I Still Want to Be a Labor Nurse

OB doesn’t usually get recognized for all the complicated, emergent care that we give.  When people think of the ER, they think of codes, and bleeding, and a lot of life-and-death situations.  When people think of OB, they think birth, and beauty, and babies. Most people on the “outside” don’t see the three-dimensional work that we do.  I think most obstetrical nurses stay in OB because of the beauty of birth and the babies, but that is definitely not all our work is comprised of. We’ve probably all seen our share of codes, and bleeding, and more than our share of life-and-death situations.

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Some of us work for hospitals that do not have a dedicated anesthesiologist. I have been there.  One of my last experiences with one of my favorite obstetricians was of a patient who came in abrupting.  We knew immediately that we would have to section her STAT…she was a classic case.  She came in to triage in tremendous pain, with a baby blanket soaked in dark red blood stuffed between her legs.  We didn’t wait to hear the baby’s heartbeat in the 20s before we began doing our dance.  Someone grabbed a physician on the unit, someone called the anesthesiologist, we put in an IV and we rolled to the OR. And that’s when we heard the news that would make our stomach’s drop and stop us dead in our tracks: the anesthesiologist was 45 minutes out.  I have never seen so many seasoned nurses look completely—at a loss.  Inside, I think we all wanted to vomit.  Have you ever had to do a cesarean section without anesthesia? With local injected into the uterus?  Have you ever heard a woman scream until she passed out from the pain?  I hope you never do, but I can tell you…if you do not have dedicated anesthesia in OB, this could be you…it will happen one day…or the alternative is a dead baby.  And isn’t all of our goal a healthy mom and baby?!?

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Sometimes we are asked to do crazy things…things that no other nurse on any other unit would ever be asked to do. I have had physicians “jokingly” ask me to steal Cytotec to give to them (ummmm, NO!).  We hike up legs, wipe vaginas, and encourage patients to push when they feel the urge, all while keeping a very focused face (no matter how heavy the leg is or what the vagina looks like).  I bet we’re the only nurses that have crawled around on an OR floor, dodging blood and amniotic fluid, after a bladder has been nicked. If we have a sudden assessment of heavy bleeding, we dig through the trash can to pull out dirty peri pads. If our patient has vaginal discharge, we’re supposed to describe the smell (and they all have vaginal discharge, they’re pregnant!). If a patient gives one great heave of a push while the doctor is complaining that we called them too early for delivery with their back towards the patient, we will not hesitate, we will grab that baby by the ankle with our bare hands to keep it from dropping into the trash bag. No one can dodge blood squirting from an umbilical cord or a spray of amniotic fluid from an AROM faster than a labor nurse. We’re like ninjas!

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Our days are made up of patients basically saying the same things and going through the same experience.  But we all have those O-M-G moments.  When I was working triage one day, a 37 weeker came in complaining of abdominal pain. She was a previous c-section x 1. She was contracting every ten minutes or so, and the physician ordered IV hydration. Her contractions spaced out, but she was having an unusual amount of pain with each contraction. If I hadn’t been putting my hands on her belly to know that each contraction was very firm, I would have just thought she was dramatic and had a low tolerance to pain. When we took her back for her c-section, she ended up having the largest window I’ve ever seen on a uterus.  I could literally see the baby blinking and swimming around in the amniotic sac.  I remember thanking God that the woman had decided to come in to triage, that I had put my hands on her belly, and that the physician had decided he would miss his golf game (it was the weekend) and come to assess the patient himself when I asked him to.  The outcome could have been a lot different if her uterus would have ruptured.  And we’ve unfortunately all probably seen some of those!

So yes, I know how to dance. And I can move like a ninja. I walk with a limp when I’m not in a hurry, but I’m able to run when I need to. And I can crawl on the floor and stick my head under a sterile drape without breaking the sterile field, and avoid this drop of blood and that pool of fluid in the process.  And every time I wonder if I still want to be a labor nurse, I just have to laugh to myself.  Even though we’ve all seen things that stop us dead in our tracks, some things that make our stomach turn and tumble, and on a daily basis we’re all praying that everything just ends up okay, I still couldn’t imagine working in any other area 😃

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Until my next delivery ❤

 

 

Summer and Seizures and Labors, OH MY

 


25 thoughts on “I Still Want to Be a Labor Nurse

  • May 24, 2014 at 3:57 pm
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    Thanks for your posts. The name of my website is http://www.fantasticnurses.com and fantasticnurses Facebook page. Can I have your permission to post your blogs on the website under blogs. It is a fairly new website. I will so much appreciate it. I’m a mother baby RN.

