The Cord

**While the story below is true, please note that all names, dates, and some details of the below story have been changed to protect the identities of coworkers, patients, and family members.**

A few weeks ago, I had an experience at work that changed the way I saw my profession, my work, my coworkers, and myself.

Now, I’m not a new nurse by any means.  So when I tell you that my experience was so fulfilling that I could hardly fall asleep after my shift was over, I’m not telling you this as a wet-behind-the-ears-noob with a freshly engraved stethoscope and rose-colored glasses glued to her brow.  I tell you this story as a nurse experienced in several different specialties of nursing; as a professional that was so burnt out a few years back that she questioned why she became a nurse in the first place.  I tell you this story as a nurse who has endured those demanding, arrogant, immature, or just plain aggravating family members; those obnoxious, loud, unreasonable, argumentative or just plain vindictive patients; and the painful introspection that those sometimes raw, utterly unpleasant interactions evoke.

I was just coming off lunch.  When I say lunch, I mean a night shifter’s lunch–it was just after midnight.  Everyone was taking turns heading in to eat and coming back out, leaving a few of us on the floor to keep an eye on things.

It was a night full of death, to be quite honest.  We had a record number of demises or pending demises in our facility–babies who had died or were expected to die either before or just shortly after birth.  I was caring for one of these patients, and the night had been a fairly quiet one.  In addition to our demise patients, we also had a good number of early patients–patients whose water had broken preterm, who had symptoms of preeclampsia, or patients who simply needed to be watched over until baby arrived for one reason or another.  At any rate, we had all of one actual labor patient, and being that she was a first-time mom who was being induced, the process was slower than a snail race on a hot July day.  The only thing potentially threatening to increase the activity level of our floor was a transfer who might be coming to our hospital from nearby–also a pending demise.

So as I exited the break room and returned to the main nurse’s station, I was a little surprised to hear a call bell alarm just as I arrived at my computer.  A tech on our floor answered the light, looked back at our assignment board, and promised a nurse would be there shortly.

“What is it?” I asked our tech, a short, quiet woman by the name of Carly.

“It’s the patient in room 20.  She wants her nurse to come see her.  She said she got up to the bathroom and felt pressure and something weird.”  Carly said, her facial expression betraying confusion, as if she wasn’t quite sure how to describe what the patient had told her.  “Tessa just went to lunch, though.  Can you go see her?”

“Yeah, of course.” I said, glancing at my computer, which displayed the unit census.  The patient in room 20 was an early patient, here because her water had broken at 29 weeks.  On her last exam, her cervix was high, thick, and barely dilated to one centimeter.

As I headed down the hall, I pondered what I might find.  Perhaps the patient’s water had broken more and she was feeling amniotic fluid leaking.  Still, that didn’t explain her saying she felt something “weird”.  My mind raced.  Could it be…?  The very idea of a prolapsed cord or fetal part made me walk a little faster.

When the umbilical cord prolapses, that is to say, falls out of the vagina before the baby is born, it is an emergency.  The patient must be transported back to the OR for an immediate C-section.  This is because the weight of the baby against the cord can pinch the cord off, meaning baby is no longer getting oxygenated blood from the placenta.  Brain injury and fetal death are two very real potential risks of cord prolapse, and it is one of the bigger emergencies that we see on L&D.

As I walked into Room 20, I saw the patient, Claire, and her husband, Ron, awaiting my arrival.  Claire sat on the bed, fully clothed. Ron sat on the couch.

“Hi, Claire.  I’m Sophina, one of the nurses working with Tessa tonight.  I hear you have something kinda weird going on tonight?” I said, approaching the bed and opening the drawer below my computer station, pulling out a sterile glove and gel.

Claire nodded. “Yeah, I just got up to the bathroom to pee, and I felt like there was something between my legs.  I don’t know if it’s maybe the baby’s leg or what, but I figured I should call you guys.”

The knot in my stomach was growing.  “OK, Claire.  Let’s take a look at that.  If you could slip off your pants for me, I want to check and make sure everything’s all right.”

