L&D Nursing Advice PLEASE HELP!

NBSAlvarez · Dec 9, 2015

L&D at night is much more fun & 'normal' than L&D during the day. During the day, the MDs want that mom on pitocin and baby blasted outta there within "normal" hours so they can run from clinic patients, catch the baby, and back to the clinic during daytime hours.....
At night, you can help women with positioning, let them get in the tub, and actually let them "labor down" instead of forcing that kid out before he's ready......
I believe L&D/OB is the most "litigious" area of nursing, so that's why you're seeing the "CYA" comments.
Side note - I loved the book "Baby Catcher" by Peggy Vincent when I was an L & D nurse.
Dont take your first OB job at a teaching hospital & get off of orientation in June/July when the med students are students one day and Drs the next, & at a place where you rarely do vag exams because there's already too many resident hands in there. I believe more than 5 vag exams greatly increases the risk of chorioamnionitis, but I havent done this area in a while....
Hope to work with Midwives as well as OBs so you can see how each does certain things better....or worse.....
And I agree about the tubal ligations and consequences of getting bought out by a Catholic hospital....but if you are pro-life at least then you dont have to be working at a level 3 hospital assisting with terminations in one room, & caring for the G6P0 IVF patient in trendelenburg in the other room.
Word of cautious advice:
For everyone wanting to do L&D nursing, IF you get a job at a non-Catholic hospital that gets sick patients (Level 3-4), find out if assisting with terminations will be part of your role. Every hospital has it's own name for this part of the job, & it's not an obvious name.
If it is part of your role and you are not comfortable with it, then find out if you can "opt out" of this part of the job, and then get it in writing. This is a very difficult thing to discuss at an interview, and I did get passed over for jobs because of it (not that I can prove it). I had no idea this would be part of the expectation of my role as an L&D nurse at a big city job ....and this information was kept from me on purpose. Seems like they dont mention it in nursing school, either.
I dont want comments about pro-choice or pro-life because I have so much empathy for mom's who are in this position....as have been friends and relatives of mine....all I'm saying is that when you interview for a job, you should be told that this is part of your role. If you already have the job & refuse this patient, it can be seen as "patient abandonment" in some cases. Not to mention you may really piss off your charge nurse, not exactly a good idea when you are new at a job. Yes, I am speaking from experience.
If you know you would never be comfortable helping with this, then dont apply to non-Catholic hospitals that are level 3, unless you KNOW from people already working there that they have a policy in place for you to "opt-out" of this part of your job. I could've really used this advice 15 yrs ago.

**** **** **** ****

I love to hear how much you enjoy your specialty. I think it is wonderful. I really enjoy Labor & Delivery and still have so much to learn but I feel like it is time to move on to something new.

It was refreshing to read your post

NBSAlvarez · Dec 9, 2015

Hi! Hello! I hope you accepted the L&D position. That is wonderful. Just like any position, you will have good and bad experiences. The one thing that I dislike about L&D is that you tend to forget about things that aren't related to OB/L&D. I had a antepartum patient who was there for pulmonary edema which was caused by the pyelonephritis. I was embarrassed that I couldn't remember the reason why that was possible. I had to go back to my textbooks.

So.. My advice to you, refresh your memories on these subjects from time to time.

Good luck! You will be fine.

OBwonKnewbie · Dec 10, 2015

Congratulations on your job offer! How exciting.

I work in a LDRP unit and have done so for a few years. My experience will be a little different, but generally the same.

Let's start with the positives....I love being there the moment a brand new family comes into existence and seeing the excitement on parent's faces. I love being there for the patient through her pain and tears and watching the moment that changes once baby is born. I love proving doctors wrong and helping my patient get to complete through positioning, etc and watching her have a lady partsl delivery when the doc was sure she would be a section. I love scrub nursing and the skill it takes to set up a sterile OR. I love maternal/ newborn education with new parents. I love being thanked by family members (dads, grandmas, aunties, etc) for helping the new baby to arrive safely. In general, I just love the skills I possess and knowing the other nurses in the hospital (in icu, med surge, etc) can't do what we do. We are our own ER, labor floor, OR, PACU, and PP unit. Really cool. I also think L&D units typically have good teamwork, you have to have one another's back. There is always something to learn, and I love that. The docs I work with are great, respectful to us nurses. Except anesthesia, they can be particular and down right rude, but they can bite me.

