Other nurses are quick to judge what other nurses do. And patients generally don’t really know the nurse side of things. So as a Labor & Delivery nurse I’ve been told this many times. If you’re thinking that’s what L&D nurses do then here’s a quick rundown of what we actually do.
1. L&D nurses can triage and discharge patients in under 30 minutes
Do you think you’re in labor? When you come to labor and delivery you’ll start off as a triage or obs (observation) patient. We put you and your baby on a fetal heart rate and contraction monitor and perform a NST, or non stress test, for a minimum of 20 minutes.
In the meantime we can draw your blood, test your vaginal fluid to see if you broke your water bag, and test your urine for protein. A provider will come in, we tell them your story, maybe check your cervix for dilation, they do a bedside ultrasound to check on baby.
If we determine that you’re not in labor, did not break your water bag, or have any concerns with you or your baby, we send you on your way with some discharge paperwork. Will you go into labor later that day? Possibly. But we know it’s not right now.
2. L&D nurses can be advice nurses
Aside from our patients that we’re taking care of at the bedside, we also respond to phone calls for advice. People call for lots of things, some not even related to labor: “I’ve been nauseous all day,” “Can my husband stay in the room?” “I have giant hemorrhoids.”
My first advice call was about the giant hemorrhoids. She was crying on the phone about how painful they were. I spent some time talking to her about comfort measures and then deferred her to our midwife. I remembered that this midwife just had a patient with very large painful hemorrhoids and that the patient had a special topical recipe for comfort.
Lately my hospital has been timing how long our advice calls are, sometimes they are up to 15 minutes! So, if you’re wondering where your nurse is, maybe they’re on a break, or maybe they’re on the phone trying to calm down a lady about her massive hemorrhoids.
3. L&D Nurses work in the or
We are pre-op nurses
Not having a vaginal or nonsurgical delivery? I say this because I know not everyone refers to that area as a vagina. Anyway.
L&D nurses are there for your c-section surgery from start to finish. Your preoperative (pre-op) nurse will check you into the pre-op room and ask you to do an initial wipe down with some cleansing wipes. Your partner or other staff member can help you wipe your back. If you have some hair growth down there we might clip (not shave) the area.
We will perform an NST, place an IV and draw your bloodwork (I do this at the same time to save you an extra needle poke) and do your covid swab. We will go through a pre-op checklist interview where they ask you things like, when did you last eat or drink anything? Do you have any allergies? Do you have an advance directive?
Another thing we will ask you to do is to remove all your belongings and remove all your piercings. You do not want me to remove your nipple piercings so you can just do that yourself at home.
we are operating room nurses
When you go into the operating room your L&D nurse will then function as the circulating nurse. They chart every detail of your surgery: what supplies were used (gloves, gowns, dressing, sutures, etc), who came in and at what time, what time the first cut was made, when were all the instruments counted, and much more.
we are post-op nurses
After your surgery, this same nurse will transfer with you to the post anesthesia care unit (PACU) or postoperative unit (post-op) where they monitor your vital signs, bleeding, pain, and overall recovery from anesthesia and the operation, hence the names PACU and post-op.
This area requires you to be on a electrocardiography heart monitor, or ekg monitor, something that not all nurses are trained to use. Depending on you and your baby’s health statuses and policies of your facility, your baby may be in the PACU with you. The L&D nurse will help you to do #5 on this list if you and your baby are ready.
4. We can also function as a scrub nurse during surgeries
Short staffed unit, what’s new? L&D nurses can cross train to become scrub nurses, not the same as what TLC sang about in No Scrubs. Scrub nurses help doctors in c-sections. They pass the surgeons the instruments they need to perform your surgery and help with retraction.
Scrub nurses do not make any cuts or sewing, we are not trained to do that and do not get paid enough to even do so.
5. We help with newborn feedings
Think only lactation nurses can help you with breast/chest feeding? Again, I acknowledge that not everyone refers to this area as breasts. Anyway.
Fear not, L&D nurses can help you. Our biggest advantage is that most times babies are born hangry and ready to eat. This makes our job easier as we can help to guide your baby to the food source.
After the initial golden hour, your baby will probably be sleepy and not interested in eating. The next day they could be too fussy to even concentration on feeding. Lactation nurses and postpartum nurses can help you.
6. We help to deliver dead babies
This is something no one ever thinks about, I definitely didn’t before working in L&D.
When babies pass away in the womb, how do you think they get out? They all get delivered somehow. I’ve seen demises from very small babies to big babies at term gestation. Sometimes there is a reason for their death and other times it’s less obvious.
The pregnant person must still go through labor to deliver the baby. Yes, they must go through the pains of labor on top of the pain of having already lost the baby.
The laboring person can still get pain medicines and they can certainly do many of the other things that other people get to do with their babies such as hold them and name them. Nurses will also weigh them and measure how tall they are.
7. We induce some patients for days
Overdue? Hypertension? Fetal growth restriction? Just some of the reasons for providers to recommend an induction of labor.
There are many tools we use to do this and most of them are done one at time. Vaginal suppositories, balloons, pills, IV medicines. The increment of dosing can be minutes or hours long. And not just one hour long, sometimes doses are given 4 hours apart, sometimes even 12 hours apart. You can see how all of this can draw out to days long inductions.
8. We can deliver your baby without a doctor or midwife
Like mentioned in number 7 of this list, labor can take its sweet old time. But for others, especially people who have had babies before, it can be like The Fast and The Furious.
Babies do not wait for anybody, just ask the woman who gave birth at a Chipotle restaurant.
When a patient comes in ready to push it’s not like we can say, “just hold it in while we call the doctor”. I mean sure, someone is calling them but our immediate attention is the screaming person pushing out another person through a tiny hole of their body.
“You get to play with babies all day.”
Labor and Delivery nurses get told all the time that all they do is play with babies. Any L&D nurse will tell you that playing with babies is actually something we don’t do (much).
There are many other tasks that we do besides this short list of 8. Which one surprised you the most?