As I pulled on my glove and swirled my fingers through the gel, Claire lay back in bed, slipped off her pants and underwear, and opened her legs just as I moved to the edge of the bed.  As her legs parted, I immediately glimpsed one of the scariest sights I’ve seen in all my years of nursing: a distinctly purplish-red umbilical cord lay coiled just outside Claire’s labia.

“Claire, this is going to be a bit cold.” I said as I grabbed the cord with my fingers and slid it back into Claire’s vagina, sitting down on the bed and quickly finding two little feet greeting me as I reached her cervix.  The cord, which had no pulse, was wedged between baby’s feet and mom’s cervix.  I pushed the feet apart, freeing the cord and manually holding the cervix and surrounding tissues open, ensuring blood flow could freely travel the full length from placenta to baby and back again.

By then, my heart was pounding.  I looked up at the wall where the call bell sat, just out of arm’s reach.  I glanced at the fetal heart machine–also out of reach.  It was then that I noticed Ron, who had darted to the door, obviously sensing that something wasn’t right.

“Ron, go out to the nurse’s station.  I need everyone in here now.” I told him firmly but calmly.

Ron nodded. “Oh–Ok!” He stuttered, jolting out the door and down the hall.

I looked down at Claire.  Fear had overtaken her features. “Claire, baby’s umbilical cord has fallen out of your vagina.  I’m holding it in with my fingers, and until we get baby delivered, I have to keep my fingers in there so that baby can still get oxygenated blood.  We’re going to take you back for a C-section.  Hang on–we’ve got help coming.”

Claire nodded. “Is the baby–is she–?”

And just as soon as Claire began to ask the question, I felt one of those little feet kick against my fingers.

I smiled, heaving a breath of relief. “She just kicked me, Claire.  She’s still with us.” I said, noting more movement of those feet on my hand.

Claire nodded. “OK. OK.”  Tears welled in her eyes.

“What’s her name?” I asked.

“Gemma.”  Claire said as her eyes overflowed and her nose began to run.

“Take some deep breaths, Claire.  Keep that oxygen coming to baby.  Good job.  You’re doing just great.”  I said calmly as Claire began to follow my instruction, her eyes locked into mine.

I had no sooner finished speaking than my charge nurse, a thin, tall, self-assured woman named Amanda, zipped into the room, with yet another of my fellow nurses, Shelly, on her heels.  Carly was on Amanda’s other side and Ron was running steadily behind them.

“It’s a prolapse?” Amanda turned on the fetal heart machine and looked to me.

“It is.  I’ve got baby off the cord.  We need Dr. Daniels and Dr. Patel.” I said, referencing the OBGYN and anesthesiologist on call.

Amanda, while calling the front desk with one hand, was squeezing gel onto the fetal heart monitor with the other.  Shelly and Carly were rapidly preparing the bed for transport to the OR.  I picked my feet up off the floor, shifting to a kneeling position on the bed while keeping constant pressure on baby’s feet and Claire’s cervix.

Gemma’s tiny feet kept moving, and it took my constant attention to ensure that those little feet didn’t move into a new position and become wedged against the cord.  It occurred to me that in a constantly changing environment like the one inside Claire, any change–especially a subtle one that might perhaps go unnoticed by me in an environment I could only feel and couldn’t see–could be fatal.  Until Gemma was delivered, she needed my rapt attention.  With every move of baby’s feet and every minute change in position that Claire made, I had to make sure that cord remained untrapped.

“Do you have a pulse?” Amanda asked.

“No, but baby is moving.” I relayed.

Seconds later, Amanda scanned Claire’s abdomen, and the faint but steady pound of a fetal heart greeted our ears.  Baby was chugging away in the 90-100 beats per minute range, a full 30 beats per minute where she should have been at very least, but it was objective confirmation that she was still with us.

“OK, we’re good.”  Shelly said as she finished unplugging the bed and monitors.

“Let’s move!” Amanda said, turning off the machine, dropping the monitor and pulling a blanket over Claire and myself as the bed began to move for the hallway.

