01.27.11: What labor nurses do on a busy day
At 6:45, I parked my car and walked into the hospital. I changed into scrubs, swiped on some lipstick and headed to the nurses’ station. By 7:10 I was in the operating room with a woman I’d never met as her doctor made an incision. At 7:20, I was resuscitating a seconds-old baby born floppy, gray, not breathing or crying. At 7:35, I handed the little girl to her beaming father who burst into tears of relief that his baby and wife were both just fine.
Twenty minutes later, I escorted the new family back to their room to start my post-op recovery routine when my charge nurse came in and said, “Three labor patients just walked in. One is sixteen, one has twins and another says she wants to push and speaks only Spanish. If you take the Spanish speaker, you’ll probably get another labor patient after she delivers. Which one do you want?”
By 8:30, I was reassuring my patient in my best, broken Spanish that if her doctor didn’t get there in time, there were plenty on the maternity unit who could deliver her super-speedy baby. I pulled out delivery supplies, yanked on my gloves and called for back-up help. A new baby boy was born at 8:45 - healthy, huge and screaming like crazy.
As I looked at the clock, I realized two hours before I was still in my car. Now, there were two more babies in the world and the day was young. I still had ten hours left to my shift and I hadn’t even had a second cup of coffee yet.
I spent the next two hours tidying up my patient and her delivery room, checking her vitals and bleeding every fifteen minutes and stabilizing her son. I introduced the little guy to his new big sister, weighed, measured, took footprints, bathed and injected him with Vitamin K. I helped mom breastfeed and get up to the bathroom, changed her bedding, gave her a sponge bath, got her some breakfast and ibuprofen, while keeping up with the never-ending teaching and computer charting.
At 11:30, my charge nurse came back. “That sixteen-year-olds’ family is out of control. You’re taking her.” They’d “fired” her previous nurse because she told them the patient was only one-and-a-half centimeters dilated.” The family told her she didn’t know what she was doing. This is not an ideal assignment. Once a family has bullied one nurse out of the room, the next nurse has to be a drill sergeant to shift the dynamic in the room. We hate these power plays.
It’s rarely the patient who’s out of control. It’s her entourage who tries to commandeer the labor unit and make it all about them. Especially when it’s a room full of teenage friends, a couple mothers, some stepmothers, grandmothers, a boyfriend and his buddies, his stepmothers, some cousins, aunties, the patient’s mother’s new boyfriend….Everybody wants to be in charge.
I grabbed my charge nurse and the patient’s obstetrician before walking into her labor room, crowded with a dozen people. Everybody was angry - some because the patient didn’t have an epidural yet. Others, determined she wasn’t getting an epidural, no matter what. There were guys on the couch watching sports, girls talking loudly on cell phones. Two 40-something women argued about who got to sit next to the patient. And amidst all this were a young girl who looked terrified and a young man who looked lost - the patient and her boyfriend.
I introduced my self and announced to the crowd “I’m the new nurse and everyone needs to leave the room so we can figure out what’s going on. No one except the boyfriend stays. I’ll let you know what’s happening after a while.”
Whoa, did that cause uproar! Somebody shouted, “Who do you think you are?” The obstetrician chimed in,” Everybody out.” Some kid said, “You can’t make us,” and my charge nurse said, “Uh yeah we can. We have security guards. Seriously, is this how you’re supporting your friend? By making us call the cops?” The patient screamed, “GET OUT!”
Everyone begrudgingly left, though glaring and muttering the whole way. My patient apologized and said, “Thank you. I didn’t know they would be like this.”
I reassured her, “Nobody ever does, honey. If you could choose only two people to be with you in labor, who would they be?”
“My boyfriend and grandma,” she answered, “but everybody will be mad.”
“Don’t worry, they can be mad at me instead,” I told her. The relief on her little-girl face was heartbreaking.
After a cervical exam, we determined she wasn’t in active labor yet. She’d walk for an hour, then we’d re-examine her cervix. If contractions got stronger and her cervix changed, she’d stay. We’d figure out crowd control later.
As she paced the hall, I admitted another patient for a labor check and watched another nurse’s postpartum patients during her break. By one o’clock, the teenager was three centimeters and finally in “real” labor. My shift was half over.
I spent the next six hours helping my young patient with her slow labor, took care of a few patients’ non-stress tests and “backed up” three other deliveries. At 7 PM, I handed the teenager over to her night-shift nurse. By 7:30 I was driving home from one shift, five births and a dozen patients.
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