Labor & Delivery Nurse – Midwest USA, August, 1981
I have begun my orientation in Labor and Delivery which is 6 weeks on day shift and 2 weeks on night shift. This 1000 bed private hospital in the suburbs of the city seems much more professional and more advanced than the inner city hospital where I worked the past 4 years. I have had many individual classes taught by the various nurses, watched videos, and read medical journals and books about normal labor and delivery, high risk deliveries, and emergencies. They alternate classes with having me work with a different nurse preceptor weekly. Each nurse has a different teaching style and level of experience, so it has been a very thorough orientation for which I am thankful.
Some days, it is a bit overwhelming trying to absorb and remember all this new information. Every day I pray and ask God to teach me and give me wisdom in every situation. God has been encouraging me through these Bible verses:
“Not that we are sufficient of ourselves to think anything as of ourselves, but out sufficiency is of God.” 2 Corinthians 3:5
“I can do ALL things through Christ, who stengthens me. Philippians 4:13
“For the Lord gives wisdom.” Proverbs 2:6
I now understand why they never hire new graduates to work in labor and delivery. My background in medical-surgical nursing is certainly helpful when making split second decisions. Probably the biggest adjustment is taking care of two people at once (mother and baby) but only being able to see one of them until the baby is born.
I passed my course in learning to read fetal monitor strips. I assess my assigned mother every 15 minutes and write my initials and all medications I give her on the paper of the fetal monitor strip. Each baby’s heart rate and the uterine contraction is transmitted electronically to the bank of 10 monitors at the nurse’s station. One of the technicians is assigned to sit and watch the monitors at all times. If they notice a baby in trouble, they immediately notify the assigned nurse. They rotate the techs during the shift since it is difficult to concentrate on the screens for more than an hour.
I am learning so many new skills such as applying the internal fetal monitor lead to the baby’s skull, and inserting the intrauterine catheter that measures the strength of the contractions. The internal exams are the most difficult to learn where I assess the stage of labor. With 2 fingers I feel how far the cervix is open (dilated), how thin it is (effaced), how far the baby’s head has descended. I check the mother first and then the experienced nurse rechecks to see if I’m correct. We go out in the hallway and I tell my preceptor my findings and she tells me hers so I can see if I’m correct. We only ask experienced mothers who don’t seem to mind double exams to help teach a new nurse like me.
After my assessment, I go out to the nurse’s station and write the findings on the 8 foot by 10 foot white board with an erasable marker. Beside each mother’s name is her doctor’s name, nurse’s name, her age, number of pregnancies she has had, time, and exam results. This way anyone can glance at the board and see how many patients we have in labor and what stage they are in. We all constantly help each other and are in and out of many mother’s rooms each shift. We all dread the days when all 10 rooms are filled! That means the next woman in labor has to go in the hallway on a stretcher. Thankfully, that doesn’t happen often! The most deliveries they have had in 24 hours in 28! They have 4000 births here annually.
I have learned how to circulate in a Caesarian section surgery, vaginal delivery, do Apgar scores of the baby at 1 minute and 5 minutes of birth, give pitocin to make the uterus contract harder, give intravenous pain medications, treat preeclampsia when the mother’s blood pressure goes dangerously high, and treat premature labor. I have not participated in an emergency C-section yet…
I have also worked in the recovery room where the mother stays for one hour after delivery. In the birthing rooms, the mother labors, delivers, and recovers all in the same room so I really get to practice all my new skills there. Every evening when I go home, I am so exhausted from so much new information! But next week I get to go back on night shift for the final two weeks of orientation. I think it will be fine once I become more sure of my assessment skills and get in a routine so I don’t have to think so hard about every little thing. Nothing is automatic yet like it was in medical-surgical nursing. It’s rather unsettling to go from an expert level in diabetes back to a novice nurse in labor and delivery. But I know over time I will become comfortable in this setting like I did in diabetes and medical-surgical nursing.
Reflection – 2014
Over the years, the Lord has allowed me to work in a variety of areas of nursing. Sometimes I have had an excellent orientation and other times it has been “sink or swim” which is extremely stressful. My transition into labor and delivery was very thorough, but still stressful. It is always difficult to go from the expert level back to the novice level when you switch areas. That is probably one reason the labor and delivery nurses seldom left once they found their niche in nursing. Plus, most of them seemed to really enjoy it as did I. But it was probably the most physically demanding nursing I have ever done as I will describe in future posts. It took a huge toll on my body and health.
On the other hand, one of the joys of nursing is having the option of switching specialty areas for those who become easily bored like me!