    Sent from my iPad

    >

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  • May 24, 2014 at 10:10 pm
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    I don’t think it was necessary in your vignette to mention thanking God that the physician decided to
    miss his golf game”. We don’t all play golf nor do we leave the hospital when we are on call. We work side by side of you and to play it off like you do all of the work is crazy. How much is YOUR malpractice premium?

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    • May 24, 2014 at 11:00 pm
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      I was just talking about this one particular case. They are allowed to do other things on the weekends, especially when they are not required to be at the hospital! I have never had a doctor not come when I’ve asked. But he could have said…her contractions have spaced out, they’re irregular, so just have her follow up in AM. He could see her strip from his phone, she was barely contacting. And I can tell you, we do a lot of the work, and most OBs will readily tell you that, but that does not mean that the OBs do nothing! And let’s face it, someone has to also run a clinic….The doctors can’t be everywhere all the time, or in two different places at once. P.s. I loooove my OBs! Don’t take what I said the wrong way, we are ALLOWED to work the way we do because physicians have to trust us and we are able to practice the way that we do because we trust our physicians. Xxxx

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      • May 25, 2014 at 1:42 am
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        Nowhere in that did she imply that “all” physicians play golf. And at the 3 hospitals I have worked at, the doctor on call absolutely does not stay in house 100% of the time. Our physicians do not particular work “side by side” with us. They usually only come in when we ask them to. So ya. We do most of the work. It’s reality.

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      • May 25, 2014 at 5:38 am
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        I would often stay on the labor ward when on call…only to be told by nursing staff that I’m not required! It’s a 2 way street!

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      • May 25, 2014 at 11:29 am
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        Along these same lines, when OB’s trust you and you’ve had the experience and knowledge to earn that confidence and trust, the result is truly gratifying and collaborative. I’ve found this especially when working permanent triage in a very high volume OB/teaching hospital. Nothing feels better as when a physician thanks you for thanking help save their patients/or babies lives. Or has the humility to backtrack a discharge from triage based on the “whole picture “from the regular triage nurse.” For example, once when working OB triage, I was at lunch and someone was watching my patients in triage for me. We were waiting for PIH lab results and patient’s pressures were significantly elevated. I got back from lunch, physician was at bedside, d/c’ing patient. I asked other RN if he had reviewed ALL the BP readings and lab results. She assured me he had. Nevertheless, I was concerned enough to review, realized the platelet level was still pending, and informed that OB. Sure enough, a few minutes later, the platelet level results were in and no surprise, very low. Called OB, reminded him of BP readings and platelet level results just in. To his credit, he came right back to triage, cancelled discharge, told pt he hadn’t had the full picture. Pt ended up being admitted, placed on Mag Sulfate, received steroids for fetal lung maturity and delivered 48 hours later.( BTW, pt had been sent in to evaluate for PTL, was 32 weeks twin gestation.)

        Another example, is working regularly with a physician with a definite reputation for being very difficult to most other staff members (outside of those of us who especially worked OB triage.) I was always requested by him to take care of his patients if I happened to be working on regular L&D that day. In fact, my coworkers would tease me and say “my boyfriend” was specially requesting that I be assigned to his patient, either those laboring or inductions. I took this as a compliment that he trusted me to call when necessary and care well for his pt/patients. In fact, I never once had an issue with him being difficult to work with personally in either triage or regular L&D. Weird, huh??!!

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    • May 27, 2014 at 1:20 pm
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      We certainly couldn’t afford yours.

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    • May 27, 2014 at 1:21 pm
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      We certainly couldn’t afford yours!

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  • May 24, 2014 at 11:06 pm
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    lol p.p.s. if this article offended you, you may not want to read anything else. But if you do, please read the article “One Bad Apple Spoils the—“. I really do love OBs. And midwives! And NPs!

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  • May 25, 2014 at 12:17 am
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    I will someday write a book about behind the scenes of labor and delivery. People would be surprised.

