Labor and delivery nursing combines elements of critical care, operating room, emergency department and pediatric nursing. If you want to work in labor and delivery, you need to think quickly on your feet, work well with families, coordinate information with medical staffers and enjoy the thrill of watching a new life come into the world. Emergencies happen quickly in labor and delivery, and labor and delivery nurses spend long hours on their feet, helping their patients through labor or assisting with deliveries or cesarean sections.
Assessing New Admissions
Obstetricians have office hours and surgery during the day; at night, they're often home asleep. The labor and delivery nurse is the eyes and ears of the obstetrician when a laboring mom enters the hospital. Checking the cervix for dilation, placing the fetal monitor and assessing the fetal heart rate and contractions to determine how fast the doctor needs to arrive are all part of the admission and labor process. In many hospitals, the labor and delivery nurse also draws blood and sends it to the laboratory to test blood type and possibly other conditions.
Helping Women Through Labor
Even though around 61 percent of American women get an epidural -- placement of a catheter in the spine that delivers numbing medication -- according to a 2008 Centers for Disease Control and Prevention report, women in labor still need support. And even if mom's doing fine, her partner and other support people might need education and reassurance. The labor and delivery nurse keeps the laboring women comfortable, either with breathing techniques or with medication ordered by the doctor based on her assessments. Labor and delivery nurses usually start their own intravenous infusions, even if the hospital has an IV team. In some hospitals, they also place internal fetal monitors that give a more accurate reading of the baby's heart rate.
Duties During Delivery
During the delivery, the labor and delivery nurse prepares for the new arrival by setting up a warming bed for the baby with emergency supplies, in case they're needed. She also prepares medications that might be needed for the delivery. After delivery, if all is well, she assesses the newborn's color, tone and general condition, weighs him and helps mom start breast-feeding, if that's mom's plan. Mom and baby normally stay in the delivery area for an hour or so before going to a new room, depending on the hospital's set-up. During that hour, the nurse helps with breast-feeding, makes sure mom's bleeding is within normal limits and watches the baby for signs of respiratory distress, infection or other complications. The nurse arranges the transport, assists mom out of bed the first time and gives a report to the new nurse.
In many hospitals, labor and delivery nurses act as circulating or scrub nurses during a cesarean section. The scrub nurse hands the doctor the instruments, prepares suture and keeps track of sutures and sponges, cotton squares used to mop up blood during the procedure. The circulator maintains the equipment outside the sterile area, such as the suction machine, and takes care of the baby after delivery. The circulating nurse or the scrub nurse might also act as the recovery nurse after delivery, checking mom for signs of complications such as infection or excessive bleeding, and also monitoring the newborn.
A registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology, Sharon Perkins has also coauthored and edited numerous health books for the Wiley "Dummies" series. Perkins also has extensive experience working in home health with medically fragile pediatric patients.