Definition of a labor nurse:
“Labor and Delivery Nurses help bring people into the world every day. They care for women during labor and childbirth, monitoring the baby and the mother, coaching mothers and assisting doctors. As a Labor and Delivery Nurse, you’ll prepare women, and their families, for the stages of giving birth and help patients with breastfeeding after the baby is born.” from Discover Nursing
So true, and so simple.
And yet…not.
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What does my labor nurse do?
Depending on the hospital, chances are you aren’t your nurse’s only patient. While you are actively laboring, she’ll most likely have at least one other patient (plus the babies inside, of course). So, what happens when she can’t leave a patient’s room? Like during a delivery?
The beauty of a labor and delivery unit– unique in the medical world– is the incredible teamwork that’s evident. You may meet several nurses during the course of your labor.
Your labor nurse is in a constant state of flux. At any moment, she may need to drop everything to attend to a pressing situation that requires one-on-one attention.
But you aren’t dropped.
Unbeknownst to you, she’s given your care to another nurse, hopefully temporarily. Don’t take it personally if you meet your nurse and then she doesn’t come back. It’s not because she doesn’t like you or a better offer came along. Ideally, when the epidural procedure is complete, or the baby is delivered, or a new patient is admitted, she’ll be back in your room to pick up where she left off. Rest assured, however, that your care has not lapsed during the time she was gone.
That’s just a small snapshot of what your nurse might be doing.
5 things your labor nurse is doing every shift
1. She’s managing your labor curve.
My labor what?
A labor curve is the graph that compares length of time to cervical dilation, essentially tracking how long the “average” labor should take. For example, patterns show that if this is your first baby, you’ll dilate at approximately 1 centimeter an hour, once you are in active labor.
Now, some labor curves don’t need management. My favorite labors are the ones where the mom comes in and gives us just enough time to start an IV before she delivers, leaving me with a 20 minute fetal monitoring strip to chart on instead of a 12 hour one. I may have to have you sign consents and ask you rather irrelevant questions after the fact, but I’ll take it!
Other labors, though, take their sweet time. There’s nothing wrong with that if there are no complications, but I’ll tell you a little secret. A good labor nurse can both take hours off your labor and be the difference between a vaginal delivery and a c/section.
- It’s not your doctor by your side throughout your labor monitoring how frequent and strong your contractions are.
- It’s your nurse who knows when you are dehydrated and slips you some juice or calories in your IV fluids to give your uterus an energy boost.
- It’s your nurse who makes you change positions when you don’t want to move and knows the tricks to getting a stubborn baby to rotate and desend into the pelvis.
- It’s your nurse who can tell when you are pushing ineffectively and coaches you to make the most of each push.
- It’s your nurse who constantly adjusts your Pitocin (the med you might need to help you contract), sometimes every 30 minutes, to keep it at just the right level to keep your labor moving forward without pissing your baby off. (Some babies just don’t tolerate labor well– our job is to keep them happy while keeping your labor from stalling.)
Want to know another secret? We celebrate when we have had to work hard at managing your labor curve and it resulted in a healthy, vaginal delivery. It may be a lot of work, but so very rewarding! And, chances are, you didn’t know about any of this. Not because we are keeping information from you, but because you have enough to worry about.
2. She’s always watching… everything.
Want to annoy your labor nurse? Call her into your room to let her know that your baby’s heartrate went all the way up to 170 a minute ago.
She knows.
More than that, she knows whether or not that’s a problem. (And if it is, she’ll let you know, too.)
The awesome thing about the technology we have today is that OB units have central monitoring. That means that when we are not at your bedside, we can still see your vital signs, your baby’s heartbeat, your contraction pattern, and even when you get up to the bathroom or start pushing during your contractions.
Sometimes your labor nurse might be watching that information for every patient on the unit, if all of the other nurses are tied up in an emergency, for instance. She might be watching your monitor while she’s breast pumping (ask me how I know).
What I want you to take away from this point is that although you may not know what your nurse is doing when she is not in your room, she knows a lot about what’s going on with you.
She doesn’t know when there’s something beeping in your room.
She doesn’t know when your water breaks.
She doesn’t know when your pain has suddenly increased and you need help.
Call for those things. But try not to worry about the health and safety of your labor. That’s her #1 job, and she’s got it covered. You focus on you, mama.
