Nurse Delivery

babyktchr, BSN, RN · Jun 26, 2006

I have caught quite a few and you do get used to it. Our docs from time to time allow us to deliver while they are there to learn, which is a great thing. Keeping a level head is key, even though you may be freaking inside, you shouldn't show that to your patient. They are probably freaking as it is, with a precip delivery and a no doc situation. Keep cool and act like you know what you are doing and instill confidence that things are ok. Get as much help as you can and delivery the baby. They have been coming out for centuries without skilled help around and in fields and stuff. It ends up being quite exciting, really...as well as scary.

RNfromMS · Jul 4, 2006

Do you guys hate them?
I attended a birth the other day and mom surprised all of us, Doc had to run and our RN was clearly, well... freaking.
I know no one wants to be resposible for a shoulder dystocia etc... but don't most nurses have some emergency birth training? Don't most get ok with it after a while? How long did it take you to get comfortable (possibly wrong word??) catching if you need to?

I work in a teaching hospital where we have one staff doctor and 3 residents for L&D. The nurses do all the work getting the patient through the pushing until the baby is crowning and then we call for delivery doctors. Needless to say, with multigravidas, the resident sometimes misses the birth (or at least the catch).

I caught my first baby during the last couple of weeks of my orientation to L&D. I was totally freaked out but my preceptor talked me through it. I have probably caught at least 1 every week or 2 ever since. Now that I'm a preceptor, I feel that a orientee is not completely trained until they can deliver a baby. You never know when a precip will happen and you sure wouldn't want it to happen when you are alone if you've never delivered one!

SmilingBluEyes · Jul 4, 2006

I don't mind them..... and I try to remember they are not nurse deliveries after all. They are babies born into our hands. They usually come very fast and easily, delivering themselves.

tinyscrafts · Jul 4, 2006

I was sort of surprised at the level of freakout. This nurse told me she'd been a nurse in l&D for 2 yrs. Could it be that was her first one? she got another nurse in to actually catch if needed, she seemed much more comfortable. I was just wondering

judy ann · Jul 4, 2006

I agree with Deb. My term is "I caught a baby" Many times it is just that, and it is my great pleasure to attend any delivery, but if I get to catch--that is great.

Moms have a baby, babies deliver, we catch. (We hope) :bow: :yelclap: :thankya: :bow: :yelclap:

anglsamngus4ever · Jul 9, 2006

As much as I enjoy "catching" a baby here and there it is not my role. My role is to support the mother through labor and pushing and to get the doctor there in time to deliver the baby.

JeanettePNP, MSN, RN, NP · Jul 11, 2006

I caught two of my own babies. It's an experience I wouldn't trade for the world!

texas-rn-fnp · Jul 12, 2006

Depending on the hospital situation that you are in, it may be very common and frequent that nurses do deliveries. I have moonlighted in places that were downtown in large cities, where the hospitals were well secured after hours. The obstetricians had their offices downtown but they lived 30+ minutes away. It was a hispanic population that was predominantly multeps. If they were primips then they were young teens. What it came down to was a very nice population that had a low rate of complications that typically didn't come in at the first twinge of pain. They waited until the last possible moment, walked in and dropped the baby.

This particular place had an awsome nursing team. A pt could come in get triaged quickly and once determined appropriate for admission most of the nursing team would focus on that patient and the whole admission could be done in five minutes, including paperwork, IV, labs, and notifying the doctors. The doctors were always immediately available by phone. They had a huge 5x8 card for each doctor that told exactly how to contact them at what day and what time of day. Their was never waiting hours trying to get ahold of someone. Very supportive doctors also.

An a converse note, these doctors would get mad if they ended up actually making it in and then only spent five minutes there to do the delivery. Every place has a similar protocol of notify the primary doctor or the one on call for that group, if they are not able to make it in time for delivery notify ER doc to come catch (never actually saw an ER doc catch. Closest was getting one in to the room while he sat in the corner and I delivered). Or if there is another obstetrician around that is not in their group, they should deliver.

It is imperitive that L/D nurses be completely competent in all aspects of OB. Our area is unique in the level of independance that we have. Many places do not have Obstetricians around 24/7. When an emergency presents itself, the L/D nurse must be able to step up and react quickly and competently to resolve the issue. The actions or lack of actions that occur in L/D can have a life changing and life lasting effect on that unborn child. If it were your child you would want the best. Many times I hear excuses from nurses and techs that say that is not my job. I don't want to learn that. Even if it is not your job, it is good to know everything about everything. The nurse is the "Army of one!" They are the one that is looking out for the welfare of that patient. We are the first and last line of defense. (enough military slogans :=>) But true. The nurse is the one that is there 24/7. The nurse better knows what is going on with that patient than anyone. They are the coordinator of care.