We dashed out of the room and into the hall, the crowd of four that pushed the bed steadily growing as we went.  We picked up Dr. Daniels and Dr. Patel somewhere along the way, and then a cluster of NICU nurses who were coming downstairs for our section.  Amanda was updating the physicians on the status of both patients and the course of events that led to the urgent stampede for the OR at all of one in the morning.

But as for me, my attention never fully left Claire and Gemma.  Claire was crying and I was giving her moment by moment updates–every kick, every nudge–while carefully monitoring what I was feeling on the inside and moving my fingers accordingly.  The two of us communicated quietly and sometimes silently, but as we rolled, I suddenly felt pulsation in that thick cord that lay between my fingers.

“I’ve got a pulse in the cord!” I exclaimed for all to hear as we rounded the corner to the OR.

“Get me a heart rate when you can!” Dr. Daniels, a tall, somewhat scruffy, but genuinely kind and highly competent OBGYN called as we crashed through the double doors into the OR.

Together, Claire and I moved in a closely coordinated effort from her bed to the OR table, my fingers steadfastly guarding that cord.  “Fetal heart rate is 90-110.” I called as Claire settled in on the OR table and I slid off the other side, standing to Claire’s right.  All had been well in the move; the cord was still free.

Everything was happening at once.  Amanda and Shelly positioned Claire on the table.  Dr. Patel started a second IV.  Jerry, our surgical tech, had the instruments set up within a minute.  Dr. Daniels inserted a urinary catheter just above my fingers, and Amanda prepped Claire’s abdomen.  In the meantime, Gemma’s heart rate was anywhere from 90 to 140.  With all the movement associated with preparing for surgery and the gymnastic effort of inserting a catheter above my fingers while still allowing me to maintain pressure on the vaginal canal and fetal feet, I focused all of my attention solely on the situation just inside Claire’s uterus, chasing Gemma’s feet and keeping Claire’s cervix off the cord.

I knelt next to the OR table on the floor as the sterile drapes came down over Claire’s lower body and my head.  Dr. Daniels stood in front of me; Jerry stood behind me.  From my new position, I realized I had lost my leverage for holding Claire’s cervix and vaginal canal open as well as for keeping Gemma’s feet pushed off the cord.  I was working against gravity and from a clear disadvantage.

“OK, she’s under! Go!” Dr. Patel sounded the shot that began the race.

Claire’s unconscious body began to move as Dr. Daniels swiftly cut down through the abdominal tissue, making a beeline for the uterus.  I struggled to keep my fingers positioned around the cord, my motivation to maintain and hold my position the same as it had been in Claire’s room and in the hallway.  There was simply no time for excuses or mistakes or fatigue, despite my cramping shoulder and aching arm.  One false move from me, one instance where I allowed something to escape my notice, one episode of inattention, and the baby whose feet I had been chasing for the past 18 minutes could die.

“How ya doin’ down there, Soph?” Dr. Daniels asked.

“Oh, I’m good.  How close are you?” I asked from under the drape.

“Almost there, Soph.  Hang in there.”  He replied.

“No worries.  We’re doing all right.”

And perhaps 30 seconds later, I felt those little feet lift off of my fingers, the cord slipping up and away.

“I got her!” Dr. Daniels exclaimed.

I was about to ask how the baby was doing when I heard a loud, rather vigorous cry.

The OR erupted in laughter and relief as the NICU nurses and respiratory therapist welcomed their new patient into the world.

Slowly, I moved out from under the drape, careful not to brush the sterile instruments as I made my way for the OR door.  I held my jacket over my mouth, having not had the opportunity to get a mask on the way in.  And as I exited, I saw a small, pink, squalling little life amidst the receiving blankets, and two little feet, still kicking.

I returned to the OR and recovered Claire in the PACU when the surgery was over.  I brought Ron and Claire’s mother into the room as Claire woke up.  I explained how things had gone, that Gemma was in the capable hands of our NICU personnel, and that her transfer was only precautionary–she was doing so incredibly great, despite the circumstances.  And as Claire woke up more fully, she suddenly recognized me, took my hand, looked to her mother, and said, “Mom, this is the woman who saved Gemma’s life.”

