When I first became a labor and delivery (L&D) nurse, I didn’t quite know what I was getting myself into. I didn’t have children and I didn’t know anyone who did. I hadn’t even held a baby before! I had quite a long road of learning ahead of me. I loved every minute of my job, but internally, I was terrified and overwhelmed by the vast amount of information that was being thrown at me every day. After almost a year of being a L&D nurse I am beginning to feel confident and knowledgeable with my patients. Looking back, I wish someone had told me what my job would truly entail so that I would have been more prepared. So for anyone out there who is interested in becoming a L&D nurse, or even is just curious about what our job is like, here is a list of things I wish I had known first.

1. Most people (surprisingly) don’t know a lot about giving birth.

You might think that most parents would spend nine months preparing for the imminent delivery of their child, but a surprising number of families do not. So as a nurse, it is your job to explain the nitty gritty of what will happen during labor and delivery. Even the most prepared moms have never felt the intense pain of contractions or pushed a human out of their body before, so they will need some assistance. Over time you will gain a plethora of knowledge about the labor and delivery process, and your patients will soak this information up like a sponge.

2. You are going to see a lot of vagina. I mean a lot.

You will quickly become accustomed to the sight of a vagina, and you will learn that each vagina and cervix are different. The first time you go to check a cervix, it will be awkward, and you may not even be able to find it! It’s not easy (or pleasant for the patient) to do a cervical check, but as you gain experience, you will learn tricks for finding a posterior cervix and how to tell which way a baby is facing. Vaginal exams are your roadmap to the laboring process, and you will learn how to use them to help you deliver a baby successfully.

3. Everyone has a different pain tolerance.

Giving birth is arguably one of the most painful things a person can endure. Some women handle this pain with grace, and others, well, do not. As a nurse, you will see women who quietly breathe through each contraction, and you will also see women who scream and thrash through every one. At first it is alarming and very difficult to see your patients in so much pain, but over time, the yelling will simply become the normal background noise of your shift. One of the most important parts of your job is assuring patients that there is absolutely no shame in getting an epidural. It is not “cheating,” and sometimes it’s actually very helpful for the dilation process (and the nurse and support person’s sanity!).

4. A lot of your job is reassuring your patient that yes, they can and will deliver this baby.

Giving birth is scary. There is no denying that. After 20 hours of labor, even the strongest woman can begin to lose hope and want to give up. This is when the nurse steps in and becomes the woman’s biggest cheerleader. You will give every ounce of your energy to help a patient deliver their baby. You will help them breathe and make it through each contraction, and cheer them on through every millimeter of movement during pushing. One way or another, the baby will be delivered, and it is your job to remind the patient of this!

5. Babies are unpredictable.

On a L&D unit, the babies run the show. Ultimately a baby’s position, cord location, placental reserve, and many other factors will decide when and how a delivery occurs. Nurses have to be ready for absolutely anything to happen….even catching a baby! Within a matter of seconds, you can go from having a routine labor to running back to the OR for an emergency cesarean section. It is always exciting and suspenseful waiting to see what will happen!

6. You will become accustomed to certain sounds.

Your ears become your biggest asset on a L&D unit. When a laboring patient walks on the unit, the nurses can predict (with surprising accuracy) how far dilated a patient is based on her moans and groans. We know when we need to walk versus run toward a patient! Your ears will also become accustomed to the sounds of a normal fetal heartbeat and ominous drops in the heartbeat.

7. Your patients and families will absolutely love you.

Everyone remembers their L&D nurse. You are their source for information, advice, support, and encouragement. They truly could not deliver their baby without you. You have the ability to make their birth experience truly amazing and memorable. Little details and thoughtful gestures like grabbing warm blankets for a cold patient or placing a wet washcloth behind a nauseous mother’s neck can really make your care memorable.

8. Watch your support people like a hawk. They need care, too!

As a nurse, it is your job to utilize your support people and help them get involved in the care of their loved one. They can assist with counter pressure, pillow placement, hand holding, and encouragement. A lot of times, they are so focused on these tasks that they forget to take care of themselves. Ask the family how they are doing, pull up a chair for them to sit down, and make sure they are eating and drinking. During procedures and the delivery process, watch for blank stares and pale skin… Remember that they are not accustomed to seeing blood and may end up passing out!

9. When it’s sad…it’s really sad.

Delivering babies isn’t all rainbows and sunshine. Some days we frantically search for a fetal heartbeat, only to have the horrible, gut wrenching realization that a baby is not alive anymore. You will carry each fetal demise with you for the rest of your career. And no, it does not get any easier. But you will get better at coping over time.

10. It is endlessly rewarding!!

Every time you go to work, you get to witness the amazing miracle of new life coming into the world. It doesn’t matter how tired you are or what your day was like, there is truly nothing as rewarding as seeing the joy on a parent’s faces as they meet their child for the first time. It never gets old seeing a child enter the world.

Sarah Cruzan, BSN, RN

Sarah Cruzan is a nurse on a Family Maternity Unit.

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