stupid questions on L&D nurses' function

ayndim · Jul 11, 2004

I am not a l&d nurse (yet) and am still a student. However, I did have CNM's with my 3 kids. So I will give you my experience.

1. Does a nurse ever get to pelvic exams at all? Nurse do cervical checks during labor to assess cervical changes (dilation/effacement). During my last birth the CNM did all of the checks but at the other two births the nurse did it. They don't do pelvics like you get with your yearly exam. Homebirth mws probably don't have a nurse but in the birth center or hospital I know my cnms use them. Midwives do pelvics and paps. My CNM is my regular caregiver, just like some women see gyn drs. If you don't use one for your yearly exam I would highly recommend it. I find them much more "comfortable" and I love the dignity duds mine uses. Instead of paper gowns they use a shirt, which looks much like a nursing shirt for the breast exam and big baggy pants with a slit in the crouch. You don't feel exposed at all.

2. What is the function of the nurse at the actual birth. I seem to see midwives working alone, so are the nurses actually not needed at that point? I had a nurse at all of my deliveries. She looked at the monitor strips, did an assesment and history. She put the IV in and at my last birth the foley. She helped the midwife set up for the birth.

3. Any nurse actually get to function as the midwife, ever - ie, "baby catching"? Only if the dr/mw doesn't make it there in time. Not sure how often it happens. I think they encourage the mom to not push until the dr/mw shows up. Me personaly, I wouldn't wait for anyone. The urge to push was overwhelming, even with an epidural. L&D nurses are quite capable of handling a "nurse delivery" in my opinion.

Hope that helps.

bsnecu99 · Jul 11, 2004

I am not a l&d nurse (yet) and am still a student. However, I did have CNM's with my 3 kids. So I will give you my experience.
1. Does a nurse ever get to pelvic exams at all? Nurse do cervical checks during labor to assess cervical changes (dilation/effacement). During my last birth the CNM did all of the checks but at the other two births the nurse did it. They don't do pelvics like you get with your yearly exam. Homebirth mws probably don't have a nurse but in the birth center or hospital I know my cnms use them. Midwives do pelvics and paps. My CNM is my regular caregiver, just like some women see gyn drs. If you don't use one for your yearly exam I would highly recommend it. I find them much more "comfortable" and I love the dignity duds mine uses. Instead of paper gowns they use a shirt, which looks much like a nursing shirt for the breast exam and big baggy pants with a slit in the crouch. You don't feel exposed at all.
2. What is the function of the nurse at the actual birth. I seem to see midwives working alone, so are the nurses actually not needed at that point? I had a nurse at all of my deliveries. She looked at the monitor strips, did an assesment and history. She put the IV in and at my last birth the foley. She helped the midwife set up for the birth.
3. Any nurse actually get to function as the midwife, ever - ie, "baby catching"? Only if the dr/mw doesn't make it there in time. Not sure how often it happens. I think they encourage the mom to not push until the dr/mw shows up. Me personaly, I wouldn't wait for anyone. The urge to push was overwhelming, even with an epidural. L&D nurses are quite capable of handling a "nurse delivery" in my opinion.
Hope that helps.

Ha, :rotfl: a zipper or a velcro flap!

SmilingBluEyes · Jul 12, 2004

we function in many ways:

We admit and triage all patients over 20 weeks' gestation for a number of things.....to rule out labor, assess for problems such as hypertension, fetal distress and/or non reassuring status, preterm labor/rupture of membranes, etc. We determine if they need admission, call the doctors and get orders for what they need, e.g. hydration, medication to stop preterm labor, admit and care for active labor, etc.

Once admitted, we monitor and treat according to patient/fetal status. We are responsible for monitoring the strips and treating accordingly. We do cervical checks and also speculum exams to determine membrane status (to rule out rupture of membranes in cases where it is not clear if they are ruptured or not).

We start all IV's (if needed), do lab draws, etc. We are responsible for placing any catheters and internal monitors (IUPC/ FSE) if needed, as well. We assist the anesthesiologist when starting epidural, spinal or intrathecal anethesia. It's up to us to monitor patient status (as well as fetal) throughout the placement of the anesthesia, as well as afterward. Complications can and do arise and it is up to us to catch them early on and treat as needed (or call the MD if there is a serious problem).

We are responsible from beginning to end of the patient stay for educating them on all manner of subjects, from the pregnancy and its changes, to labor/delivery progress to post partum care. We initiate breastfeeding with the moms, usually in the first 30 minutes after birth and help them learn to breastfeed all throughout their stay with us. It's up to us to determine if serious problems that exist as barriers to breastfeeding to get help for the moms, to include our Lactation Consultant or put them in touch with LaLecheLeague if they are at home.