That was the first instance of the copious thanks that came my way that night.  Before leaving Claire and Ron with their new nurse on postpartum, Claire’s mother approached me for a fiercely grateful hug.  Claire then called me over for a hug herself, both of us nearly in tears.  And despite the death that had surrounded us that night, I left work that morning knowing that one baby was alive–for 20 minutes and for the rest of her life, she was alive in no small part because of me.

So when I awoke the next evening and took note of a soreness in my shoulder and an ache in my arm, I stopped, perplexed but for a moment until I remembered Claire, Ron, Claire’s mother, and little Gemma with those kicking feet.

I don’t think a sore arm has ever felt better.


The Happiest Job On Earth

Somewhere between the shampoo and conditioning experience of my haircut a few days back, I mentioned to Anna, my hairdresser, that I am an L&D nurse.

“Ohhhh, you’re so lucky! I’ll bet you have the happiest job on earth!” She cooed.

“Well, kinda…” I trailed off, realizing that I was in a salon full of nice-looking ladies who probably didn’t want to hear about the ugly side of my work.

“Well, I’m sure it has its downsides, but you spend your whole shift holding babies, right?”

“Actually, Anna, babies are only on my floor two hours before I send them to postpartum.” I said, not even bothering to foray into the real meat and potatoes of just why L&D nursing isn’t what practically everyone who isn’t an L&D nurse seems to think it is.

I left my haircut exceedingly happy with my new look, but a bit rubbed by Anna’s faulty yet common opinion of my profession.  And then I realized–Cervix With a Smile!  What better place to write an expose on the real ins and outs of L&D nursing?

This post is admittedly geared toward nurses who are interested in L&D, but really, it applies to anyone, especially if you think my shift is entirely comprised of baby powder and cute little outfits with a Johnson & Johnson “Nurses Heal” ambiance and slow string music.  As an aside, if you know a postpartum, pediatric, PICU or NICU nurse, many of the below points also apply to their work.

So here we go, folks.  Take a walk in my plastic wipe-able clogs and see what L&D looks like from my side of the bed.

Why L&D Nursing isn’t what you think it is:

  1. I’m a professional.
    When you walk into your friend/family member’s room and see that brand new little baby, you see a new part of your life.  You see your friend or family member’s new son or daughter, a new part of your social circle, a new little person that you will come to know and love.
    I’m a nurse.  You know what I see when I look at that same baby?  A patient.  That baby, just like his or her mother, is my patient, and while I will certainly talk to the kiddo while I’m taking her temperature and making her cry with her first shot, I’m not forming emotional attachments to the baby like you and the baby’s parents are.  While some may see it as cold, I view that infant through the objective eyes of a professional.
    Case in point, when I visited a close relative in the hospital and met her baby for the first time, I had to remind myself that I was not her nurse–and it wasn’t my job to watch the monitors (although I admittedly did, purely out of habit!).
    My perspective on my tiny patients isn’t to diminish the significance of their lives; rather, it is for his or her protection.  Because if something bad starts to happen to that baby, what would you rather have me do–freak out like your best friend or react like a professional nurse?
  2. I have a lot of things to do that don’t involve holding the baby. No really, I mean a lot.
    During the course of my shift, I am charting on mom’s contractions and baby’s heart rate and ensuring that those are happy patterns every 15 minutes.  If something goes wrong with either, I am at the bedside to intervene.  That may include changing the rate of medications on the IV pump, giving more fluids, giving oxygen, or sometimes even repositioning mom to make baby happy–even if that takes five coworkers to do because mom is 300lb and has an epidural.
    Speaking of which, if mom has an epidural and all is going well, I’m checking on her level of consciousness, respiratory pattern, anesthesia level, pain rating and a host of other things every 30 minutes.  I’m getting her temperature and emptying her bladder every 2 hours.
    And all that stuff is what I have to do before baby is born.
    After baby arrives, I’ve got vitals, pain and fundal checks (those fun, fun tummy presses for those of you who have delivered in a hospital) on mom every 15 minutes for the first hour, every 30 minutes for the second hour, vitals on baby every 30 minutes for 2 hours, two meds for baby, one med for mom, and a whole ton of charting that has to be done before I can move mom and baby to postpartum.  And that doesn’t even begin to cover teaching mom to breastfeed or doing a recovery from a C-section!
  3. Once baby is here, my work is almost done.
    As an L&D nurse, I only keep mom and baby on my floor for another 2 hours after birth.  This certainly doesn’t even begin to encompass an entire shift of baby holding.  But even if you were to talk to a NICU nurse or a postpartum nurse, they’ll tell you they certainly don’t spend their shifts holding babies.
    Postpartum nurses have 4-6 couplets (moms and babies) to tend to.  That’s 8-12 patients that are fully dependent on them!  Between med passes and breastfeeding assistance and parent education and charting, you probably won’t catch any of them spending their shift baby rocking in the nursery (which is minimally used anymore at most hospitals anyway).  While there certainly are nurses who take a few minutes here and there to rock their smallest patients to sleep if mom is already out, this is a rarity, especially in the 21st century.
    NICU nurses are highly specialized, rendering care to the most fragile little humans on the planet.  Just like myself and postpartum nurses, they especially view their infant charges as patients and keep their carefully trained eyes open for the first hint of trouble.  Many of their patients are so small that they are actually being shielded from external stimuli such as touch to simulate the warm, dark environment of the womb.  And while some of those babies certainly are big enough to hold, the fact that many NICUs have volunteers who come in specifically to hold their babies should tell you that a NICU nurse’s day is filled with much, much more than baby holding.
  4. Labor is hard…on everyone!  Ladies, I’ll take your high fives in the comments.
    Even with an epidural and a great nurse and doc and a wonderful partner and supportive family, labor is tough.  And that’s under the best of circumstances.  How about we look at a more common scenario.
    Let’s say you come in at 5 centimeters with killer contractions.  The anesthesiologist is back in a C-section, your breathing techniques aren’t working anymore, I have to strap a bunch of monitors to your abdomen amidst your contractions and need you to stay seated so I can monitor the baby, but the only thing that helps your pain is walking–but then I can’t see baby’s heartbeat.  Your mother is freaking out at me because I can’t sugar-plum-fairy your pain away, your other relative is taking pictures of you as you cry on the birth ball, and the OB is trying to get ahold of me to let me know that she/he wants you delivered by 1700.  Somehow, an anesthesiologist magically appears, but it’s your unlucky day because the epidural isn’t everything you dreamed of and more, and you can still feel some amount of pain through your epidural (which is normal, but God forbid anyone suggest to a woman these days that labor will still have its painful moments!).  Meanwhile, your baby’s heartbeat is starting to dip in ways that I don’t like, I have a room full of your crazy family, and you’re so caught up in your contractions and your screaming family members that you can barely hear my coaching, which might actually make your labor tolerable until the anesthesiologist comes back to give you a nice extra epidural dose right after this next C-section, assuming you are still pregnant.