3. She’s constantly charting.
I’m just going to sneak this in super quickly, because I really don’t like to talk about it too much. It’s a real thing, though.
In other areas of the hospital, the nurses may have to chart on their patients only once every couple of hours or so. That’s a pipe dream in L&D.
The policies change from hospital to hospital, but if you are in active labor, your labor nurse is likely charting information such as the status of your labor, your pain scale, your vital signs, your baby’s heartbeat, your contraction frequency, duration, and intensity, your medication levels, and more every. 15. minutes.
‘Nuff said.
4. She’s helping other nurses.
I mentioned briefly the teamwork that has to exist on a labor and delivery unit. Labor is at best unpredictable, and one person just isn’t enough to get everything done in a safe and timely manner.
At any given moment, your nurse may be helping a coworker with an IV start, explaining consents, transporting a patient to another unit, resuscitating a baby while waiting for the NICU staff to arrive, adjusting the monitors on a mom whose baby’s heartbeat is difficult to trace, entertaining a two-year-old whose dad hasn’t arrived yet (it happens), and the list goes on and on and on.
There’s a reason we wear running shoes.
5. She’s being an advocate for you.
You want certain things for your labor. We hear you. We want those things for you, too.
Remember that labor curve? Your nurse might be petitioning the doctor for just two more hours to try to advance your labor before they recommend a c/section to you. Or, she might be the one to throw up the red flags and ask for more tests, because her gut says that something isn’t right. Sometimes, she is the one to go up the chain of command because she feels the doctor isn’t doing what’s best for the patient.
Important note: I work and have worked with so many amazing obstetricians that I respect immensely. I don’t want to give the impression that we work with an “us against them” mentality. Gone are the days when the doctor says “jump” and the nurse says “how high?” The best outcomes are dependent on a collaborative relationship among members of the health team, and that’s what we work towards daily.
However, since your labor nurse spends far more time at your bedside than the doctor does, she has a different perspective. Conversely, the doctor has a different point of view that affects their decisions as well. Advocacy is a real part of your labor nurse’s job, but we all want the same outcome: a healthy mom and a healthy baby.
What is your labor nurse not doing?
You’ll notice that I didn’t say anything about peeing and eating, lol! If you haven’t seen your labor nurse in a while, I’ll bet you my salary that she hasn’t skipped off the unit for an extended lunch down the street. More likely, she’s grabbing a few bites at a time at the nurses’ station because she won’t get a proper lunch break for the entire 12 hour shift.
She’s also not wasting time on her phone. She might take a rare moment to sit and scroll through Facebook, but chances are she’ll get pulled away before she has a chance to respond to a text. (My husband knows to call the unit number if he really needs me because I won’t notice a call or text to my cell phone.)
She’s not avoiding you to socialize. If you see her talking and laughing with coworkers at the nurses’ station, it means that it’s a good night, and they probably haven’t had a chance to catch up with each other in weeks. Walk by 20 minutes later and it will be a ghost town, every nurse scattered to put out little fires everywhere.
Your labor nurse’s #1 role
As labor nurses, we know that you are in our care during the most vulnerable and scary time of your life, and we will do our very best to be at your bedside for emotional support when you need it.
But unless the hospital has set up its unit in a way that allows her to be in your room constantly, your labor nurse won’t be able to be your constant labor coach.
She’ll give you tips and tools to cope. She’ll come running when you call. She’ll teach you how to breathe and push out a baby. She’ll give your partner ways to support you.
She won’t be able to hold your hand through each contraction, though. You might want a doula for that. I can help you know if that’s a good decision for you.
As much as your labor nurse empathizes with the pain you are going through, she has a job that supercedes it:
TO KEEP YOU AND YOUR BABY SAFE.
That seems like such a trite thing to say, but really– it’s why you are there, right? Sure, the pain meds are a plus, but if safety was a sure thing, you could just have your baby in a field, or in your bathtub, or at the Ritz.
Your labor nurse is trained to see what could go wrong and prevent it before it does.
You might want to thank her. She’d like that. Cookies are a bonus. 🙂
I hope this gives you a little glimpse into the world of labor and delivery, and helps you feel better prepared for your time there when your little one arrives. Nurses love to teach, and we don’t blush easily, so ask away and don’t be shy.
As a rule, L&D nurses are there because they love their jobs. Like, really love their jobs.
That’s a good thing, because you’ll never forget your labor nurse.
