Labor & Delivery Nurse – Midwest USA, August 1981
I have begun my orientation in Labor and Delivery of six weeks on day shift and two weeks on the night shift. This 1000 bed private hospital in the suburbs of the city seems more professional and advanced than the inner city hospital where I worked for the past four years. I have had many individual classes taught by various nurses, watched videos, and read medical journals and books about normal labor and deliveries, high-risk ones, and emergencies. I alternate classes and working with a different nurse preceptor weekly. I thank the Lord for their thorough orientation.
Some days, I become overwhelmed with trying to absorb and remember all this new information. Daily I ask God to teach me and give me wisdom in every situation. and He has encouraged me.
“Not that we are sufficient of ourselves to think anything as of ourselves, but our sufficiency is of God.” 2 Corinthians 3:5
“I can do ALL things through Christ, who strengthens 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 helps me make needed split-second decisions. The biggest adjustment is taking care of both mother and baby but only being able to see the mom until the newborn emerges.
They certified me in reading fetal monitor strips. I assess my assigned mother every fifteen 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 ten monitors at the nurse’s station. One of the technicians sits and watches the monitors at all times. If they notice a baby in trouble, they immediately notify the assigned nurse. They rotate the techs hourly to prevent a lapse in concentration.
I have learned how to apply the internal fetal monitor lead to the baby’s skull and insert the intrauterine catheter to measure the strength of the mother’s contractions. The internal exams are the most difficult to learn to assess the stage of labor. 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 permission of 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 my findings on the 8-foot by 10-foot whiteboard with an erasable marker. Beside each mother’s name is her doctor’s name, nurse’s name, her age, the 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 go in and out of the mothers’ rooms each shift. We all dread the days when all ten rooms are filled. When the eleventh mom arrives she has to lie on a stretcher in the hallway until a room is vacated. Thankfully, that doesn’t happen often. On the busiest day, 28 babies arrived in 24 hours! Four thousand little ones begin life on this unit every year, the size of a small town.
I have learned how to circulate in a Caesarian section surgery, vaginal delivery, and complete Apgar scores of the baby at one minute and five minutes of birth. I know how to give pitocin injections to make the uterus contract harder, give intravenous pain medications, treat preeclampsia when the mother’s blood pressure goes dangerously high, and handle premature labor. I’m still waiting for my first emergency C-section.
They also taught me how to monitor moms in the recovery room where the mother stays for one hour after delivery. In the birthing rooms, mothers labor, deliver, and recover there so I use the entire range of my new skills. Every evening when I go home, I am totally exhausted from so much new information. But next week I return to the night shift for the final two weeks of orientation. Nothing is automatic yet like in medical-surgical nursing. I have gone 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 also.
Over the years, the Lord allowed me to work in twelve specialty areas of nursing. Sometimes I had an excellent orientation while other times it was “sink or swim”. Not pleasant. My transition to labor and delivery was thorough but still stressful. I always struggled with going from the expert level back to the novice level when I switched areas. That is one reason the labor and delivery nurses seldom left because they enjoyed this niche in nursing. But these were the most physically demanding years of my career and 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 want the challenge of always learning more like me.