-prepared for a birth without medication and with few interventions. They played wonderful music softly in the background. The young mom walked around the room, breathing through contractions, smiling the moment they finished. Her husband offered words of encouragement and praise. The labor progressed normally and the birth was a quiet, intimate experience for the husband and wife and the medical team. When the squirming, wailing baby was placed on her chest for toweling off, the mother looked up at her bawling husband and said, “That was so perfect.” And it was.
What certifications or trainings are recommended?
Advanced fetal monitoring, NCC inpatient certification, Neonatal Resuscitation Program, ACLS and BLS.
What steps would you recommend for nurses or nursing students interested in L&D?
The current trend is not to hire directly into L&D, so most new graduates will need to enter L&D from another discipline, like antepartum or postpartum care. There are also classes that can be taken, including neonatal resuscitation and fetal monitoring. A nurse can also become an International Board Certified Lactation Consultant. Obtaining these sorts of certifications and trainings demonstrates your great interest in perinatal services and maternal health to potential employers.
Is labor and delivery very competitive in terms of jobs?
Yes, it’s difficult to get a job in L&D right now, perhaps because many older nurses are putting off retirement due to the economy. Labor and delivery — and nursing in general — will be wide open again after the economy repairs itself.
Do you feel that the so-called “medicalization of birth” has eased in recent years?
I don’t know if the statistics will bear this out, but one of the huge factors affecting C-section rates is the number of multiple births. Due to IVF (in vitro fertilization), twinning and multiple births are very common, and these are essentially always C-section births. In Orange County, rates of IVF pregnancies are very high.
Patients are also coming in much better informed about the advantages of full-term pregnancies and there is a hard stop on elective inductions before 39 weeks unless there is a medical indication. I have not had a patient ask for an elective C-section in several years.
How has technology impacted the birthing experience?
It’s both technology and a paradigm shift in the way we think about birth that have changed. There are strong campaigns against elective C-sections, especially the March of Dimes’ recent campaign. There is also a strong push against elective induction. The March of Dimes is not recommending induction before 39 weeks and AWHONN (the Association of Women’s Health, Obstetric and Neonatal Nurses) is encouraging 40 weeks of gestation whenever possible.
Our facility has adopted these evidence-based recommendations and we are seeing fewer inductions and shorter lengths of stay. C-section rates also should be going down. Other technological changes include the move to electronic medical records and a paper-free environment. This transition is a challenge for many nurses, but is truly in everyone’s interest, including the patients’.
What are your broader career plans?
So many people just go to work each morning with no sense of anticipation. I am grateful to have the coolest job in the world. I never, ever get up in the morning and think to myself anything other than, “I can’t wait to see what the day brings.” I am a self-admitted “labor junkie” and I hope I can do it for many years to come.
Keith Carlson, RN, BSN, has worked as a nurse since 1996 and maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.