It is not all roses and butterflies. The bad stuff.......demises, of course. Unfortunately not every pregnancy ends well. You can see a couple on the worst day and it is heart breaking. I have seen babies with defects, which is also sad. The part that pisses me off the most are babies who are withdrawing from drugs mom used. When you see those tiny faces frantic and in pain vigorously sucking that pacifier it will anger you...or at least it does me. We get quite a few moms who have to have cases opened with CPS, and it can frustrate you if you don't see things being handled how you think they should. It is also hard to see parents who have no business parenting take babies home. Won't lie, it can be hard not to judge. And the ones that lie to you until their urine drug screen comes back positive, or worse, will continue to lie about it even when its positive...frustrating. There is a lot of charting in L&D and a lot of protocols to know. It is high risk and high stress, labor is unpredictable and keeps you on your toes. A good labor nurse will watch closely for subtle clues, because when things go bad they happen quickly and you must move quickly. Tons of charting. Some OBs can be annoying, they try to cut corners because they want to sleep, etc. Need a thick skin and confidence. Disagreeing with an OB or anesthesiologist can be a difficult, sticky situation that requires strong knowledge and tact. Some L&D nurses I have encountered have an arrogance. ......it's gross.

Hope you love it, OB is rewarding in many ways

cayenne06, MSN, CNM · Dec 19, 2015

And I agree about the tubal ligations and consequences of getting bought out by a Catholic hospital....but if you are pro-life at least then you dont have to be working at a level 3 hospital assisting with terminations in one room, & caring for the G6P0 IVF patient in trendelenburg in the other room.
Word of cautious advice:
For everyone wanting to do L&D nursing, IF you get a job at a non-Catholic hospital that gets sick patients (Level 3-4), find out if assisting with terminations will be part of your role. Every hospital has it's own name for this part of the job, & it's not an obvious name.
If you know you would never be comfortable helping with this, then dont apply to non-Catholic hospitals that are level 3, unless you KNOW from people already working there that they have a policy in place for you to "opt-out" of this part of your job. I could've really used this advice 15 yrs ago.

I agree with this, to a point. But I hold the (probably unpopular) position that you should not work in reproductive health if you aren't comfortable counseling and caring for women who are considering or undergoing an abortion. And I think it is malpractice and completely inappropriate for Catholic hospitals (who are the only health system in many areas!) to restrict access to family planning services in their hospitals. I don't care if they are a religious organization. I don't see Catholic hospitals refusing to treat pedophiles or abusive spouses, even when their health care needs are directly related to their criminal and unethical behavior. Yet, women facing an unwanted pregnancy, or a fetus with tay sachs, or who want a damn tubal or postpartum IUD are refused care because of some cherry picked idea of Christian morality?

I don't mean this to be a prochoice/prolife comment. It's just that working in abortion care has made me acutely aware of the stigma some women face when seeking care for an unwanted pregnancy. And to speak to your example above, I can guarantee that women undergoing inpatient abortions are usually doing it for a very good reason (fatal fetal defect, critical maternal health problems, or unfortunately maybe because they were not able to access timely abortion services).

I understand the idea of conscientious objection. I struggled heavily with the idea of assisting in routine infant circs when I started working in OB, and even just being complicit in ethically questionable situations (like the 39wk G1 induction because doctor is going on vacation, etc etc). So i understand the internal struggle.

