Behind the scenes glimpse into the life of your labor and delivery nurse.
I've been a labor and delivery nurse for a long time. My job is incredible, however its tough. It's a very physical and emotional career. Labor and delivery nurses are a unique breed. We are our own people group. Trust me, I know there are labor and delivery nurses who suck. However, the majority of labor and delivery nurses chose this path as if it were a calling. It's more than a job to us. So join me and glimpse into one of my slightly harder days.
I am responsible for the life of my momma patient and her unborn child.
I wake up around 445, get dressed and kiss my family goodbye while they are asleep. In my car, I pray for my family, for my day and for my patient that I will be assigned. I drive to work in the dark and get to the hospital around 630 am and change into my scrubs. AKA my OR scrubs. I can't wear my scrubs because at any minute I could be a circulator in your cesarean section if things don't go as planned.
After changing, I go into the nurse's lounge and get my assignment. I chug a bottle of water because quite possibly I may not drink again until lunch and I rush off to get a report from the night shift labor and delivery nurse.
After getting the report that my patient is a 32-year-old, primigravida (first baby) who came in ruptured (water broke at 3 am) and dilated to 2-3 cm, I head into your room and meet you. Now you're mine, and I'm yours, for the next 12 hours. Unless you deliver at shift change which in most cases, I may stay for a 13th hour. Why? How could I leave you with a new labor and delivery nurse at such a pivotal moment?
You tell me how you can't believe it finally happened and we both agree that pregnancy goes fast. I hear all about your baby shower and ask you if your nursery is ready. You fill me in on the details of how your labor started and why you were afraid to come in to be checked. We talk about the fetal monitor, and I explain in detail what our day will most likely look like if all goes well. I educate you about fetal heart patterns and my responses to them.
Your husband asks me how long it will be and I tell him truthfully that everyone is different. I know from looking at you that you have some time and that you are still very early in the game. But my best guess is that you most likely won't deliver until late that night or possibly early am. It's your first baby after all. Now you both look crushed, and I reiterate it is my best guess based on many years of experience.
However, I can always be wrong.
I am in and out of your room about every 10-20 minutes checking on you and adjusting your monitors, helping you in and out of bed, and just talking with you. We laugh about his parents and how nervous they are about you two being parents yourselves. I hear how you are scared to breastfeed and I spend about an hour explaining the ins and outs of that subject. When I'm away from you, I am at the desk watching your baby's heart monitor like a hawk.
Around noon, I am about to head to lunch, so I go into your room to give you a heads up. For the first time all day, I notice that you are not smiling and you seem a bit agitated. I grab a sterile glove and ask you if you mind if I check you. I lay you back and tell you to put the bottoms of your feet together and relax your knees down to the bed like a butterfly.
When I pull the sheet down, I see a bloody show, which indicates dilation and I think to myself, she's probably dilated to 4-5. Things are progressing, Woohoo! I check, and sure enough, you are 5 cm, and the baby has come down significantly. It happened way faster than I thought and I remind you that sometimes I'm wrong about the timeline. I sit with you as you cry and reassure you that you were made to birth this baby. We decide together that since you want an epidural, we need to do it now and not wait. When I get to the nurse's station, I brag about my first-time momma going so fast. I call the CRNA and get your epidural supplies. While I am doing this, a coworker asks me if I had lunch and I say no, I can't leave my patient; she's scared.
The next few hours, I dim your lights and tell you to limit your visitors because this is your last sound sleep for the next 18 years. Your epidural is infusing on its pump, and for now, you are pain-free. You ask me, how will we know its time, since you can't feel anything, and I explain to you that I know the signs. I show you how the baby's heart pattern tells me what is happening to her and how I am watching it continually. I inform you that all the nurses are monitoring all the fetal heart patterns at all times. We are a team.
I tell you to let me know if you feel any increased pressure.
I leave your room and walk to the bathroom. However, you push your call light before I get 10 feet away. I come back, and as you are telling me that you feel pressure, I am listening to your baby's heart, and I do not like what I hear. I know fetal heart rates, and I detect an abnormal one. Your baby's heart rate is too low. I tell you that I am going to check you, but I need you to roll to your left side quickly. I described earlier that if the baby's heart rate drops, we do a few predictable things, change your position, apply oxygen, stop pitocin, and increase your fluids. I made sure I educated you both just in case we had a situation such as this.
