Thank You, Nurses! Q&A With a Labor and Delivery Nurse
Thank You, Nurses! Q&A With a Labor and Delivery Nurse
Cara Terreri, LCCE, CD(DONA)
How long have you been a labor and delivery nurse? Where are you currently practicing?
I have been an L&D nurse for six years. I am a travel nurse at the moment and my current assignment is in Clyde, NC. I have also worked in Myrtle Beach, Florence, Dillon, Boca Raton, and the Ft. Lauderdale area.
Why and how did you get into labor and delivery?
My first interest was in sports medicine in high school, but then life happened and my first son was born when I was 17. During my pregnancy, a wonderful doula taught me all about childbirth and, in doing so, taught me that this was my body, my pregnancy, my baby. She told me about all the things I could do. I would ask "will they let me do that?" and she would say IT IS YOUR BABY! From the seeds of self responsibility and autonomy, motherhood blossomed. I knew from then on that what I wanted to do was become a nurse midwife. I finished high school, went through my college's hoops of pre-reqs and waitlists (they have since become more organized). By the time I finished nursing school, I was pregnant with my third. It was difficult, but I finally found a job in OB in Dillon, SC and started there as soon as my eight weeks were over.
What motivates you to stay in labor and delivery?
Some days I say I want to be a greeter at Walmart, other days I go home so proud of my work I could burst. Labor and delivery takes a special kind of nurse. There is a lot of gray; your decisions are not always black and white. You have to learn to be sure of yourself despite this. You have to be able to think and act quickly; a mother and/or baby's life could depend on it. You have to be tough mentally and physically. All nurses are advocates for their patient; but labor and delivery takes that to another level. In labor and delivery you are advocating for a patient that no one can see. The signs of trouble are often subtle and other care team members (non-OB) may not understand or recognize the severity of the situation you are facing. That being said, I love the pace of labor and delivery. I love watching women become mothers. I love that first cry. I never want anyone to experience anything abnormal; but when it happens I love to be there to help. I am honored to help families through perinatal loss; to be present in their sorrow and to acknowledge the short and beautiful life of their precious baby. Some shifts are divine reminders of all the best things life has to offer, then there are some that leave you empty, doubting every step you took and asking why knowing you will likely never find answers. L&D has a special place in my heart and my job is truly a blessing to my life.
In what ways do you help women and families in your role as a labor and delivery nurse? Which part do you enjoy most? Which part is most challenging/frustrating?
Sometimes I am nothing more than a lifeguard and a cheerleader. When all things go as they should, all I do is I make sure they stay safe and validate the efforts and progress of the mother in labor (and document it all, of course). I help educate mothers on the medications they may receive, provide suggestions and advice, like "you should get some rest now," or "perhaps if you laid this way we could make ever so slightly more room for baby to move through your pelvis." I keep the provider up to date on all progress. It is my responsibility to recognize when things are veering off course and mobilize the resources required to keep mom and baby safe. I assess for labor. I read fetal heart rate tracings that tell me whether you baby is well oxygenated. I prepare for what ifs without anyone being the wiser. Along with your provider, I perform life saving maneuvers in the event of a shoulder dystocia. I sometimes catch unruly babies that refuse to wait for the provider. I resuscitate babies that need support at birth. I administer medications and treatments to stop the bleeding in a postpartum hemorrhage. I move quickly and calmly. When there is trouble I remove the barriers to delivery so that we can go to the operating room quickly. I help mothers to accept the unfortunate fact that things cannot always go as planned and that, despite this, they are not lesser for it. These are the parts of my job I enjoy the most, when I feel like I can make a concrete difference. When I can help to avert bad outcomes or successfully support mom through a difficult labor, these are the days I go home smiling.
The more frustrating days are days where I work my butt off all day and can never meet all the needs in front of me because all the babies decided to come on the same day. The days where bad outcomes happen out of nowhere, with seemingly no rhyme, reason, or cause despite everyone's best efforts. Sometimes you are so busy keeping everyone safe and happy that you become buried in paperwork and your 12 hour shift quickly turns into a 16 hour shift. Those 16 hour shifts (if you have a consecutive shift) only leave you 8 hours to get home, shower, eat, sleep, get up, and come back again. Emotions run high in a place as intense as labor and delivery, this can become overwhelming sometimes. Labor and delivery is often seen as the place where you rock and play with the babies, but what we do is so much more than that!
Some days are all of the above rolled up into one!
What's one thing mothers/families often bring with them to birth that's unnecessary?
That is easy. Extra people. Bring only 1-3 people with you for labor. Everyone else can come ooo and ahh at the baby after he/she is born. Send them home, let them know you will need their help later and they should save their energy for that time. It is so frequent to see someone labor all night with 7-10 people waiting for the delivery only for mom to deliver, everyone to be thrilled, then go home. This leaves everyone exhausted, but most especially the new parents. It's a much better strategy to have all those wonderful family members come the next day, in turns, and rock the beautiful bundle while mom and dad sleep, and maybe even bring some much needed yummy food for the frazzled new parents.
What's one thing mothers/families should always remember to bring with them to birth that's very helpful?
The most useful but extremely commonly forgotten item is a nursing positioning pillow. These can be priceless in those early exhausting days of nursing when mother and baby are both learning this new dance. Please bring it with you!
Please share one of your most memorable experiences in your career as a labor and delivery nurse.
The memories that remain the most clear and long-lasting are of the births that had severe complications. Many births happen without incidence, but it's important to know that worst case scenarios do exist and safety is truly paramount! My biggest piece of advice is to find the balance between knowledge and trust, risk and safety, rules and autonomy. Above all, be flexible -- do not let your self worth be determined on the success or failure of a plan*. Use your birth plan to explore your options and learn about the processes. It is ok to be upset if things don't go as planned and it is ok to feel let down. It's important to acknowledge those feelings, and to seek professional counseling if you are struggling to come to terms with your birth at any time after you've had your baby.
*Obstetric violence is real and is more than "things not going as planned." My comment here is not to minimize in any way the experiences of women and families who suffer the trauma of obstetric violence.
If you had just a couple of minutes to talk with a family before they went in to give birth at a hospital, what would you share about working with their nurse?
Know that their nurse is there to help. Know that it is ok to ask why something needs to be done, but please also treat the nurse as if they are your ally, not the enemy. Often times, your nurse will be your strongest advocate, so it's to your advantage to maintain a friendly relationship. Understand that there is paperwork that has to be done and questions that have to be asked as part of your arrival to the hospital. Understand that facilities have policies that nurses are required to follow to maintain their employment. Recruit your nurse to help you find the compromises where they can be safely made, then trust her to educate you** on what cannot be compromised safely. An engaged nurse can make all the difference in the world.
**Ideally, you will go into your birth with the education provided by a good childbirth class. That way, you can engage with your nurse from a place of knowledge about birth and your choices.
Thanks, Haley, for your time and wisdom! Families in your care are very lucky to have you. We wish you continued joy and strength in your career as a nurse.