Wanting to go into women's health; how to deal with the bad

SoldierNurse22, BSN, RN · Jan 22, 2016

Unfortunately, OP, the bad is just part of the job, as it is in just about every nursing specialty I've encountered. You'll see it everywhere in varying degrees. While larger hospitals are generally going to see more in the way of stillbirths, birth defects, and antepartum disease processes that affect both mom and baby, that's not to say that kind of thing won't show up in a smaller hospital setting, and in my experience, when it does, it's often even more traumatic as many smaller hospitals aren't equipped to handle those kinds of problems and the potential for really, really bad outcomes is much higher. As far as abuse and other social issues? Beyond L&D and even nursing, that's everywhere. You'll see your fair share of that wherever you go.

I was an infusion nurse once. It is in fact the lower-acuity, repetitive (and yes, sometimes mundane) nature of the outpatient setting that can seemingly shield nurses from "the bad", but that's only because we're not there when our outpatients are admitted for treatment when their disease process(es) worsen beyond what can be managed in an outpatient setting. So in short, "the bad" is always there; it's just a matter of how close you are to it.

As far as how to approach stillbirths, fetal demises, neonatal loss, maternal deaths, miscarriages, and all the bad things that can happen in pregnancy, I can tell you that unless you've experienced something that yourself, you will not know how to handle the situation, and even if you have experienced something like that in your personal life, it's still different when you're the nurse and not the patient. It's normal to feel uncertain and out of place in those situations, especially when starting out. You will likely rely heavily on your preceptor/senior nurses/charge nurses to guide you through the process and draw from their experience in how to comport yourself, what to say, what not to say, etc.

Personally, despite my own experiences with loss, when I was orienting on L&D and encountered these types of situations, I watched my preceptor like a hawk and said very, very little. I watched everything from her body language to what she said to how she approached the patient. I saw things I liked, things I'd change, and things I wanted to add to my approach. And of course, people handle things differently, so not only do you need to find your own way to approach patients experiencing these events, but you also need to learn to approach appropriately for their emotional state/phase of grieving/religious beliefs/overall feelings toward the event. It really is a process. Don't put undue pressure on yourself and expect to go into this field feeling confident in this particular area. You almost certainly won't, and that's OK. Give yourself the freedom to learn.

People handle "the bad" in different ways, but I'd suggest that you minimally start with professionalism, compassion, and a healthy dollop of self-awareness (which, based on the fact that you posted on this topic in the first place, I'd say you already have!). Working in this field is very different from having your own pregnancies and babies. It is much less personal--except, of course, when it's not (and those moments can often pop up when you least expect them in the midst of both good and bad). If you can't take the bad with the good, you may not be cut out for the job, and there's no shame in that. It's something that's good to find out early.

https://cervixwithasmile.wordpress.com/2015/10/03/the-happiest-job-on-earth/

10 Things You Should Never Say to a Woman Who's Had a Miscarriage | What to Expect

Helping Someone After a Miscarriage

PS: the web is full of stories and blogs from women who have miscarried, experienced still births, and all kind of problems in pregnancy. I found it useful to read about their experiences and try to understand their perspective so that I could better meet their needs.

Also, try doing a search on AN (top right of the page) for fetal demise, miscarriage, etc. There is a lot of experience and expertise here from which you can gain a lot of wisdom!

perfexion, ASN, RN · Jan 24, 2016

Nursing is nursing. No area of nursing is 100% happy all the time. You take the good with the bad. It's what makes our profession unique.

Courtney Nurse Writer, BSN · Jan 24, 2016

Thank you @SoldierNurse22. I have bookmarked your links for further review. Just recently having kids has really changed my perceptions on things, and has really made me sensitive towards "the bad" aspects of this area. I hope to have a great preceptor if and when I go that route who will have adopted his/her own set of coping capabilities that can be passed on. [emoji106]ðŸ» I just hope it doesn't start to affect me mentally outside of work. Perhaps focusing on the families will be the best distraction.

cayenne06, MSN, CNM · Jan 24, 2016

The bad in women's health can be hard to handle. The unexpected death of a baby, trying desperately to save a kid only to never have them take a breath on their own- that stays with you forever. Losing a mom (thankfully so rare) is something you will never forget. Having to call DCF on your patient for neglect or abuse, seeing your patient go home with a partner who you know is abusive to her, losing your patient to follow up only to have her back in your office with a new pregnancy at 6 weeks postpartum- that stuff is HARD! But it is rewarding to be a part of people's lives when they are going through difficult situations, and I get great satisfaction from that part of midwifery.

