Though there are thousands of different healthcare jobs and hundreds of differing nursing career paths, few are more rewarding than those that lead to interactions with newborns. Working with parents who are thrilled to expand their family and excited to bring a new bundle of joy home is a wonderful opportunity. It can bring a lot of happiness into your career.
It may come as a surprise, but there are a variety of jobs out there for those interested in working in healthcare with babies. Passionate people who are serious about ensuring the safety and comfort of not only the newborns, but their parents as well, can make a profound difference. Specializations such as these can vastly improve the quality of care received at the very beginning of life.
As you explore potential careers in nursing, it is certainly worth considering some of the options available. There just might be a lot more out there than you’d ever previously considered.
Improving Birth Outcomes
Working in the healthcare field as a nurse interacting with newborns and their parents isn’t just about being in the delivery room when the baby arrives. Rather, it is about all of the steps along the way and immediately after that improve birth outcomes. Being the nurse who provides recommendations on exercise and what to eat during pregnancy is every bit as crucial as being the nurse who cuts the umbilical cord.
Even with all of the modern medicine our society has, there is still an increasing trend of complications during pregnancy compared to previous decades. One study completed by Blue Cross found that a greater number of women are starting pregnancy with pre-existing conditions, and the number of women experiencing both pregnancy and childbirth complications is on the rise. Addressing some of these health concerns early on is imperative to improving birth outcomes.
Unfortunately, many of these complications are experienced disproportionately amongst minority women and women with lower household incomes. One tragic review found that the risk of death from childbirth complications was over three times higher for minority women than it was for white women. Many experts indicated that these increases are not necessarily linked directly to pregnancy, but rather to an increased likelihood of pre-existing conditions and a general lack of high-quality care to address issues.
Specialties in Nursing
Fortunately, there are a lot of opportunities to turn these statistics around in the healthcare field, especially within nursing. It is no secret that nurses are one of the most highly trusted groups of professionals — even more so than doctors — which can make the advice and recommendations they give particularly powerful. Career opportunities for nurses to work with babies are expansive and include options such as going into pediatrics, neonatal nursing, labor and delivery, or midwifery.
For example, becoming a nurse-midwife provides an unparalleled opportunity to interact directly with expecting parents and newborns when they arrive. Midwives are instrumental healthcare providers and are expected to do several tasks such as:
Providing prenatal care and advice to expecting parents.
Creating a birth plan and educating women about their birthing options.
Coordinating with medical doctors and specialists as necessary.
Treating routine health concerns during pregnancy.
Assisting in delivery and coaching.
Helping with breastfeeding consultation and other post-partum care.
A career path such as this also has the potential to make a positive impact on addressing disparities among minority women as well. Research suggests that more professionals dedicated to helping women throughout pregnancy and postpartum care can greatly reduce health risks. This appears to be especially true if minority nurses are working with minority patients.
Though many of the career options described above have a lot to do with directly caring for newborns, other surprising options may seem a little more distant. They are, however, every bit as essential to improving birth outcomes long-term. For instance, lactation consultants are valuable assets who work to help teach new mothers how to breastfeed properly.
Another career opportunity is becoming a birth or postpartum doula. This position essentially serves as a ‘super coach’ for expectant mothers. They do everything from providing aromatherapy and massage to helping design an organized and effective baby nursery. Doulas can play a major role in helping mothers with pre-existing conditions plan healthy meals or monitor their conditions to ensure everything continues to go smoothly for mother and baby.
Some people even specialize in prenatal or infant massage as a means of helping mothers and babies. Prenatal massage requires special certification that teaches therapists how to relax and ease strain without harming pregnant bellies. Similarly, infant massage professionals help early babies improve blood flow and strengthen their tiny muscles.
There is certainly an abundance of healthcare and nursing-specific careers that can allow for direct interaction with newborns and their families. Caring professionals in these types of fields can make a substantial positive difference in birth outcomes. This is especially true in areas where access to healthcare isn’t always as prevalent.
We have another indefatigable and seemingly unstoppable Nurse of the Week on the verge of earning a BSN! The Nurse of the Week this time is Sabrina Bertsch, whose path to a Rutgers University–Camden nursing degree wound across the United States and included struggles with illness and financial insecurity.
Bertsch became interested in health care in her early 20s after the birth of her first child. She worked as a professional skateboard photographer in Philadelphia, utilizing her first bachelor’s degree in photography.
While she always planned to pursue a career in midwifery, life circumstances forced her to put her plans on hold for nearly 20 years.
