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Carisa
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Rochester, Minnesota
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What does a L&D nurses specifically do when the patient gives birth?
I'm in a LPN program soon doing a LPN to RN bridge program once I graduate. I plan on being a labor and delivery nurse once I get my RN.
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Carole Louis
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Carole’s Answer
Hello Carisa! A labor and delivery nurse does so much to support the birthing person and their family through the process of delivering their baby (or babies). There are several phases to support a vaginal birth (latent labor, active labor, second stage of labor (pushing phase), the recovery period (about two hours in the best case scenario), and finally transfer to postpartum. During cesarean delivery there is the preop, operative, and recovery in the PACU. There is also L&D triage, which is like an emergency room where pregnant and postpartum people get seen for potential complications, rule out labor, etc.
The role of the L&D nurse is to support the patient and infant during the labor process to ensure maternal and fetal wellbeing. This is done primarily by monitoring the fetal heat rate. The fetal heart rate can be monitored continuously or intermittently, with electronic monitoring or auscultation. The woman’s uterine contractions are monitored simultaneously with a device called a tocodynomanometer. Some women (most women) need medication to facilitate labor. This medication is called oxytocin (Pitocin-brand name). It’s a powerful hormone that is classified as a high-alert drug because it can harm the patient and fetus if not properly titrated. The bulk of the labor nurse’s responsibility is to titrate this medication to ensure labor progress (as witnessed by a consistent contraction pattern of the uterus and monitoring to ensure the fetal heart rate tolerates the stress of the contractions). Monitoring and documentation is required at a minimum of every 30 minutes. The frequency increases with maternal complications such as high blood pressure, diabetes, and labor progression. The RN also assists with epidural placement by supporting positioning, maintaining fetal heart monitoring during the procedure, and closely monitoring maternal vital signs until delivery. The nurse assists with all procedures performed by the physician or certified midwife—such as breaking the bag of waters, vaginal exams (nurses can do this too), and of course circulating in the OR. We help with obstetric emergencies such as cord prolapse, hemorrhage, seizures from eclampsia and other complications. Nurses coach the patient during the pushing phase and finally we monitor the patient immediately postpartum (2 hours) for increased bleeding, ensure the fundus remains firm, vitals are stable, support any complications that may arise or persist and promote bonding with baby.
During this labor process the nurse also provides caring, emotional support and answers questions and concerns from the patient and the family. This part is equally as important as the clinical process. Treat every patient with respect and dignity and be mindful that Black patients and patients with limited English language proficiency experience the most disparities and maternal morbidity and mortality. Listen to them and recognize that they may not trust the health care system due to racism and bias. Do your best to support their needs, advocate for your patients if you witness injustices. Mostly, have a heart for all patients and show love and compassion.
Best regards,
Carole L., DNP, CNS, RNC-OB, C-ONQS, EBP-C, C-EFM
The role of the L&D nurse is to support the patient and infant during the labor process to ensure maternal and fetal wellbeing. This is done primarily by monitoring the fetal heat rate. The fetal heart rate can be monitored continuously or intermittently, with electronic monitoring or auscultation. The woman’s uterine contractions are monitored simultaneously with a device called a tocodynomanometer. Some women (most women) need medication to facilitate labor. This medication is called oxytocin (Pitocin-brand name). It’s a powerful hormone that is classified as a high-alert drug because it can harm the patient and fetus if not properly titrated. The bulk of the labor nurse’s responsibility is to titrate this medication to ensure labor progress (as witnessed by a consistent contraction pattern of the uterus and monitoring to ensure the fetal heart rate tolerates the stress of the contractions). Monitoring and documentation is required at a minimum of every 30 minutes. The frequency increases with maternal complications such as high blood pressure, diabetes, and labor progression. The RN also assists with epidural placement by supporting positioning, maintaining fetal heart monitoring during the procedure, and closely monitoring maternal vital signs until delivery. The nurse assists with all procedures performed by the physician or certified midwife—such as breaking the bag of waters, vaginal exams (nurses can do this too), and of course circulating in the OR. We help with obstetric emergencies such as cord prolapse, hemorrhage, seizures from eclampsia and other complications. Nurses coach the patient during the pushing phase and finally we monitor the patient immediately postpartum (2 hours) for increased bleeding, ensure the fundus remains firm, vitals are stable, support any complications that may arise or persist and promote bonding with baby.
During this labor process the nurse also provides caring, emotional support and answers questions and concerns from the patient and the family. This part is equally as important as the clinical process. Treat every patient with respect and dignity and be mindful that Black patients and patients with limited English language proficiency experience the most disparities and maternal morbidity and mortality. Listen to them and recognize that they may not trust the health care system due to racism and bias. Do your best to support their needs, advocate for your patients if you witness injustices. Mostly, have a heart for all patients and show love and compassion.
Best regards,
Carole L., DNP, CNS, RNC-OB, C-ONQS, EBP-C, C-EFM
This was super helpful, thank you!
Carisa
If you are interested in learning more about Labor and Delivery you may contact a hospital or birth center about the steps it would take to be approved to shadow a birthing patient. You can also consider doing doula training like DONA or take a course like Spinning Babies. By offering doula support, you can learn tools that can be applied to support birthing families. You would get a glimpse of birth and be doing some initial hands on care that will transfer to your RN duties down the road.
Elizabeth Ribbeck DNP, MN, MA, RN, CNM