    Take any aspect of that scenario.  I see at least one of those situations on every shift, usually more.  There are some shifts that I’d kill to spend a night rocking babies.
    The last few points mostly focused on the circumstances of my job that make my work what it is.  But what about the circumstances that my patients bring in with them?
  5. Not all moms are healthy.
    In fact, a rising number come into pregnancy with serious preexisting conditions.  Obesity, diabetes, heart disease–you name it.  Women with all kinds of health problems get pregnant, and pregnancy is often no walk in the park for those who do begin the race healthy.  Add an already unhealthy mom and you’ve got a stage primed for preeclampsia, gestational diabetes, HELLP syndrome, and a myriad of other conditions and complications that go along with disease processes that not only affect mom but baby, too.
  6. Not all moms stay healthy.
    The truly unfortunate cases are those women who enter pregnancy from a healthy vantage point only to be blindsided by something unforeseen.  They had no risk factors, no predisposing issues, but they got hit with whoppers anyway.
  7. Not all moms care enough to keep themselves healthy.
    These are the cases that infuriate most healthcare workers.  They’re the moms who get pregnant and just don’t want to kick that smoking habit.  Or using crack or heroin.  Or drinking.  Or cutting or overeating or under-eating.
    Or, they’re diagnosed with a serious illness either before or during pregnancy, and they won’t take their medication, follow up with their doctors, or do much of anything to ensure not only their own safety, but the well-being of their unborn child.  It’s heartbreaking and frustrating and ultimately, I as a nurse can do nothing about it other than educate and try to help mom see a better way to live her life.Between the women in any of the categories above, some will stay with us for months prior to delivery.  Some will deliver early.  Some will have emergency C-sections.  Some will become NICU moms.  Some will deliver normally and everything will be fine.  A small number will get seriously sick, and a few will even die.  Some will lose their babies either before or shortly after birth.  Either way, their ailments will not only affect their lives, but the lives of their babies, their families, and all those around them.
  8. Not all babies are wanted.  It isn’t necessarily the norm, but L&D nurses see the full range of the human spectrum.  We see the parents who are ecstatic and have read every book on the planet about parenting.  They’re ready.  They’re beaming.  It’s glorious.
    And then, there are those moms who don’t want anything to do with their baby after he or she is born.  Mom sits in bed withdrawn, numb to the little life in the bassinet beside her.
    I’m not talking about mothers who have postpartum depression or some other condition that prevents them from bonding with their infant.  I’m talking about fully healthy and entirely capable women who just don’t care.
    Neglect is often evident long before mom leaves the hospital.  And the kicker?  There’s not a darn thing any of us can do about it.
  9. Not every parent will treat their baby right.
    In a similar vein as the category above, there are those moms who scream and cuss at their unborn babies and newborns, who have begun the process of ruining them with profanity and abuse and anger.  There are the angry fathers, the disappointed parents, the ones who wanted a girl and not a boy or a boy and not a girl.  They’re the ones who you say a silent prayer as they slip down the hallway–an innocent life disappearing into violent, unloving arms.  They’re the ones you pray don’t end up in the NICU, PICU, or worse.
  10. Sometimes children have children.  I know, I said it.  In an age where Teenage Mom is all the rage, I’ll tell you that from my standpoint, often times, those are sad stories, no matter what the good ol’ TV or the teenage mom’s mom or her sweet little old auntie will tell you.  I know that not every child born to an adolescent will end up in the admittedly fatalistic picture I’m painting, but I also know there are a good many who will, and when you’ve seen your third 16-year-old who has miscarried twice in a year and is now on her third pregnancy because “I just wanna have a baby”, then perhaps you’ll understand my disdain for the culturally rampant lie that would have you believe that teenagers in the USA are ready to be parents.
    These aren’t daytime soaps.  They’re stories about innocence and opportunities lost.  They’re stories about children raising children who will never have the benefit of being raised by an adult, and as a result, will likely struggle to become adults themselves someday.  They’re stories about balancing high school and parenthood, about a child clinging to the tattered remains of a past adolescence as circumstances thrust them into a premature adulthood, often without any real role models to copy.  They’re stories about absent parents and the perpetuation of a cycle that sees children as possessions, not human beings to be treasured and disciplined and brought up.
    And it’s a sad reality that our culture has opted to sensationalize and normalize such behavior instead of exposing it for what it really is–a selfish, dangerous lie.