After moving to Albuquerque, where she worked as a bartender and was pregnant with her second child, Bertsch was motivated to work in emergency medicine after witnessing customers at the tavern become sick from high alcohol consumption. “It pushed me to do something immediate to help save lives,” says Bertsch.
Bertsch was an emergency medical technician in Albuquerque and then in New Jersey, until she was diagnosed with idiopathic cardiomyopathy during her third pregnancy. A subsequent divorce and another move back to her hometown in Tennessee required putting off a nursing education for another 10 years.
After earning a master of arts in teaching degree from Liberty University in 2015, she briefly worked as a substitute teacher. “My heart was truly in nursing, specifically nurse-midwifery, so I decided I had put it off long enough and began my earnest path toward that goal,” she says.
Financial issues and caring for a sick child at home made the journey difficult but did not deter her from pursuing her dream career.
While working full-time as a server at a restaurant, Bertsch began taking prerequisites for a nursing degree, paying cash for the classes.
In early 2020, Bertsch faced some of the most challenging times in her life. While raising her four children, Bertsch began the 15-month Rutgers–Camden ABSN program for students who hold a degree in a non-nursing major.
Just a few weeks into the Rutgers School of Nursing–Camden program, Bertsch suffered a medical crisis that required hospitalization, nearly derailing her plans to pursue the degree.
Then the pandemic hit New Jersey.
Her partner’s acupuncture business shut down, and the family had no income for several weeks. Her children suffered anxiety from the lockdown and having to take classes online.
By drawing on her experience in conquering hurdles, Bertsch persevered with support from her partner and her children.
Bertsch’s 20-year-old son, a sophomore at Rutgers, was living at his grandparents’ home. Her 17-year-old son was taking virtual classes at home, and she was homeschooling her 15-year-old son, and caring for her four-year-old daughter.
“It wasn’t perfect,” says Bertsch. “Probably too much screen time and boxed mac-n-cheese, but we have all come together as a team and as a family.”
For Bertsch, a positive outcome of taking classes online during the pandemic has been a greater appreciation of opportunities to learn. “I think that being online has pushed me to not take a moment, an opportunity, or a lesson for granted,” says Bertsch. “I became a hyper-alert student, taking in everything I could; every question I had, I asked without hesitation.”
Bertsch will be working as a birth assistant for a homebirth practice in Pennington.
In August, she will begin a Georgetown University online dual-graduate program for certified nurse-midwife and women’s health nurse practitioner.
Now that diversity and inclusion programs can sigh with relief that they are not “unAmerican” after all, we can proceed to celebrate their vital role in encouraging non-Whites to enter the nursing workforce. One of the nursing school champions in this area is Frontier Nursing University, and this year, Dr. Geraldine Young, DNP, APRN, FNP-BC, CDCES, FAANP, FNU’s Chief Diversity and Inclusion Officer, is being recognized as one of the Outstanding Women in Higher Education by Diverse: Issues in Higher Education magazine. This is the 10th consecutive year that Diverse has named 25 women “who have made a difference in the academy by tackling some of higher education’s toughest challenges, exhibiting extraordinary leadership skills, and making a positive difference in their respective communities.” The issue will be published on March 4, 2021, in honor of Women’s History Month.
“I am incredibly honored and humbled to be recognized on this special list of women,” Dr. Young said. “I am thankful to have led the diversity, equity, and inclusion initiatives at FNU over the past year. As we strengthen our own environment, we have the opportunity to set an example and standard for other institutions to follow. I thank Diverse magazine for this honor and for giving us this platform to inspire others.”
As a member of the Essentials Task Force and NONPF Board of Directors, Dr. Young is ensuring cultural diversity and inclusion are at the forefront of nursing education to address the health disparities and inequalities that exist in our nation. She has effectively delivered models of clinical practice to improve the outcomes of underserved and minority populations with diabetes in conjunction with the Health Resources and Services Administration (HRSA) and the Centers for Medicare and Medicaid (CMS).
FNU President Dr. Susan Stone, CNM, DNSc, FAAN, FACNM cheered Dr. Young’s “experience and expertise as an advocate for diversity, equity, and inclusion,” and added, “With the guidance of Dr. Young… we will continue to make diversity, equity, and inclusion a top priority at all levels of the university.”
In each of the past three years, FNU has also received the prestigious Health Professions Higher Education Excellence in Diversity (HEED) Award from INSIGHT Into Diversity magazine. The Health Professions HEED Award is the only national honor recognizing U.S. medical, dental, pharmacy, osteopathic, nursing, veterinary, allied health, and other health schools and centers that demonstrate an outstanding commitment to diversity and inclusion across their campuses.
