By Tori Hamilton RN, IBCLC

What do you envision when you think of a maternity nurse? Perhaps you are taking in the tastefully decorated delivery suite, and then observing the nurse lovingly placing the newborn infant on the scale while the mother looks up–grinning from ear to ear at her new bundle of joy.

The truth is, some days are like this in labor and delivery. The stars align and you feel so blessed to witness a beautiful birthing experience. Other days, well, let’s just say that obstetrical nursing is so much more than holding babies.

1. Two Patients At the Same Time

Even before a baby is born, the nurse is caring for two patients at once–the mother and her fetus.

A mother breastfeeding her child.

This means that the safety of any procedure or medication must be carefully considered to detect risks for both mom and baby before moving forward.

I will also let you in on an important tidbit of information: when there is a complication that has compromised mom’s health, always consider that baby is at-risk, as well. You very well may have two patients who need immediate care at the same time. Think of a large-for-gestational-age (LGA) infant born apneic after a shoulder dystocia,while the mother begins having massive postpartum hemorrhage. This is when you depend on your obstetrical team to back you up.

2. Obstetrics is a Diverse Specialty

Obstetrics is a specialty that involves most other specialties. Many obstetrical nurses assist in the operating room by scrubbing-in, monitor baby once delivered, and take over recovery for cesarean sections.

Obstetrical nurses triage antenatal patients and must be able to assess and prioritize care. They assist in the emergency department when there is a precipitous birth, and may find themselves assisting with a delivery in the back of an ambulance. They complete mental health assessments to monitor for signs of postpartum depression and psychosis and refer to community outreach centers when appropriate.

Maternity nurses manage high-risk drugs like IV magnesium drips, epidurals, and spinals that require constant monitoring. They look after patients with critical conditions such as HELLP syndrome. They must be proficient at performing life-saving measures for both adults and infants– often with a crowd of worried friends and family members nearby. Don’t let their sunny disposition fool you–obstetrical nurses are highly skilled and poised to jump into action at a moments notice.

3. You May Have to Catch That Baby!

In obstetrics, nothing seems to happen according to plan. The nature of labor itself is so unpredictable, and there are so many unforeseeable circumstances and possibilities. In addition, obstetricians are typically very busy–running their clinics, performing cesareans, and assisting in other vaginal deliveries. They rely on OB nurses to monitor progress.

Obstetrical nurses have a lot of autonomy and use their expert assessment skills to monitor mom and baby. However, sometimes labor progresses too quickly, and the obstetrician cannot get there in time. Most nurses working in obstetrics have ‘caught’ a baby a time or two. It is important to learn how to safely support a delivery from an obstetrician or family doctor you trust– just in case!

doppler FHR

4. Funding is Always At Risk

Though the need for quality obstetrical care is on the rise, many services throughout many regions are being discontinued for a couple of different reasons. In our increasingly litigious society, obstetrical care is the specialty that has the highest risk to health care providers and the highest insurance premiums.

About half of the 3,143 U.S. counties do not have a single OB-GYN to provide care, so 10.1 million women living in these rural counties must rely on trained family physicians to provide obstetrical care.1,3

Another factor: many family physicians are moving away from obstetrics, making it difficult to ensure 24/7 coverage in rural areas. Obstetrics expenditures for hospitals is significant, so these services are the first to be cut in rural centers.

Between 2004 and 2014, 179 rural birthing centers were closed in the United States, contributing to an increase in premature births and births in a hospital without obstetrical services. 2 For obstetrical nurses, this equates to an expectation to do more with less, be on-call, float to other units, or leave work early.

5. Obstetrics Can Be Heartbreaking

In many hospitals, a purple butterfly signifies fetal demise.

Obstetrics is a very rewarding specialty with new challenges and experiences each day–but that doesn’t mean that it is always a happy setting to work in. The obstetrical nurse must be prepared for the worst case scenario–an extremely premature infant that requires mechanical ventilation, a placental abruption resulting in stillbirth and severe maternal hemorrhage, a newborn experiencing neonatal abstinence syndrome, or assisting with an apprehension…the list goes on and on.

Obstetrics can be absolutely heartbreaking, and it is so important to talk through these terrible situations and lean on your team–because they have been through it too.

6. Obstetrics Takes a Special Kind of Nurse

The obstetrical nurses I work with are master critical thinkers with a skill set unmatched, but they also put their patients first–before tasks and paperwork (and let me tell you, there is an enormous pile of paperwork in OB!).

It takes a certain kind of person to support a woman in labor–to recognize when she needs to change positions, wants a warm blanket, or just wants you to be there–supporting her through the most difficult and life-altering transition of her life. Obstetrical nurses are the strongest and most empathetic people I know.

Fetal Heart Monitoring strip

Guest Blogger Bio

Tori Hamilton is a Registered Nurse, International Board Certified Lactation Consultant and La Leche League Leader. She owns a motherhood website, works at a rural hospital in med/surg/obstetrics and is an obstetrical subject matter expert at Higher Learning Technologies. She spends her free time with her husband and three young kids in Ontario, Canada. You can find her lactation services and blog at https://www.themamanurse.com

Image free attribution: Butterfly, Wikimedia Commons retrieved on April 16, 2019.

References

  1. Avery, D. M., & McDonald, J. T. (2014). The declining number of family physicians practicing obstetrics: Rural impact, reasons, recommendations and considerations. American Journal of Clinical Medicine, 10(2): 70-78.
  2. Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. JAMA, 319(12): 1239-1247.
  3. Rayburn, W. F., Klagholz, J. C., Murray-Krezan, C., Dowell, L. E., & Strunk, A. L. (2012). Distribution of American Congress of Obstetricians and Gynecologists fellows and junior fellows in practice in the United States. Obstetrics & Gynecology, 119(5): 1017-1022.

Posted by Cindi Bell MS RN

Registered Nurse and Subject Matter Expert for educational content created for nurses. She is a nursing subject matter expert at Higher Learning Technologies, the developers of award-winning Nursing Mastery nursing education products including NCLEX Mastery and the all-new Nursing Clinical Mastery. Specialized in emergency nursing, Sexual Assault Nurse Examiner and HIV Counselor, Graduate Degree in Health Informatics and Management, with certifications in Guided Care Nursing from John's Hopkins, ACLS and PALS, trauma nursing, Neonatal Resuscitation and Pediatric Emergency Nursing, currently focused on Population Health, dabbled in Public Health, School Nursing, and Urology, Love all things created with passion and innovation! #SANERN #ERRN #Nurserock #ACLS #PALS

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.