We triage by telephone often, as well. People call for all manner of things from wondering if they may be in labor to having huge breastfeeding problems at night and in tears.

We are present for every delivery, including midwife ones. Our function there is to assist, set up equipment, help mothers w/pushing, positioning, etc. and help fathers/family members be involved in the process. It's up to us to monitor all the machinery involved as well. When delivery is over, we clean up the patient as well as tidy up the room and remove all unnecessary equipment.

As said earlier, we help initiate breastfeeding. We usually have a 2nd nurse in the room for each delivery to "catch" the baby and assess him/her and give all meds, etc. This nurse may be the one helping w/breastfeeding while the other cleans up.

In the case of a csection, it's our job to wheel Mom back to the OR, skin and shave prep her and assist anesthesia to get things going. We circulate the case then, getting whatever is needed as the case is done. A 2nd nurse goes to take care of the baby. We then wheel mom back and do a PAR recovery in her room, meaning, we stay with the mom and baby for a full hour, doing every 5 minute vital signs and assessing her recovery, as well as getting breastfeeding going.

It goes on and on, I tried to paint a bit of a clear picture of what we do on a day to day basis. the thing that gets most annoying is all the darn PAPERWORK, MOUNTAINS OF IT------that takes up HOURS and HOURS Of our time. That is anywhere in nursing, and the most frustrating thing about what we do. And it seems, more comes every year. OB is one of the most litigious areas of nursing, so you can bet we are charting for the lawyers.....

HTH! I LOVE WHAT I DO, really! Being part of new life and families being born is a privelege and honor to me, I try not to take it for granted!!!

The paperwork is the biggest pain in my work. MOUNTAINS OF IT, so much that sometimes I feel it gets in the way of providing the care I want.

epiphany · Jul 12, 2004

Smiling:

Thank you for taking the time to provide me with a clear picture - exactly what I was looking for. Your info is so useful and much appreciated.

SmilingBluEyes · Jul 13, 2004

You are more than welcome!

rndani · Jul 27, 2004

Wow! I couldn't have written a better reply! Just a quick question for you Deb--how long are you alloted for recoveries at your facility before turning the patient and baby over to a post partum nurse? Do you have a written policy on IUPC placement? Do you arom? Nurses do not arom at my facility unless a fse is medically necessary and we do not place IUPCs. Our recovery time is 90min. This includes full baby assessment, meds, bath, teaching, breastfeeding, get mom up to bathroom and room cleaned and yes, charting. Oh and we only get a second nurse in the OR if there is significant fetal distress.

SmilingBluEyes · Jul 27, 2004

Good question but I can't help much here, since we do LDRP---- we dont' turn over mom and baby to anyone. We keep them as our patients. Makes for great continuity. But when I did do LDR and P, we recovered them for roughly 2 hours and once they were able to walk, took them to the other hallway and new room for PP care. HTH.

rndani · Jul 27, 2004

That sounds really great. We call ourselves a LDRP. The patient/family stay in the same room for the entire stay, but once they're "recovered" they are put in a post partum group of 4-6 couplets which has a post partum nurse and CNA. The labor nurse moves on to another active patient or induction after she gives report. I'd love to stay with my patient through the rest of the shift!

L&D_RN_OH · Jul 27, 2004

That sounds really great. We call ourselves a LDRP. The patient/family stay in the same room for the entire stay, but once they're "recovered" they are put in a post partum group of 4-6 couplets which has a post partum nurse and CNA. The labor nurse moves on to another active patient or induction after she gives report. I'd love to stay with my patient through the rest of the shift!

That sounds similar to our setup. Although L&D nurses do keep PP pts if our load allows it. But our PP nurses are not crosstrained to L&D, so if L&D is busy, we give up our PP pts to a PP nurse.

We also do not AROM or place IUPC's at my facility.

SmilingBluEyes · Jul 27, 2004

we do NOT AROM, but we do place all internal monitors as needed.

CA CoCoRN, RN · Jul 28, 2004

At our facility we recover the patient for one hour: we don't do couplet care. So after a period of time of bonding, the baby goes to the nursery to be assessed, washed, weighed, vaccinated, etc., and mom goes to her post partum room (assuming she has no complications) where baby will be brought back to her. If she has to be on Mag, etc, she stays with us in L&D.

As for internals, we place them. We don't AROM, but SROMs do happen on VE :coollook: . We place IUPCs after we've been certified and signed off on them by our CNS or MD. FSE doesn't need an order: it's a standing order when necessary. IUPC and/or amnioinfusion are on order. Certain docs do have a standing order for internals, though.

Our unit is an LDR unit, with PP being downstairs, and overflow on the gyne floor. But since we've been so busy and need to turn our pts over faster, sometimes, we have trained PP nurses who work on our floor and take over the patient after two sets of VS to finish recovery.