FNU’s commitment to emphasizing and valuing diversity and inclusion was formally instituted in 2006 when the university began intense efforts to recruit minority students in an effort to diversify the advanced practice nursing and midwifery workforce. FNU’s initial efforts were funded through the support of an Advanced Nurse Education grant from the Health Resources and Service Administration (HRSA). In 2010, FNU held its first annual Diversity Impact Conference. Held each summer since then, the Diversity Impact Conference opens the door for nurse practitioner and nurse-midwifery students plus faculty and staff to foster collaborative discussions, address health disparities, and find proactive solutions to improve minority health among underrepresented and marginalized groups. Today, the goal of a diverse health care workforce continues with efforts to recruit and educate faculty, staff, students, and preceptors and integrate diversity, equity, and inclusion efforts throughout all of FNU operations with a goal that it should be fully integrated into the university’s culture. FNU’s diversity, equity, and inclusion efforts are currently funded with a Nursing Workforce Diversity Grant from the HRSA.
These diversity initiatives span all facets of the university, but one of the most telling and important data points is the percentage of students of color enrolled at FNU. In 2009, that number was 9 percent. Starting in 2010 with the HRSA funding, FNU’s diversity, equity, and inclusion initiatives have resulted in the percentage of students of color enrolled growing to 25 percent today.
Nearly overnight, the coronavirus pandemic transformed health care, including perinatal care. Anticipating more and more COVID-19 patients, hospitals needed to create space quickly, both to manage the influx of patients with the disease and to protect non-infected patients from exposure to SARS-CoV-2.
Elective surgeries were postponed, telehealth was utilized when possible, and some care shifted to outpatient with remote monitoring. One procedure that cannot easily be postponed or managed remotely, though, is childbirth. And, even as the pandemic dramatically reshapes parents’ expectations of labor and delivery, the coronavirus is colliding with crises already affecting pregnant people and new mothers and parents — namely, the struggles to reach families in rural or remote areas and to prevent the unnecessary perinatal deaths of Black people.
Melicia Escobar, BSN, MSN, CNM, WHNP-BC, believes this complex moment in perinatal health is one that nurse-midwives, trained to move through a crisis without forgetting the client at the heart of it, are more than prepared to meet.
“This is why I think midwife leaders are really shining in this time, across academic settings, medical centers, and home birth, because that’s what we’re trained to do,” said Escobar, a certified nurse-midwife (CNM) and Women’s Health Nurse Practitioner (WHNP) and Clinical Faculty Director of Georgetown University’s Nurse-Midwifery/Women’s Health Nurse Practitioner (WHNP) and WHNP programs.
Intentional support provided by antenatal and birthcare providers is essential in helping families navigate this crisis safely — as well as mitigating the potential negative effects that the pandemic’s social and economic consequences could have on perinatal health in the future. Escobar considers these and offers action steps for supporting people in pregnancy, birth, and the postpartum period below.
Parents Have Fewer Choices About the Birth Experience
Parents tend to have better outcomes when they are empowered to make choices about their birth experiences.
“Having options, offering unbiased guidance around those options, and listening to clients is so important. When people have options for where to birth, for example, and have information to weigh pros and cons, then they know where they should be,” said Escobar. “They know what’s best for them. We just need to listen.”
Consider one key decision parents have to make: Where should I have my baby? In many rural areas, birthplace options can be extremely limited. Options for out-of-hospital care may be rare, and even when parents choose an in-hospital birth, they may only have one hospital accessible to them. Some community hospitals have discontinued childbirth services completely, forcing families who want a hospital birth to travel elsewhere for care.
A CNM in Philadelphia, Escobar set the scene of the pandemic’s early days: “People were afraid of being in a hospital and exposing themselves or their babies to COVID-19. They were also afraid of being subject to hospital policies around COVID-19.”
At some hospitals, one such regulation was limiting the number of support people allowed at the birth to reduce providers’ exposure. But there was an unintended — and unjust — effect, as detailed in the article “Reflecting on Equity in Perinatal Care During a Pandemic” in Health Equity: “A policy of no support persons unduly impacts marginalized communities and implicitly reinforces the ‘sacrificial’ or expendable status of Black and Indigenous parents, who have long borne the consequences of mistreatment and abandonment in their health care experiences.”
Protecting parents’ options and respecting their choices surrounding the birth experience is especially important in a crisis. Options should be safe, affordable, and respectful — in other words, a real choice among viable options.
