L and D Job Concerns

buster4 · Mar 28, 2008

I have been out of L&D for quite some time, I got so burned out, I couldn't stand the site of a pregnant woman!! so I got out.. but I did it for 10 years...

The stressful part at least for me was not knowing what was coming through the doors.. how many etc... how bad... and with limited staff... it could get hairy.. physically demanding, on your feet by the bedside... for hours.. helping them push, etc..... my legs and feet would feel like my legs were going to break into at times...keeping the charting up to date... in active labor charting was at least q 5 minutes etc....anyway.. thats my 2 cents worth...

hope it helps!!

GrumpyRN63, ADN, RN · Mar 29, 2008

They say it takes at least a year to feel comfortable/competent on L & D, I did it for 9 months as a filler job with the float pool, I always thought I wanted it before actually working there. where I work we see lots of high risk patients, and I agree , it's like a pregnant ED. You never know what comes thru the door, and even if its straight forward, things change in a moment. I am not an adrenaline junky, I like to plan my care, have pretty much stable pts.. plud I couldn't stand the docs, same docs I knew for years, but they are really demanding 2/2 tension, stress esp in the OR. I didn't like it, loved the nursing staff tho :)

RNBelle · Mar 29, 2008

my first job out of school has been post partum. and i LOVE PP! i originally thought that i wanted to do L&D but for me personally its to risky of an area. you dont know what will walk through the door and things change in an instant. i too realized i dont like to thrive on adrenaline that much. PP will give you a great idea on how that hospital's L&D works and if you want to move into their unit. at my hospital, you couldnt get me to work in L&D because a lot of times on nights they have 1 RN and 1 tech....too risky for my license. but if your L&D is well staffed with people that have a lot of experience, go for it! and a lot of hospitals will cross train you in PP, L&D and nursery and that will give you a lot of good experience and a good idea on what you like best.

magz53 · Mar 29, 2008

L & D is physically demanding as in never getting a break of any kind to eat or go to the bathroom. The ENTIRE shift on your feet, be it an 8 or 12 hour shift. I ruptured my L5 S1 disk with a huge extrusion impinging on the sciatic nerve while at work and had surgery a few weeks later ( after insurance makes you jump through the hoops of PT etc. before you have a diagnostic MRI ) I know I did it at work, but never tried to go the workman's comp route....... ( you will never be seen and are at the mercy of your facility for scheduling care. NY workman's comp is a nightmare ) Fast forward a few years and I tore a meniscus in my knee........don't try to wheel a 380 pound woman by yourself on a stretcher and turn a corner.......you will be planting your foot and pivoting the weight of your body and hers on your little meniscus and RRRRRiiiiiiippppppp !!! Again, I didn't tell anyone as it would have been a workman;s comp nightmare. And I would have been chastised for not getting help ( had there been help available, obviously they would have been helping me. ) Don't forget, bottom line with anything, IT IS ALWAYS THE NURSES FAULT. Mental stress...............I won't even go there. Look through past threads and posts.....you will get an idea of short staffing, poor management, high census, no vacations etc. etc. We will be lucky to get out alive and sane.

SummerGarden, BSN, MSN, RN · Mar 29, 2008

Oddly, the things most people complain about are the reasons why I love L&D except the part of not eating until I am about to pass out (it almost happened today)!!! Oh, and some of the beds can be hard to push, run, and navigate around corners (And yes, you push and run)!! Other then these two things I am SOOOOOOOOOOOOO glad to be on L&D. At first I wanted nothing to do with L&D when I started nursing school because I believed the "Princesses of Nursing" myth that is attached to L&D. After being a tech I became a Nurse Extern and I am absolutely loving every moment!

L&D is nothing like the fluffy floors other nurses and nursing hopefuls make it out to be. Many patients are like med-surg patients but pregnant (BTW, I don't hate med-surg)!!! I agree with the others that it is fast paced and can be ED in nature!!! Again, I love it...!!

If L&D ever becomes less hectic and all of the patients are healthy (anyone else ever hear that most L&D patients are healthy and have no complications? I wonder where they are...???), I will go do something else after graduation! For now, I will stay on my floor... In the near future I plan to remain and train as a New Grad. :nurse:

NurseNora, BSN, RN · Mar 30, 2008

If L&D is what you think you want--go for it. I've been doing it for almost 40 years and wouldn't want to ever do anything else. I no longer work in big city teaching hospitals with over 500 deliveries a month. I have moved to a small rural hospital with about 1000 deliveries a year, but I love L&D.

