What Do Labor and Delivery Nurses Do?
Labor and Delivery nurses work in the happiest place in the hospital. Where else do you get to go to birthday parties all day and night long?
If you love adrenaline, babies and a little bit of everything, the “Baby Factory” might be the place for you! Labor and Delivery is a mix of the Emergency Department (ED), Medical-Surgical, Operating Room (OR), Recovery Room, Neonatal Intensive Care Unit (NICU), and Critical Care all mashed together into one exciting unit!
What Does a Typical Day Look Like for Labor and Delivery Nurses?
Your day is different every single time you walk into work. In Labor and Delivery, you could be assigned to an OR case, an antepartum patient, or a woman in labor. Job assignments are not cut and dry. They are dynamic and always changing.
A “slow” (Shhh!!) morning could instantly turn into riding on the gurney with your patient, heading straight for the OR. Why are you on the gurney? Well, your stable antepartum patient’s water just broke and the umbilical cord slipped into the vaginal canal causing fetal distress.
In these situations, an emergency cesarean is the only resolution. It is the nurse’s responsibility to place their hand in just the perfect position inside the vagina so the baby doesn’t compress the cord, which could cause a lack of oxygen to the baby. As the decompressor of the cord, you’ll probably be draped in the OR along with the patient because your hand will be inside the patient until the baby is delivered. You might even get to give the doctor a handshake from inside after they get the baby out! Talk about a rush!
If you followed that patient until they went to the postpartum unit, you’ve had an antepartum patient, an OR case, AND a recovery room experience in the span of a few hours. Talk about a whirlwind!
Since there are so many aspects to Labor and Delivery nursing, I’ll discuss each type of patient and what a day would look like with them!
Labor and Delivery Triage
If you love the Emergency Department (ED), you might give Labor and Delivery a try. The labor unit is usually independent of the rest of the hospital, meaning they run their own triage like a mini ED. Unlike other units where admits come straight from the ED, pregnant patients typically bypass the ED and go to Labor and Delivery triage instead.
Any medical or surgical complaint in pregnancy is evaluated by Labor and Delivery triage. Whether it’s appendicitis, vomiting, headache, dizziness, contractions… it all is taken care of in Labor and Delivery triage. If a woman is admitted for labor, they head to a labor room. If someone has appendicitis they might go to an antepartum room for further evaluation.
Once a patient is assigned to you in triage, immediately assess how far along your patient is in her pregnancy and if you have a viable baby. If the baby is viable, you’ll put on a Toco (which monitors contractions) and a Sono (to monitor fetal heart rate). Typically, this is your number one priority and done before continuing your assessment.
Why is this monitoring a priority? If you have a baby with a low heart rate, you could be running to the OR minutes after saying hello. I’ve gone from introducing myself to delivering the baby via emergency cesarean section in 6 minutes flat! That’s how fast things move in Labor and Delivery.
It’s a good day when a triage patient complains of contractions with no other medical problems. If you check her cervix and it’s dilated more than 4-5 cm, she’s just bought a ticket to a labor room!
Care of the Laboring Mom
Taking care of a laboring patient can best be described by going through a typical shift change report, or nursing handoff. The great thing about Labor and Delivery is the majority of your patients are healthy, so report often does not involve complicated medical problems.
The most pertinent things you’ll ask during a patient report are:
G’s and P’s (Gravida and Para): Gravida is how many times the patient has been pregnant, and Para is how many times she has given birth. For instance, if you have a G10P8 (a history of 10 pregnancies with 8 births), you’ll be aware that the baby could come FAST with little to no pushing. With this history, it’s ideal to have the doctor close by! It’s always best if the baby is born with the doctor, not mom sneezing it onto the bed!
Obstetric History: Has the patient had a cesarean section in the past? Does she have a history of precipitous labor, placenta previa or pre-eclampsia? These are all things that will shape the plan of care for the patient.
Medications: It’s rare that a laboring patient will have scheduled medications like Colace. Many times medications on Labor and Delivery are given unscheduled or as needed. These include pain medication, nausea/vomiting medications… etc.
One medication unique to Labor and Delivery is Pitocin. Pitocin (a medication used for labor inductions) is used to increase the strength and frequency of contractions. This medication is titrated by the nurse until an adequate labor pattern is achieved.
Fetal Status: Fetal monitoring is unique to Labor and Delivery. Nurses take multiple classes on how to accurately interpret fetal heart rate patterns. Accurate interpretation is imperative to proper care. For instance, if there is a dip in the fetal heart rate, the nurse needs to assess whether the baby’s head is being compressed, if the cord is getting pinched, or if the placenta is not working properly. Each of these scenarios has different interventions, which is why the nurse needs to know how to act appropriately. At the bottom of this article, there are some resources if you’re interested in learning more about fetal monitoring!
Once you get the report, it’s time to assess your patient. As I mentioned earlier, the majority of your patients aren’t sick. Most of them are in labor, which makes an assessment fairly easy.
Unique nursing assessments in Labor and Delivery include palpating the abdomen for the contraction strength, checking contraction frequency, assessing the baby’s heart rate, and performing vaginal exams to assess cervical dilation. In many hospitals, nurses perform all assessments and notify the doctor of progress. When it’s time to push, the nurse will assist the patient until it’s time for the doctor to perform the delivery.
After pushing for a while with the patient, the physician or midwife will arrive for the baby’s delivery. The nurse is responsible to support the mother as she pushes her baby into the world. During this time, the nurse also cleans the perineum, prepares the delivery cart (which holds tools the physician might need), and retrieves warm blankets for the baby’s arrival.
Once the baby is born, he or she is placed on the mother’s chest as the nurse dries the baby with warm blankets. At 1 minute and 5 minutes after birth, the nurse will be in charge of assigning an APGAR score, which is an assessment of the baby’s status. An APGAR score includes the baby’s heart rate (which is obtained from the umbilical cord), breathing, color, muscle tone, and reflexes.