Whether because of the coronavirus or biased, inequitable treatment, “it’s not really a choice when going into the hospital can mean real and present danger,” said Escobar.
Existing Risk Factors May be Compounded, Especially for Women of Color
Some methods of adapting perinatal care during the pandemic could ultimately prove harmful to women, especially women of color, according to the aforementioned Health Equity article. For example, some providers have encouraged early inductions and elective cesarean births (C-sections) to help manage “hospital census and staffing.”
However, these procedures often require increased close contact between patients and providers, increasing the risk of COVID-19 exposure. They can also lead to longer inpatient stays, creating a higher risk for both the parent and newborn.
“Given that women of color already experience higher rates of inductions and cesareans, these policies are likely to further exacerbate the disparities in outcomes,” wrote the article’s authors.
Traumatic Experiences Could be Worsened
Most people bring trauma into the childbirth experience to begin with, said Escobar. COVID-19 adds another layer of stress and fear that may be especially difficult for expectant parents.
~14% of women are affected by perinatal depression.
“Then there’s a second-layer trend where Black, Indigenous, and people of color (BIPOC), who already enter our health system at a disadvantage and carrying trauma, are forced to choose between COVID risk and a system in which they perceive they are unsafe due to racism and bias,” said Escobar.
“The baseline level of trauma that Black birthing people in particular experience is already so high,” said Escobar. “For folks opting to stay out of care or seeking out-of-hospital birth, it is very easy to understand the logic: Why compound things by introducing either of those two factors, COVID risk and racism?”
Action Steps for Supporting Maternity Care in a Crisis
Giving birth during a pandemic can be traumatic, especially for those who have already experienced trauma in the health care system. With trauma comes fear. When people — both patients and providers — start making fear-based decisions, “that’s when you start getting bad outcomes,” Escobar said.
Still, a negative outcome does not have to be traumatizing. Listening to and empowering the person giving birth can transform the experience.
“There have been clients I’ve been caring for in labor who have had obstetric emergencies, like postpartum hemorrhages or uterine abruptions, where my perception was that the experience was probably traumatic for them,” said Escobar.
However, the patient tells a different story. “Afterwards when we were debriefing, one of those clients said to me, ‘Thank you so much. That was the most empowering experience in my life,’” she said.
Escobar believes the difference between a traumatic childbirth and a difficult but empowering birth is in listening, sharing information, and partnering together even in the midst of a crisis. When people start from a place of listening to expectant parents, they can understand and mitigate their fears. They can work through or around the trauma to comfort the client and overall have better outcomes — even if the childbirth has scary elements.
Below, find suggestions for providers, loved ones, and communities to better listen to and support women in pregnancy and the postpartum period during the coronavirus pandemic and beyond.
Adopt a midwifery-model mindset: Nurse-midwives are trained to stay calm in difficult births, create an action plan, and move through it with the person “always centered,” said Escobar.
Treat listening and clear communication as vital clinical skills, as essential as doing an abdominal exam or listening to heart sounds.
Listen to the client, especially when discussing sexual health history and gender-based violence.
Find ways to communicate empathy and understanding, even through layers of personal protective equipment.
Share information and partner with the patient throughout their care, especially in potentially traumatic childbirths.
How Can Family and Friends Offer Support When You’re Expecting During a Pandemic?
Reserve judgement and honor the choices being made around childbirth and coronavirus precautions.
Before visiting, ask about the family’s comfort level with in-person interactions, and again, avoid adding to guilt or shame about those precautions.
Identify alternative ways to be helpful, such as sending takeout meals or taking care of yard work.
Consider offering financial support if needed and requested.
Check in if you have not heard from a new parent and ask if they need any support or reassurance.
Extend compassion to new parents in the postpartum period. “We’re going through a collective grieving process in this pandemic,” said Escobar. “That loss and fear juxtaposed with the excitement, joy, and hardship of transition is a really intense nexus.”
How Can Communities Better Preserve Perinatal Health in a Crisis?
Develop a trauma-informed approach to every level of health administration and public service, from intake to birth to discharge.
Consider how to address the external factors that affect pregnant and birthing people and their families. “Pregnant people don’t exist in isolation,” said Escobar. “They have housing needs, they have food needs.”
Have a nurse-midwife on maternal health leadership teams. “It improves outcomes, culture, and patient satisfaction everywhere,” said Escobar.
Create policies that make perinatal care more holistically accessible. For Escobar, accessibility includes having a hospital to go to that offers safe, effective, unbiased, and respectful care.