All while maintaining a calm and a reassuring demeanor, even though my heart is beating faster, I go to push the nurses light for help. However, before I can do it, two more labor and delivery nurses and my charge nurse enter the room. They are all calm and collected. No one wants to scare you. As I check your dilation, one nurse applies an oxygen mask, and the other increases your IV fluids. I find that you are dilated to 7 now. The baby's heart rate has returned to normal, but I am not feeling peace about it.
Once you are calm, I head out to call your provider. I tell him something isn't sitting well with me, due to my experience and his trust in my judgment; he tells me he is on his way.
When your OB arrives, we both go into your room to check on you. He checks your dilation and says you are only 6. You look at me, and I explain that his six is my 7 and it's ok. We are just about to leave the room when your baby's heart rate drops again. This time a lot lower and despite our best efforts, we can't get it back up. The Dr calls a cesarean section and the entire team jumps. We all know our roles, and we all do them fast. I am trying to explain to you while I unplug all your monitors and roll your bed out into the hall. All while covering my hair and putting on a mask.
I have to assist my team to get your baby out as quickly as possible. We arrive with you into the OR suite and get you on the table. In a scheduled cesarean section it would be just me, you and a few others. But in an emergency, every labor and delivery nurse available comes running and plays a role. We all have a single mission, and that is getting this baby out and to the baby team. In minutes the sterile scrub is performed, we drape you in sterile sheets, the surgeon begins the incision, and the baby is out, and handed to waiting hands.
We are waiting on the other team (NICU nurses, respiratory therapist, and Neonatologist) to take over and do their job. 60 seconds of silence, while waiting on the newborn to cry, is the longest 60 seconds possible. I can hear the Neo quietly leading his team, the NICU RN saying the heart rate, and the clink of metal as the scrub tech lays down instruments on her table. These sounds magnify as we wait.
As they are doing their job, I move to the head of the OR table, peering around the drape into your eyes. My most important focus right now is you. I am there for you; even though I'm listening and peeking around for the smallest of hints that all is well. I watch for the quick exchange of eyes between the surgeon and the Neonate team, all while talking to you and telling you that my team is working diligently. I'm distracting you with questions. Quite possibly you may not know that the cry should have happened already. I know that not only is this your first baby but also your first hospital visit, and you don't know how worried you should be.
It's my job to keep you calm and for you to see that I am calm. My heart is racing because I've spent the day getting to know you. Laboring you. I've heard all your plans and how your mom is going to be a grandma for the first time. All this is racing in my head, and I'm silently praying for your little family. You are mine for right now, and I am longing to hear your baby cry so that I can say to you, everything's okay.
A roaring cry erupts in the echoing OR and the team breathes again. We all exchange a look from over our masks, as we finish your case. The CRNA and I take you to the recovery room, where we reunite you with the baby and her daddy. We all coo over your little one and watch as she breastfeeds like a champ. She is oblivious to the fright she caused.
I glance at my watch and realize that I have about 2 hours of charting to finish before I can go home. But first, I need to go to the bathroom. I go into the quiet of the bathroom, and before I turn on the lights, the tears come.
I'm thankful. I am aware of how quickly this night could have ended differently. One in which, I am bathing and preparing your newborn for you to hold her in your arms only this one time. I would have done it with honor. I would have tenderly cared for her and given her, her first and last bath. I would have cried over her. And I would have stayed even later into the night, while you cried. My heart is full of gratitude that you and your newborn are in the recovery room and that she is healthy and pink.
I finish charting and head to your postpartum room to say goodbye. You tell me the baby won't latch now and I spend 20 minutes helping you. It's 1045 p.m., and I am beyond exhausted. But this is the life of a labor and delivery nurse, so it is what it is.
After driving home in the dark, I take a shower and cry again. I sneak into my daughter's room and quietly kiss her. She sleepily wakes and asks me if I delivered any babies today. I tell her, yes, and she asks if the baby was cute. I smile, and she falls back to sleep.
** this is just a fictitious (ish) story based on my experiences **