Anyways...enough rambling. The final point...nurses need to know how to catch. The more you practice in a controlled situation under appropriate supervision, the better you will be able to perform under unplanned, unsupervised situations. In most places I have been the nurses are afraid to catch or do many other things. If there is an a unplanned, unsupervised delivery I am the one that usually does the catching because the other nurses are not confident, afraid to do it, prefer not to do it, etc. With the appropriate education, training, and practice, it is something L/D nurses must be able to perform competently.

ItsyBitsySpider, BSN, RN · Jul 12, 2006

Depending on the hospital situation that you are in, it may be very common and frequent that nurses do deliveries. I have moonlighted in places that were downtown in large cities, where the hospitals were well secured after hours. The obstetricians had their offices downtown but they lived 30+ minutes away. It was a hispanic population that was predominantly multeps. If they were primips then they were young teens. What it came down to was a very nice population that had a low rate of complications that typically didn't come in at the first twinge of pain. They waited until the last possible moment, walked in and dropped the baby.
This particular place had an awsome nursing team. A pt could come in get triaged quickly and once determined appropriate for admission most of the nursing team would focus on that patient and the whole admission could be done in five minutes, including paperwork, IV, labs, and notifying the doctors. The doctors were always immediately available by phone. They had a huge 5x8 card for each doctor that told exactly how to contact them at what day and what time of day. Their was never waiting hours trying to get ahold of someone. Very supportive doctors also.
An a converse note, these doctors would get mad if they ended up actually making it in and then only spent five minutes there to do the delivery. Every place has a similar protocol of notify the primary doctor or the one on call for that group, if they are not able to make it in time for delivery notify ER doc to come catch (never actually saw an ER doc catch. Closest was getting one in to the room while he sat in the corner and I delivered). Or if there is another obstetrician around that is not in their group, they should deliver.
It is imperitive that L/D nurses be completely competent in all aspects of OB. Our area is unique in the level of independance that we have. Many places do not have Obstetricians around 24/7. When an emergency presents itself, the L/D nurse must be able to step up and react quickly and competently to resolve the issue. The actions or lack of actions that occur in L/D can have a life changing and life lasting effect on that unborn child. If it were your child you would want the best. Many times I hear excuses from nurses and techs that say that is not my job. I don't want to learn that. Even if it is not your job, it is good to know everything about everything. The nurse is the "Army of one!" They are the one that is looking out for the welfare of that patient. We are the first and last line of defense. (enough military slogans :=>) But true. The nurse is the one that is there 24/7. The nurse better knows what is going on with that patient than anyone. They are the coordinator of care.
Anyways...enough rambling. The final point...nurses need to know how to catch. The more you practice in a controlled situation under appropriate supervision, the better you will be able to perform under unplanned, unsupervised situations. In most places I have been the nurses are afraid to catch or do many other things. If there is an a unplanned, unsupervised delivery I am the one that usually does the catching because the other nurses are not confident, afraid to do it, prefer not to do it, etc. With the appropriate education, training, and practice, it is something L/D nurses must be able to perform competently.

Awesome post..I'm not even an OB nurse and I feel like I should learn how to catch!

RNnL&D · Jul 12, 2006

I agree with texas rn fnp. Even though it is technically "not our job", well, it sort of is, if there is not a doc around. We have an attending doc in house, but even then, if he/she is in the OR or consulting in the ER, they might miss a delivery. I caught one the other night and the doc was just down the hall in her call room. I called her when baby was +2 just because Mom pushed so well. Another push she crowned, another the head delivered. Generally, when the nurse has to catch a baby, it is a precip and baby comes out just fine on his own.

It's good to be prepared. A nurse freaking out is not what a Mom wants to look down at when she's delivering her baby.

texas-rn-fnp · Jul 12, 2006

I agree with texas rn fnp.
Generally, when the nurse has to catch a baby, it is a precip and baby comes out just fine on his own.
It's good to be prepared. A nurse freaking out is not what a Mom wants to look down at when she's delivering her baby.

Thanks for the support.

When you are lucky they just fall out.

What do you do when the baby comes precip then stops after the head is out? (shoulder dystocia) or hemorrage or multiple tight nuchals or tight nuchal breaks or prevents baby from descending furthur? Baby crashes (in utero or after delivery)? You need to be able to take care of everything you can. Obviously can't do a c/s yourself, but you can have that pt in the OR, prepped and ready to go, gear out and ready for the surgeon. Do everything that is in your power and that you are trained and competent to do.

The key is to become educated through training (didactic and hands on), practice with appropriate supervision, get your skills verified (in writing), and have policies that support you intervening in an emergency. Don't start doing things when you don't know what you are doing. You may cause more harm than good. Think of the cliche "an ounce of prevention is worth a pound of cure." Better to be proactive than reactive.

Emergency drills are a great learning tool. Do a variety of them in a variety of circumstances with a variety of staff. It is not always the newbies that need help. The old folks need training too.