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  • May 25, 2014 at 3:44 am
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    I will never forget watching an instant deceleration on the monitor as a newly admitted VBAC ruptured, right before our very eyes. The anesthesiologist that was on call for OB was in route but still had about 20 min to his drive. Fortunately, one of our more seasoned OB’s was in house and on the unit. You see, he never left the hospital when he was on call. Thank God for his “old way”. We had the pt to the OR, prepped, localed, and delivered in approx 5 min. I had only been a nurse for about 7 months and the amount of respect I had for the excellent staff grew exponentially…and in the process reminded me that it wasn’t always rainbows and butterflies. I LOVE your blog! You can put into words pretty much every thought and experience I have had in my 9 years in OB! Thank you and keep it up!

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  • May 25, 2014 at 12:21 pm
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    I know EXACTLY what you mean! I worked in Main Operating Rooms specializing in Trauma, Neuro, Ortho, GU, GI and Open Heart for almost 20 years before I started working in L&D. I started out almost 32 years ago as a unit clerk then became a surgical technician prior to becoming an RN. Throughout all the years that I have worked in hospitals some things change…. a LOT. The one thing that never changes is that some MD’s don’t feel appreciated by their nurses and some nurses don’t feel appreciated by their MD’s. It’s a team effort to take care of patients effectively. OB docs in particular should have a good working relationship and trust with the nurses they work with since no one person can be everywhere all the time

    A large University Hospital with HROB L/D is where I trained as an OB RN and worked both triage and L&D sides there for over seven years before leaving for a much slower paced community hospital. I love both places for very different reasons. The University setting was great because we had in house anesthesia and there were always residents around for any emergency that came in. However the smaller place is great to because we are truly jills-of-all-trades. Clerk, housekeeper, scrub tech, nurses aide….we do all of it! I find myself actually feeling much closer to the MDs at the smaller hospital because they know us and our skill levels so well that there is a great amount of trust between us. Not that the University docs didn’t trust us and work with us, but there is definitely something different about working in a slower paced environment that lends to a closer working relationship. At least this has been my experience.

    Thank you for reminding me all the reasons why we do what we do. Great article.

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  • May 25, 2014 at 12:25 pm
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    Well, in my 14 years as an OB nurse, I only had one doc that never came when called in for a delivery. The poor old, exhausted guy actually fell asleep behind the wheel of his car before he ever left the driveway! Now he’s retired and hopefully enjoying life after a long, dedicated practice. :)

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    • May 26, 2014 at 2:59 am
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      that is so funny. I think OBs usually do it until they physically can’t do it any more. They have to love it! lol

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  • May 25, 2014 at 12:31 pm
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    PS-I was fortunate enough to work in a busy OB unit that had a certified nurse anesthetist on call at all times. They were very good at what they did and I never had to face what you did (C-section by local). I cant even imagine the panic and helplessness. It should be a law to have anesthesia on call at the hospital!

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  • May 25, 2014 at 3:07 pm
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    I’m lucky to work in a hospital that has an anesthesiologist and doctors around 24-7. I went and did L&D registry for 2 years and saw what it’s like when anesthesia and OB’s are not in-house and it scared me! I don’t ever want to work at a place that doesn’t have an OR team readily available. I don’t understand why it’s not a requirement to have an in-house team to run an L&D unit. With that said, we still have our share of bad outcomes. Thanks for putting our efforts into perspective.

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  • May 25, 2014 at 3:31 pm
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    As an anesthesiologist who specializes in OB I couldn’t agree more! Luckily I have never had the experience of doing a csection under local. The anesthesia world is similar. The trauma and cardiac anesthesiologist get all the glory but I wouldn’t change with them for anything. Daily miracles in our world.

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    • May 26, 2014 at 3:01 am
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      yeah, that poor anesthesiologist, he felt so bad. he was stuck in traffic. and when that happens, what can you do?!? but for the record, I once had a patient say that the OB anesthesiologist deserves a Nobel Peace Prize. lol that cracked me up. So we ALL appreciate you! lol

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  • May 25, 2014 at 8:02 pm
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    Been there, done that- c-section under a local- no fun, no fun at all! But…..we had a healthy mom and baby at the end of the day.

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    • May 25, 2014 at 8:16 pm
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      Amen to that! Lol but it still sucks!! Lol I’ll never forget the look on that docs face when the nurse kept coming into the OR and telling him she still didn’t have an anesthesiologist…

      Reply

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