  11. Especially these days, many people see their children as accessories.
    On the same note as item #10, sometimes even adults are really just children having children.
    I guarantee you, you know someone like this.  They’re the mother who is being induced because she has to have her baby on this specific day so she can still make her hair appointment two days after.  Or she has to have a boy because that’s the color she painted the nursery.  These are the parents who love to talk about their kids like prize trophies, but the instant the children become real little people with needs of their own, the desires of the parents trump the needs of the kids, and suddenly mom’s throwing a tantrum because she doesn’t have time to feed the baby–she’ll be late for girls’ night out!
    Now, I’m certainly not saying that once you’re a parent, you forego any semblance of your own life.  I’m talking about parents who consistently and arrogantly put their own desires above the needs of their children, and when you see it as often as I do, it’s an ugly sight to behold.  It is a disease borne out of a very human urge to think only about me, me, me, and there are few traits more disgusting and misplaced than when found in parents.
  12. Some births don’t go as planned and some are downright traumatic.
    There are few things more heartbreaking to me than to have to tell a mom who is hell-bent on delivering her baby vaginally that it just isn’t going to happen–we must do a C-section.  Or seeing a mom, with no support from her partner, opting to get an epidural when all she wanted was to deliver without pharmacological pain intervention.  Or watching the on-call OB cut an episiotomy without warning or reason on a woman who didn’t want to be cut.  Or watching a traumatic birth take place, knowing that that woman’s sex life and bowel patterns will never be the same.
    Say what you want to about some women who come in with 12-page birth plans, but if it were your birth and your baby, you’d be just as heartbroken if things didn’t go the way you wanted.
    As a nurse, I am your advocate, and when you experience what you perceive as failure or trauma in the process of delivering, you can bet that I feel it as well.
  13. Not all babies are born alive.
    I know that’s a loaded statement, but it’s one that you should think about when you imagine me at work.  Some of my most important contributions to my profession and my patients are when I take care of those parents who have lost their children.
    L&D nurses, despite our usual role in delivering new life, are also present for when babies are born dead.  Moms still labor, contractions still hurt, and babies must be born, even when their lives are over before they begin.
    L&D nurses are present in that process from start to finish.  Often times, it’s the L&D nurse who will look for baby’s heartbeat when mom comes in, telling us she hasn’t felt baby move in a little while.  It’s an L&D nurse who calls the doc, orders the STAT ultrasound, and is there when the parents get the bad news.  L&D nurses admit those patients and are with them and their families throughout labor and all the way through delivery to recovery.  We are the ones who set the tone for the family, provide the keepsakes and photos they will treasure, and try to protect and respect the body and memory of a child that the no one will never get to know.
  14. Not all babies live.  If you thought #13 was as tough as it gets, think again.  L&D nurses are not only there with the parents who deliver stillborn or miscarried children, but also for those who deliver babies who are alive, but will almost certainly die.  Anything from birth defects to prematurity to unknown causes can be the culprit, but it’s only one more aspect of the heartbreaking and frighteningly common theme of loss in obstetrics.
    When that baby is born alive and gasping for air, who will the parents rely on to teach them, to reassure them, to make baby comfortable as he or she slips away or to try to save that life?  How will those precious moments with that little one be remembered?  It is possibly the most difficult aspects of the job.

The points listed above certainly do not comprise an exclusive or complete list of why L&D nursing is difficult; they’re just the most obvious ones to me; the ones that come immediately to mind.  I fully expect to return to this article and edit as needed, either to clarify or augment points listed.

And sure, I could write a whole different article on why I love my job and why it’s so rewarding, but honestly, those are reasons you can probably think of yourself.  They’re things you commonly associate with my work and perhaps things you’ve had the pleasure of experiencing firsthand.  What you need to take away from this is that it takes a certain kind of person to do my job and still walk away at the end of shift feeling fulfilled and happy.  And unless you can take all the wonderful, happy things that come with L&D nursing and accept that with the list above, you’re not cut out to do what I do.

So the bottom line is that L&D nursing is still nursing.  It still is an art and science that deals with human beings, and as long as that is the case, it will include pieces of all the heartache and pain contained in the span of a human lifetime.  Indeed, if pregnancy and childbirth have the potential to be some of the brightest and happiest events in a person’s life, they also have great potential to be the darkest and saddest.

In short, if you’re looking for the happiest job on earth, don’t look to L&D.  Heck, please don’t even look in nursing.

But I hear Disney’s still hiring.