Stressful things: Obstetrics has the highest legal risk. If a baby is born damaged, you can pretty much count on a law suit even if no one did anything wrong. The damage awards are huge because if you show a damaged child to a jury, they want to throw money at it. Americans think that if something doesn't go perfectly, it's because someone did something wrong. And the legal liability lasts a long time. There is a time limit of, I think, 2 years after discovery of damage to decide to file a suit. But in OB, the child has that 2 years after reaching the age of majority to decide if he/she wants to file a suit if the parents didn't file one when he was a baby.

Never knowing what you'll come in to or what will come in the door next is stressful, but it's one of the things I like about L&D. I don't want to come into the same thing night after night after night. Sometimes you'll have no patients, sometimes too many. Most of the time your patients will be healthy. Pregnancy and childbirth are natural, normal functions not illnesses. Considering how many things can go wrong, it's amazing that it ever goes right. But it almost always does!! But when it doesn't--it can go bad quickly. You have to keep "normal and healthy" in the front of your mind while being alert to signs that something is going wrong.

Physicians can be difficult, but that's true anywhere. I think L&D nurses have a better relationship with their docs than nurses from most other departments. The docs spend a lot of time waiting around for deliveries. (some more than others) It's a good chance to get to know them. Most docs love to teach and if they're just there waiting for a delivery, it's a good chance to ask questions. Why do you do it this way? What does this mean? What's the latest thinking on X? How does Y work? Once they see you're interested, they tend to relate better to you.

When you take care of a pregnant woman, you're taking care of 2 patients, only one of which you can see and assess directly. The other one, the most vulnerable one can only be assessed indirectly. That takes some getting used to.

You have to be able to multi task. During a delivery, you have to keep an ear open to listen to the baby's heartbeat, while coaching and giving the mother emotional and probably physical support, keeping an eye on the doctor to see if he/she needs anything, and keeping an eye on the coach to be sure he isn't about to faint on you. You may have to hand hold the U/S while the patient pushes to keep the heart rate recording while you're still doing all this other stuff.

It is usually a happy place, so when there is a bad outcome it's even more sad. That's why I'm still up writing at this hour after working 12 hours last night and going in for another 12 hours again tonight. Last night I delivered a mascerated 20 week stillborn. It's sad, and I'm still grieving.

Physically demanding things: Caring for 2 patients who need to be charted on every 15 min, hopefully in real time. And that's if you're in a well staffed unit that doesn't give you more than 2 active labor patients at once. And even in those rare well staffed units, there will be times you have to have more patients than you should. Pregnant women seem to have a herd instinct and tend to arrive in clumps. Ask any L&D nurse about the pregnant bus. The larger the unit, the farther you may have to run between rooms (they're rarely in rooms next to each other). The nice thing about my now small hospital is that the unit is physically smaller and I can't put in as many miles a night as I could on the physically larger units. When I introduce myself to my patients I clain the doctor's stool (we have LDRs and it's there for him to use during a delivery) and tell the patient that I'm old and fat and I sit every chance I get. I sit almost all the time I'm in a patient's room unless I'm actively doing something for her. The family usually laughs at my old and fat remark and if one of them is using the stool, they almost always give it to me when I come into the room and I'm not too proud to take it.

It's hard to plan breaks and meals and potty breaks. Do yourself a favor and teach yourself to be flexible and to make sure you eat and empty your bladder. You don't always get a break, but if you're alert you can usually find 90 sec to get to the bathroom. You may have to grab a bite of your sandwich in the hall way as you run between your patient rooms (just don't let the infection control nurse see you), but if you are creative, you should be able to get something to eat and drink during your shift. By now I'm pretty well organized, more so than you'll be for some time yet, and very rarely go without eating, drinking, and urinating for 12 hours, but it does still happen once in a while.

Patients with epidurals are becoming more and more common. They need help in turning from side to side. Many can't move their legs at all to help you move them. I have a large Native American population, so 300+ pound patients are not uncommon. Learn good body mechanics!!!!

Many patients need help pushing. You may find yourself holding a woman's legs, or one of them anyway, for a couple of hours. I still sometimes have a woman pull against me as she pushes.