I don't have easy answers, but I do believe that the health and well being of our patients is first and foremost, and as a rule that means providing compassionate care for our patients even if we personally disagree with their choices. ED nurses don't get to "conscientiously object" to caring for the critically injured murderer, you know?

kdkout, BSN, RN · Dec 19, 2015

To "Cayenne06" above;

I understand what you are saying also, and your viewpoints matched most of my coworkers at the time. I found I couldnt do L&D nursing anymore because of the termination issue; I was too stressed out about it & had so much guilt. That was the best choice for me - to leave that field and do something else. I didnt think it was fair to me OR my potential patients to stay. If I feel like I cant be non-judgemental and give the care I should be giving, then it's time for me to leave.

My "beef" was that the hospital never told me assisting with terminations was an expectation of the job, and I feel they should've - at the interview, before it was too late.

There's ethical dilemmas in every area of nursing! No way around it, that's for sure. Thank you for speaking about this professionally; it can be a tough topic :-)

cayenne06, MSN, CNM · Dec 19, 2015

To "Cayenne06" above;
I understand what you are saying also, and your viewpoints matched most of my coworkers at the time. I found I couldnt do L&D nursing anymore because of the termination issue; I was too stressed out about it & had so much guilt. That was the best choice for me - to leave that field and do something else. I didnt think it was fair to me OR my potential patients to stay. If I feel like I cant be non-judgemental and give the care I should be giving, then it's time for me to leave.
My "beef" was that the hospital never told me assisting with terminations was an expectation of the job, and I feel they should've - at the interview, before it was too late.
There's ethical dilemmas in every area of nursing! No way around it, that's for sure. Thank you for speaking about this professionally; it can be a tough topic :-)

Well said! I agree, and I commend you for recognizing that a different specialty might be a better fit for you. I respect and empathize with people who hold pro-life viewpoints- it's hard to know the reality of abortion and not wrestle with the profundity of it all. I have been a midwife since 2006 and have brought countless babies into the world, and have devoted my life to caring for women and families- spending endless nights on call and long days in the clinic to oversee the health of mothers and their little growing beanie babies.

I remember clearly the first baby I caught when I was a baby student midwife (back when I was doing my CPM training). It turned my world inside out in the best possible way. 2 years later, I'm now a licensed midwife (CPM, licensed in florida) this same mom came back to me for her second baby. Beautiful birth. A few years later, I left the birth center due to my daughter's health crisis, and took a job at an abortion clinic. And who would show up, but that same mom, needing a termination for her third pregnancy. She had two kids under 5, an absent babydaddy, and was desperately struggling to keep her and her two girls warm and fed. And I guided her through the termination, just like I guided her through her two births. She asked for the fetus/POC to bring home, so I facilitated that.

I am not sure why I am sharing that story. It was a turning point in my career, and ever since then I have been drawn deeper and deeper into the public health component of midwifery and away from the lovey hippy healthy affluent home birth side, which was what initially got me hooked. The messiness of the human condition, the blood and sadness and joy of sex and reproduction, the broad public health implications of sexual/repro health access. . . I just love this stuff so much, so so much. I feel like I make a real and measurable difference every day in my work. The beauty, drama and adrenaline of birth, the deep pleasure of labor sitting- I miss it. But it never scratched my itch like working at Planned Parenthood does. Best job ever!

(sigh, my post turned into a come-work-at-PP plug. I just love my job so much I can't even help myself lol)

Cheers!

Very truly yours,

A Planned Parenthood Midwife

Sky359 · May 23, 2016

I love that you wrote this. These are all the reasons why I love/hate my job. Lately, it seems like more of a dislike. For all of these reasons, I spend most nights feeling like I am not really helping anyone. The only time I feel as though I am helping is when its my rotation to be on postpartum. I love educating patients and could talk about breastfeeding for ages. The labor part is what kills me. I feel like its all wrong and our c section rate is about 40%. I feel like I contribute to that with all the ridiculous interventions. All of these reasons makes me feel like I am the wrong area of nursing.

BabyLover23 · May 23, 2016

Thank you for your comment. This gives me a lot to think about. I am current considering an offer to work on L&D at Northside ATL as a new graduate and find comments like yours helpful. Is there anything you do like about working at Northside in L&D? What is the nurse to patient ratio and do you feel supported? Thanks!