How attentive should L&D nurse have been?

RNLaborNurse4U · May 5, 2005

A question for my L&D nurse experts-(I'm ICU so I'm out of my expertise area.) My daughter-in-law just delivered our first grandbaby this week, and I was surprised at how little she saw her nurse during the long night. Even after she was 8 cms dilated, the nurse only popped in when she put her call light on and asked for something. She had to call three times that the "baby was coming", which it was, before they even checked her and found her crowning. Thankfully she had a perfectly normal delivery, and a healthy baby. She joked "I might as well have had the baby at home. "We were at a very large and busy hospital that typically delivers 25 plus babies a day, but everything seemed rather quiet that night. I know enough to know that the monitor wasn't showing late decelerations (I was rarely in the room with her however,) but I guess I though that at least towards the end she would have had nurse stay with her!

There are multiple things - did she have an epidural in place? Was this her first baby? How busy was the rest of the L&D unit that night? How many other patients was that nurse caring for? Do they have centralized fetal monitoring?

At night, when I have a labor patient with an epidural, I try and stay out of the room as much as possible, so she can sleep/rest (as well as her support partner can rest too). Especially if she's a first time mom - first timers with an epidural typically take 1-2 hours to push, so those babies do NOT just "fall" out, and there is no need for me to be by her side continuously, even if she's 10cms). We have centralized monitoring, so we can be watching how the baby is doing, and not have to be in the room. Also, if I have multiple patients at night (which I usually do), I may be watching other monitor strips and charting on each patient. Just easier to do this from the nurses station, at night, if all patients are sleeping with epidurals in place. Easier to watch all of the monitor strips at the same time. Or I might be helping another nurse in a delivery, or admitting another patient, or caring for another patient in their room.

Obviously, her baby must have been looking fine on the monitor, or you definitely would have seen her nurse much more often in the room.

Night shift where I work is sorely short staffed, so many times everyone has 2-3 patients at one time. We on nights are not lazy, sleeping, or kicked back with our feet propped up. Nights can be just as busy, if not busier because of the smaller staff, than day shift.

Jen

L&D RN

SmilingBluEyes · May 5, 2005

Now it does seem, *just based on what you say*, not attentive enough. But why????? There may be lots of reasons.

It's hard to say what all happened, as I was not there, but to have to ring THREE (3?!) times for the nurse to tell her the baby was coming is not, in my book, truly what I would call attentive care. Again why? WAS the baby really coming imminently----? Usually for primips, it can take HOURS from 8cm to delivery, really. Like Jen before me said, these babies don't just fall out, usually!

I will try and speculate a bit, but remember, I was not there.

I do know, when our moms have epidurals, I don't pop in all the time, especially if they are comfortable and resting. Some get irritated by constant presence. But I DO watch on the central monitor to see how the baby is doing and for subtle changes in heart rate that tell me the baby may be coming. I usually let them "labor down" so pushing is short and sweet as possible. If I am not there, does *not* mean I am not watching and monitoring the mom and baby. I am.

Many things I do not know in your case--------

I don't know if your daughter in law had anesthesia/epidural....I don't know the condition of her labor and how the baby was doing while she was laboring......I don't know how busy they were on the unit (just cause it '"seems quiet" does not mean it is, gone are the days of screaming heard up and down the halls of patients in labor, thanks to epidurals).......and I don't know how many labor patients your nurse may have been assigned that particular evening. Often, nightshift is "downsized" and therefore, not as well staffed as day shift in many units. This is very common. And they think patients sleep at night.....well that is another thread.

One thing I do know: in some very busy units, nurses are monitoring a minimum of 2 and even THREE at a time (which is very wrong). The AWHONN standard for low risk labor patients prior to pushing stage is a ratio of 2:1, so at times, even that can get busy. When one of my patients has to push, I have to get another RN to cover the other. This can get tough as they also have a load to carry. But we do manage as best we can. Fortunately, most of the time, we only have one labor patient per RN and if that patient needs me there, I am THERE by her side, to support her. It's rare anymore, since so many elect to have epidural anesthesia, to need me or even want me around them. But if they do, I am happy to be there. I love a good natural labor experience and all the intensity that surrounds it! It gets my juices flowing; I miss that daily experience, it's all-too-rare now for me.

Truly, I have no way of knowing what kept your nurse from being there when you needed her. I am just sorry this happened. I am very glad it all turned out alright. I can certainly understand your concerns!

I know I did not probably answer your questions well, but, I just was not there to know the ins and outs of your daughter in law's labor experience. Yes, on the surface, it seems at least from what you tell me, it was not the most attentive nursing care there.

Maybe next time, if you daughter in law is low-risk, she could seek out a midwife-run birthing center or even deliver at home under the care of a good midwife. It would be a lovely experience for her and the entire family. I wish you all well, and again, congratulations.

joyful nurse · May 6, 2005

Thanks for the reply, that makes perfect sense-I bet they did have centralized monitoring. And she really was doing great, the room was dark, and everything was calm and went just as expected, except that she did finish up quicker than they had anticipated- she only pushed about 15 minutes! I imagine the unit was incredibly busy-it looked like a baby factory to me!

There are multiple things - did she have an epidural in place? Was this her first baby? How busy was the rest of the L&D unit that night? How many other patients was that nurse caring for? Do they have centralized fetal monitoring?
At night, when I have a labor patient with an epidural, I try and stay out of the room as much as possible, so she can sleep/rest (as well as her support partner can rest too). Especially if she's a first time mom - first timers with an epidural typically take 1-2 hours to push, so those babies do NOT just "fall" out, and there is no need for me to be by her side continuously, even if she's 10cms). We have centralized monitoring, so we can be watching how the baby is doing, and not have to be in the room. Also, if I have multiple patients at night (which I usually do), I may be watching other monitor strips and charting on each patient. Just easier to do this from the nurses station, at night, if all patients are sleeping with epidurals in place. Easier to watch all of the monitor strips at the same time. Or I might be helping another nurse in a delivery, or admitting another patient, or caring for another patient in their room.
Obviously, her baby must have been looking fine on the monitor, or you definitely would have seen her nurse much more often in the room.
Night shift where I work is sorely short staffed, so many times everyone has 2-3 patients at one time. We on nights are not lazy, sleeping, or kicked back with our feet propped up. Nights can be just as busy, if not busier because of the smaller staff, than day shift.
Jen
L&D RN