What I have a harder time with is witnessing the... less than evidence-based care that remains so common in the field. Elective inductions at 39 weeks with an unripe cervix, policies that discourage breastfeeding and skin to skin, routine infant circumcision, drug dependent women treated like criminals... just a few examples. I've seen laboring moms wrestled into stirrups for delivery when all they want is to stay on their side. I've seen forcible lady partsl exams on a teenager, as she crawls up the bed crying and saying NO (I reported that, btw.). A mom who has prohibited from breastfeeding because of a positive THC. This stuff hurts my soul. But there is so, so much good in this field. So much opportunity to educate, connect, and help new families get off on the right foot. Helping a young mom develop confidence in her skills, and giving her the opportunity to regain control of her reproduction by setting her up with LARC in the hospital. Warm fuzzies :)

Courtney Nurse Writer, BSN · Jan 24, 2016

@cayenne06 thank you so much for the feedback. I worked before on a cardiac floor with adults so I have experienced loss before, however, the heartache of loosing the young for me is a lot to bear. I always loved the OB part of nursing school and wish that I had gone right into it when I graduated. Thank you so much for your words. I frequent the Facebook page of a group of breast feeding advocates in Texas and am astounded at all the lack of knowledge in regards to women's right with breast feeding. This is something else that I am so passionate about and another reason why I'd like to go into this field. I love to educate! Thank you again for your words, they were most helpful. I hope to be a positive change in a mothers life as you have so wonderfully described.

Katie71275 · Jan 29, 2016

I work in a very busy hospital doing L&D(and am hopefully starting CNM school in the Fall). I personally feel, the good outweighs the bad. I have done many fetal demises, because as I said, we are a pretty large hospital with a large number of deliveries, so we are going to see more. They are always sad. My last one was right before Christmas, and I was there when she found out and was told. It was awful. I stayed with her through her induction and a friend/coworker and I were her labor nurses the entire time she was with us. She had a beautiful delivery(it's hard to understand how an IUFD can be a beautiful delivery, but it was), and watching the love she and her husband had for their baby was sweet and emotional, even if it wasn't a baby they got to take home. It's so hard, but so rewarding at the same time. I cried all the way home after each shift and all the way to work during that time. It doesn't make me hate my job. You have to be able to understand that terrible things happen to amazing people through no one's fault. You also have to be able to accept that not everyone is perfect and you will have patients whose babies die because of their drug use...or who are in bad family situations. You still have to care for them and treat them with respect. I saw a lot more of this when I worked in a teaching hospital....where I work now, we don't see it as often, but it does still occur.

rnnluvnit2006 · Jan 31, 2016

There is no greater teacher than life itself...

I have been in OB for the better part of 10 years...and have experienced my share of grief and loss with patients and families alike.

I have found that being human is by far the greatest way to deal with the bad. When you lose your compassion for the patients you are caring for...its time to move on...

I had a patient deliver a stillborn at 34 weeks. The saddest situation ever, and yet her affect was so stoic and calm. The baby delivered on a Friday, and after it was born she didn't want to see her, so the baby was taken to the morgue. Thank goodness it was a Friday...

anyways...I had her in postpartum all weekend, and on Monday morning at 7 am right at shift change her boyfriend came out with a christening dress and asked if we would put it on the baby, I asked if they wanted me to bring her to them, and he said please. Mind you I had just done 3 12 hours shifts in a row and had already given report. So I redirected to the oncoming nurse, and her attitude was so callous...she was like...im busy I don't have time to deal with this... I asked the other nurse that had come on, and she too did not want to deal with it....so the other night shift nurse and I called the house officer to see if she could meet me down in the morgue to get the baby...she met me there in 5 minutes. Did I mention before thank goodness it was a weekend? The baby was still there, because the coroner doesn't come on weekends.

So I bring baby up, take her into nursery...cover all her orifices with tegaderm, put a diaper on her, and warm her up...it took the other night shift nurse and myself over 30 minutes to get her rock hard iced body into the gown, wrap her up and bring her back to mom.

We took baby in and as we lifted her out of the bed and gave her to mom, she openly grieved. There was not a dry eye in the room, how could you be human and not feel her pain? You couldn't.

My coworker and I stayed over an hour past our shift to make sure she got her child and was able to grieve. The fact is the oncoming shift should have done it...but both nurses were what I call nurse cratchetts...lacking any kind of human compassion whatsoever...those nurses do not belong on an ob floor...actually probably not on any floor...

So that said...Ob comes with lots of good and some bad. The rewards are far greater than any negative...

I wish you luck in your endeavor.

Courtney Nurse Writer, BSN · Jan 31, 2016

Thank you for sharing your experience. That was both beautiful and heart wrenching. It's those moments that I fear going into this specialty. I think I can sometimes be "over humanly".

The women was very lucky to have you as a nurse and for taking the time to do that for her. I cannot imagine having to go throw anything like that. It's good to hear though, that it's ok to show emotion in a time like that on the nurses part.

Thank you for sharing.