I have been punched, scratched, kicked, vomited on, had membranes rupture in my face, delivered babies barehanded. In the old days before AIDS, we used to use mouth suction for the De Lees. Every once in a while a baby would have more in it's stomach than the De Lee trap held. I can tell you from first hand experience that meconium stained amniotic fluid tastes very salty. Thank God, we now use wall suction for them!!!!

You move a lot of furniture. The first 20-25 years all the patients were moved, in their beds to the delivery room and onto the delivery table, then back into the bed and on to the recovery room. I got really good a walking backward, pulling a bed. Now that most places have LDRs there's not as much furniture moving, but you still have the occasional run to the OR for a stat C/S. Sometimes you have to climb under the OR drapes to unkink a foley catheter that isn't draining or to put on a glove and push up on a head that is stuck in the pelvis so tightly the doctor can't get it.

Why it's worth it:You get to be present at miracles on a regular basis. All at once there's a new person in the room who didn't come in through the door. A new person with a lifetime of hopes and dreams ahead of them. Any you got to help!!!

Putting a baby skin to skin for the first time and watching them fall in love with each other. Helping the baby nurse for the first time and watching the Mom's amazement and the baby's contentment.

Watching a big grown man cry as he is wrapped very completely around a teeny little finger.

Knowing that you have helped a woman reach deep down inside of herself and find strength and resolve that she never knew she possessed.

Knowing that a mother and/or baby is alive today because you recognized somthing was not right and responded aproprietly.

Showing a coach how to give his/her partner back pressure or use breathing techniques to help her. You're helping a family grow stronger.

Running into a woman in the grocery store who says, "I don't know if you remember me, but you were my labor nurse and I just wanted to thank you and show you my baby now." Most people don't have the time to write the thank you notes we all love to get, but when they run into you, they remember you. Of course, women in labor look different than they'll look in even a week, so unless she tells you a little about herself, or has her husband with her (they look pretty much the same) you may well not remember her. But it still feels good.

I'm sorry I went on for so long, I tend to be wordy at the best of times, but this is really bad. I love L&D and can't imagine why everyone doesn't want to work there. But I'm glad not everyone does want it because there's still a place for an old woman like me.

Elvish, BSN, DNP, RN, NP · Mar 30, 2008

So very well-put NurseNora. :yeah:

tntrn, ASN, RN · Mar 30, 2008

You summed it up well, NurseNora. I've been at it 31+ years but I'm ready to give it up. After an 8 hour shift on a unit that is built like a football field with everything you need on the 50 yard line (no matter what yardline you are on), I feel like I've been hit by a truck. And the physical demands are ruining my body; so as much as I've enjoyed my run, I'm looking to give it up. My own body needs to come first, finally. Holding up those epiduralized legs for 1-2, ever 3 hours of pushing, has done no favors for my back, my feet, my bladder and all the rest. I'm more than ready to hand it off to the young, energetic and idealistic ones.

Surgerygirl · Mar 31, 2008

I did L&D for 9 years and keep my RNC just in case I want to go back... I made the natural upgrade to OR Circulator. Anyway.... I have a comment on the " hold the legs while pushing " statements. I always had " Dad " hold one leg and the over- anxious Mom / Sister / Best Friend hold the other while I massaged the lady parts and assesed quality, station ...etc. It helped them become a part of:redbeathe the delivery. I still love L&D but I got tired of the prima donna patients who thought they were at the New York Plaza Hotel. :bowingpur I might go back someday.... it is a place of daily miracles.......

tntrn, ASN, RN · Mar 31, 2008

Anyway.... I have a comment on the " hold the legs while pushing " statements. I always had " Dad " hold one leg and the over- anxious Mom / Sister / Best Friend hold the other while I massaged the lady parts and assesed quality, station ...etc. SIZE]

There are occasions, rarely these days, since birthing has become such a spectator sport, that the laboring mom has no SO, husband, or any other person there to support her. Or just one person. And if someone is pushing 2-3 hours, there's no need to be massaging the perineum that entire time.

Surgerygirl · Mar 31, 2008

There are occasions, rarely these days, since birthing has become such a spectator sport, that the laboring mom has no SO, husband, or any other person there to support her. Or just one person. And if someone is pushing 2-3 hours, there's no need to be massaging the perineum that entire time.

Well .... that was a broad generaliztion. Point is you can do things to reduce the physical demands associated with this job. BTW, Not that many of my patients pushed over 2 hours as the docs are sometimes too impatient.