After delivery, the nurse continues to monitor vital signs on mother and baby, measure the baby’s weight and length, give the baby medications, and assess the mother’s bleeding. If mother and baby are both stable, the nurse transitions them to the postpartum unit about 1.5-2 hours after birth.
In the case that labor doesn’t lead to a vaginal delivery, an emergency or scheduled cesarean section is needed. During a cesarean section, the nurse will assist in the Operating Room (OR). In the OR, the nurse acts as the circulating nurse. Duties include placing an indwelling urinary catheter, doing surgical prep, performing instrument counts, and answering the physician’s pages. Once the baby is delivered, you’ll have another nurse present. One nurse will assess the baby, determine APGAR scores, and assist with skin to skin; the other nurse will continue taking care of the mother until the surgery is complete.
On the units I’ve worked, Labor and Delivery nurses also perform recovery after surgery. During recovery, the nurse will be exclusively with the patient and the newborn for about two hours. Along with administering medications, the nurse checks the patient’s fundus (the uterus) to make sure it remains firm and assesses the amount of bleeding every 15 minutes.
The ideal recovery patient will have had a spinal (a type of medication administration). With a spinal, the mom’s pain will be well controlled. If the patient was laboring with an epidural prior to delivery, the anesthesia staff can also dose it to use in the OR for a cesarean section.
Unfortunately, if your patient had an emergency surgery without an epidural, the patient will likely have general anesthesia, making the pain more difficult to control. In this case, the nurse will be busy administering medications during the recovery period. It’s ideal to get a PCA Pump to help manage the patient’s pain. (A PCA Pump is a type of pain management that allows the patient to control the pain medication administration).
What Totally Sucks About Working as a Labor and Delivery Nurse
Although Labor and Delivery is usually the happiest floor in the hospital, 1% of the time it is sad… really really sad. No one ever wants to hear the words “you’ve lost your baby.” When a baby passes away in the womb, it is called a fetal demise. These patients deliver in the same way as other patients. However, the nurses have additional things to include in the plan of care.
Once the baby is born, nurses allow patients to grieve in whatever way they choose. If they want to hold the baby for hours… that’s okay. This is their time. To make special memories, we often call services like Now I Lay Me Down to Sleep to take pictures of the baby and family. In addition to pictures, the nurses will do footprints, hand molds, and any other special things the family requests.
Even though it’s heartbreaking, it’s very special to be allowed the privilege to support a family during such an emotionally difficult time. I’ve even had the beautiful experience of supporting a family through a loss, and a year later, celebrating as they met their next child.
What’s Great About Being a Labor and Delivery Nurse
I could go on all day about why I would never work anywhere else in the hospital! I LOVE birth. It’s so raw, natural, and beautiful. So, here are my top three reasons why I love working Labor and Delivery:
As a nurse on Labor and Delivery, I love the working relationship between the nurses and the doctors. Even though nurses and doctors have very different skills and roles, there is a collaboration between these two professions. The role of a nurse is more of a partnership with the doctors, making for a fulfilling work environment.
Another aspect I love about Labor and Delivery is the diversity in the job. Nurses participate in a wide variety of areas, such as triage, OR, recovery, and labor. I know that every day I walk on the floor is going to be different. I love the variety that Labor and Delivery offers.
Perhaps the thing I love most about working Labor and Delivery is that every labor story is different. As the nurse, I get to be a part of a family’s unique birth story. Being in the room when a family meets their baby for the first time is such a privilege. So, I try to make each patient feel special. It is so rewarding to witness the excitement of a family welcoming a new baby!
So, You Want To Be a Labor and Delivery Nurse?
Is the prospect of being a Labor and Delivery Nurse exciting to you? If so, check out some of these resources that can help launch your career as a Labor and Delivery nurse!
Labor and Delivery Resources:
- Learn Fetal Monitoring
- Labor and Delivery Vocabulary
- Labor and Delivery Procedures
- APGAR score
- Mosby’s Pocket Guide to Fetal Monitoring
In “Baby Land,” we have a lot of unique procedures and verbiage that you won’t hear on any other floor in the hospital. You can check out my Labor and Delivery vocab and a list of procedures unique to Labor and Delivery.
Perhaps one of the more difficult areas to master in Labor and Delivery is reading fetal heart tracings. If you’re interested to learn more about heart tracings, I suggest checking out this site. This site is an awesome resource that teaches you the basics of fetal heart monitoring.
I hope that this article sparks your curiosity into learning more about Labor and Delivery nursing. I am so excited to say that I have found my nursing passion for Labor and Delivery. Who knows… maybe it’s for you too!
Brianna Babienco, BS, RN, RNC-OB has been a nurse for over 7 years and specializes as both a nurse and clinical instructor on Labor and Delivery.
Outside of work, Brianna is a wife and mother of two beautiful children. She enjoys swing dancing, scuba diving, and going on game shows. (She is a winner of the Price is Right and Let’s Make a Deal!)
If you want to find out more about Labor and Delivery, connect with Brianna Babienco as she explores the nursing experience on Facebook, Twitter, Instagram, and Pinterest. Check out her blog at Nurse Gold, where she and her sister Marissa Salsbery blog about all things nursing and specialize in helping nurses becoming more financially prepared for their future.
OB/GYN Peds Notes: Nurse’s Clinical Pocket GuideFast Facts for the L&D Nurse, Second Edition: Labor and Delivery Orientation in a Nutshell (Volume 2)Womens OB Nurse, We Help People Get Out of Tight Spaces t-shirt XL Heather BlueMosby’s Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach, 8e (Nursing Pocket Guides)