By Megan M. Krischke, contributor
March 24, 2013 - Labor and delivery nurses have the unique opportunity to work with families during some of the most important moments of their lives and to care for mothers as they go through the childbirth process.
“Labor and delivery nurses participate in the joy of helping families give birth and helping mothers who are ill to achieve a state of wellness and to move through their high-risk pregnancy,” noted Anne Santa-Donato, MSN, RNC, director of childbearing and newborn programs for The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). “In labor and delivery, nurses promote the most normal and natural childbirth experience, but when that isn’t possible, they have the expertise to help manage a high-risk pregnancy and newborn care.”
“At Hennepin County Medical Center (HCMC) we are focused on patient- and family-centered care,” said Rachelle McCarthy, RN, BSN clinical care supervisor, labor and delivery, midwife and OBTU at HCMC in Minneapolis, Minn. “I think many nurses are drawn to this specialty because they want to work with the babies and help women in one of the most important roles she will ever have--becoming a mom.”
Some of the challenges of the labor and delivery specialty are the unpredictability of birth and the resulting ebb and flow of activity on the patient care unit. This creates difficulty for scheduling an appropriate number of nurses and the inherent challenges of shift work.
“It is sometimes difficult to help the families understand the birthing process, especially if labor becomes complicated,” remarked McCarthy. “When labor doesn't follow the birth plan, we need to relay the message that even though the labor and delivery of the baby may not be what the family anticipated, the ultimate goal is to have a healthy baby and mom.”
Anyone considering the labor and delivery specialty needs to determine their ability to work in a high stress and fast paced area of nursing. The specialty requires specialized knowledge and skill and a willingness to work all shifts.
“The labor and delivery RN needs to be able to assess and respond to changes quickly and safely,” suggested McCarthy. “Also, you must evaluate your personal views and how they may affect your ability to support families in achieving their birth plan and goals. Part of the role of a labor and delivery RN is to empower women and provide choices for their birth experience.”
“I would say that a labor and delivery nurse needs to feel dedicated to and enthusiastic about caring for women in labor and their fetuses,” reflected Santa-Donato. “Labor and birth is by and large a very happy process, but bad things happen to good moms and babies. While the majority are healthy and normal, there are many circumstances where the outcomes hinge on the quality of care provided and moms can get very ill and need specialized care.”
Because working in labor and delivery requires specialized knowledge beyond what a nurse would receive in school, many hospitals and birthing centers offer specialized training. AWHONN has developed a standardized curriculum for both perinatal and neonatal orientation and education designed to be used by hospitals and birthing centers for training their nurses.
Nurses working in the specialty need to be trained for high-risk situations, managing obstetrical emergencies, interpreting fetal heart monitoring and critical thinking. Pertinent certifications are offered for nurses who desire to gain specialized knowledge in areas such as obstetrics or fetal monitoring.
“At AWHONN, we strongly support the baccalaureate level entry into nursing,” commented Santa-Donato. “It opens so many more doors for career development and helps nurses to achieve an understanding of not just the technical skills of nursing, but also the humanity of nursing.”
There are a variety of arenas in which nurses can be involved with the birthing process, including operating room, critical care, and high risk and low risk midwifery care. Nurses can also pursue an advanced degree to become a nurse midwife and provide pre- and postnatal care and oversee childbirth, among other patient services.
“Technology is continually evolving and fetal monitoring is becoming more sophisticated, but we need to balance that with also trying to decrease the amount of technology brought into a normal birthing experience to help women achieve spontaneous birth,” remarked Santa-Donato. “There is a movement across the nation to decrease the number of unnecessary cesarean births. It is an exciting time for nurses to go into labor and delivery."
“The job of a labor and delivery nurse is so important. As moms, we share our birth experience with others, including the care we received when our babies are welcomed into the world,” said McCarthy.
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