L&D RN Role

[traceychan]

Hello fellow RNs!

I am new to All Nurses, but I recall reading many, many threads back when I was going to take the NCLEX due to fear of failing (thankfully I passed the first time!). I have been an emergency RN for the past 3 years, a nurse for 5 years, and I am finally back in school to finish my BSN (graduating in July! huzzah!). I am passionate about pregnancy and love to teach others about childbirth after having two very different labors with my two children. I hope to be an L&D nurse some day, but for now, I'll stick with the ER :)

For one of my BSN classes, I am teaching a few classes regarding the physiology of childbirth and also birthing methods. I would like to enlighten my attendees about the role of the RN in L&D, so if you could please help me out, I would be very grateful!

I have seen what the nurse does during my own labors, but I would like to know your perspective on your role. What are you monitoring, what kinds of things do you chart on, common medications given, physician communications, etc. I also need to know how long you have been a L&D RN. Thanks so much!!

[traceychan]

Darn, I thought I'd get more responses. I'm bumping this up to see if I do :) I would really appreciate your comments!

[cayenne06, MSN, CNM]

Whew, that is a big question!

Basically, we are monitoring the mom's vital signs at regular intervals, monitoring her contraction pattern, watching for the many physiologic signs that signal labor progress, assessing the amniotic fluid when it breaks, checking effacement/dilation/station, and assessing fetal well being by monitoring the fetal heart rate either intermittently or continuously. We also give lots of backrubs, fetch cold wash cloths, run interference with family members, ets. After birth we (ideally) keep baby skin to skin with mom for at least an hour, and monitor the two of them as a pair. We assist with breastfeeding and monitor postpartum bleeding, watch the baby closely as they transition, etc etc.

Charting- vitals, obviously. I do a full labor/FHR assessment at regular intervals, more or less frequently depending on the situation. I chart any cervical exams I do, if her water breaks (and color, amount, odor, etc), any deviations from normal and what i do to address them, and probably a million other things I am not thinking of.

Medications- During labor, sometimes no medication is needed at all. Some patients don't even get a heplock. But probably the most common intrapartum meds are pitocin, prostaglandins (for cervical ripening or PPH), IV fluids, antibiotics, narcotics, antiemetics, and maybe methergine. Other drugs used with some regularity are magnesium sulfate, tocolytics, corticosteroids, um.... probably a bunch more but it is late and I am tired! Postpartum, we often give stool softeners, narcotics, ibuprofen/tylenol, sometimes topical anesthetics for tears, vit k and eryth ointment for babies, rhogam, sometimes tdap... thats all i can think of right now. And of course any other medications to address other medical issues- synthroid, anticoagulants, whatever.

Provider interactions- In my facility, the providers (CNMs usually) are usually in house to assess the patient when she first gets there, but sometimes we do the initial assessment and call them to discuss the plan of care. They are always in house when we have someone in active labor.The acuity of labor and delivery is such that the nurses have a high degree of autonomy and the providers rely heavily on their judgment. And the providers are very involved with care, checking in frequently and working closely with the nurses and the patients.

I've been an L&D RN for 2 years. Before that, I was a home birth midwife, and now I am just a few months away from being a CNM. I love labor and delivery!

Hope I didn't make too many typos; it's late and i'm not proofreading!

[sadiemae1123]

The RN is also providing a great deal of education for the patient, especially if she didn't attend any prenatal classes or is a first time mother. The nurse may provide information about stages of labor, pain management options, medications needed during labor, initial newborn care, routine newborn medications, and breastfeeding.

If there are health issues with the infant, like expected congenital defects, or a stillbirth/miscarriage then the RN may be providing emotional support for the family as well as educating them on what to expect at the time of birth. Hopefully there will be other professionals from the NICU or pastoral care there to assist the family as well, although in smaller hospitals that may not be the case.