The Medscape 2020 nurse job satisfaction survey dove into fears, PPE woes, and other highs and lows of life in the workplace during the pandemic. Medscape surveyed 10,400 nurses across all regions of the US and analyzed responses from 5130 RNs, 2002 NPs, 2000 LPNs, 500 clinical nurse specialists (CNS), 401 nurse-midwives (NMs), and 391 CRNAs. Most respondents fell within the 35-54-year-old age group.
Despite the hardships of 2020, most respondents are still quite happy with their choice of career. A full 98% of NMs and CRNAs are glad they chose nursing, closely followed by 96% of CNS, 95% of LPNs and NPs, and 93% of RNs.
Given the chance of a do-over, though, some are not sure they would make the same choice. 85% of NMs and CNS say they would pick nursing again. Among RNs and CRNAs, 76% and 78% would stick with nursing.
The Impact of Covid-19
Among CRNAs, 73% have treated Covid-19 patients. Midwives came in second, with 60% of NMs saying they had treated Covid patients, followed by NPs (57%), RNs (53%), LPNs (50%), and CNS (38%). Have they had sufficient PPE? Responses were almost evenly divided, with a majority of LPNs (59%) and RNs (56%) affirming that they have enough PPE.
Who was furloughed? CRNAs were at the front of the line, with 34% saying they had been furloughed during the pandemic. NPs came in second, at 18%, followed by LPNs (15%) and RNs (14%). On average over 30% of the nurses surveyed lost income last year, but CRNAs took the biggest hit, with 59% saying they lost money in 2020.
Telehealth is becoming routine for nurse-midwives and NPs. In the 2020 survey, 77% of NMs and 75% of NPs told Medscape that they met with patients online or by phone, and 53% of the LPNs surveyed made virtual visits.
Fears and worries during this scary year were to be expected, of course. Nurses’ greatest concerns during the pandemic were concentrated on the fear of transmitting Covid to family and oneself, but 38% singled out the discomfort of wearing extra PPE as their main woe, and 23% worried most about higher patient loads.
Best and Worst Parts of the Job
Asked about their main source of job satisfaction, nurses offered a range of answers, but helping people and making a difference in their lives was the top choice for RNs, LPNs, and APRNs (click charts to enlarge).
Least satisfying aspect of the job: Workplace politics ranked first for RNs and LPNs at 23% and 21% respectively, and for 26% of CNS’s. LPNs also pointed to their paychecks as a source of dissatisfaction.
Even before hard data was available, many pregnant women were taking extra precautions against COVID-19, and a new CDC report indicates that they may indeed face additional risks from infection. “Although the absolute risks for severe COVID-19–associated outcomes among women were low,” the report states, “Pregnant women were at significantly higher risk for severe outcomes compared with nonpregnant women.” Another recent report found that pregnant women with Covid were also more likely to have pre-term births.
In a January-October 2020 study of symptomatic cases among over 400,000 women between the ages of 15-44, the CDC study found that pregnant women were up to four times more likely to require ventilation and two times more likely to die. The results varied depending on ethnicity. Pregnant Latina women faced a higher risk for infection and death compared with nonpregnant Latina women, and regardless of pregnancy status, non-Hispanic Black women experienced a disproportionate number of deaths. To view data on ICU admissions and invasive treatments (ventilation and ECMO life support) broken down by age, pregnancy status, race/ethnicity, see this table.
Based on these reports, the CDC advises pregnant women to
Limit unnecessary interactions with persons who might have been exposed to or are infected with SARS-CoV-2, including those within their household, as much as possible.
When going out or interacting with others, wear a mask, social distance, avoid persons who are not wearing a mask, and frequently wash their hands.
Take measures to ensure their general health, including staying up to date with annual influenza vaccination and prenatal care.
Dr Denise Jamieson, chair of the gynecology and obstetrics department at Emory University School of Medicine, also commented, “Pregnant women need to be included in the different phases of vaccine trials, so that when a vaccine is available we understand the safety and efficacy of vaccines in pregnancy.”
The data on COVID-19 and pregnant women appeared close on the heels of an American Academy of Pediatrics report stating that infections among children are on the rise. The 61,000 new cases in children during the last week of October “is larger than any previous week in the pandemic,” according to the AAP. However, most cases in children still tend to involve milder symptoms. CDC studies have found that just 54%-56% of children experience fever and cough, compared to 71%-80% of adults, and only 13% suffer from shortness of breath, compared to 43% of adults. Pediatric cases requiring hospitalization, though, are as likely to require ICU care as adult cases, with one in three leading to the ICU.