SNOWSTORMS AND HOLIDAYS GET ON NURSES' SCHEDULE
- nine months in advance
By Joan Tupponce

Whitney Bush, charge nurse of labor and delivery at Bon Secours St. Mary's Hospital in Richmond, takes special notice of major snowstorms that have folks snuggling for warmth. "You can pretty much guarantee that nine months down the road from that snowstorm we are going to be busy," she says.

"We're also busy at the end of September and in October because of the holidays each year."

Bush loves working in labor and delivery. "We have a lot of autonomy," she explains. "The physicians trust our nursing staff a great deal because they can't stay with the moms 24 hours a day, seven days a week. We are the eyes for these doctors."

Dr. Emily Drake, assistant professor at University of Virginia School of Nursing, became familiar with labor and delivery during her student nurse rotations. "I knew that this was my thing," she says. "I knew these were my people."

Bush and Drake agree that labor and delivery often is a happy, healthy place. But, there are times when the mood becomes somber. "The truth is, it can be either very, very happy or very, very sad," observes Drake.

JEANNETTE BROWN, RN, holds Jack Harris for the admiring glance of his parents, Leslie and Martin.

Some of Dr. Mary Gibson's most rewarding experiences have come from providing care to mothers with either genetic abortions or fetal demises. "Women during these times are so in need of knowledgeable support and a caring presence," observes the assistant professor at University of Virginia School of Nursing, "that I feel a real commitment to them and want to see them through the experience."

By the nature of their business, labor and delivery units tend to be a combination ER, OR, ICU and med/surg unit. "It's a very different type of unit," Bush explains. "It's hard to predict what's going to happen." Because of that, nurses in the unit have to be a jack-of-all-trades. "We have a little bit of everything," Drake says. "We have surgery, anesthesia, genetics, infectious disease, psychiatric disease, pediatrics and geriatrics (the grandparents). We have cardiac and hematologic problems, diabetes and even death."

Even the most low-risk delivery can become an emergency situation within minutes, Drake adds. "People walk by the newborn nursery and look inside and see us rocking babies and they think, 'What a nice job.' Sure, it's fun to rock the babies, but you also have to be ready to resuscitate those babies if needed. We're on alert, assessing them all the time."

NURSES Dee Dee Wyche (left) and Jennifer Brickey check out their newest arrival. In the background are Nellie League (left) and Lori Booth.

Most new moms coming into the unit are excited about the experience. "You also have the moms who aren't excited because it was an unexpected pregnancy," Bush says. "We try and help them make the best of it and make the delivery as easy as we can. We also have support services for moms who need help putting their babies up for adoption."

Sometimes, moms just need their space. "That's when we don't need to be in their face constantly," Bush says. "You [learn] when you are working with them how much you need to be in there with them."

Coaching a woman through delivery is hard work, Drake adds. "It's push, push, push! I walk away from every delivery exhausted, almost as if I had delivered the baby, too."

While moms are the focus in labor and delivery, nurses also have to deal with new dads. "You really have to calm their nerves," Bush says. "They may be scared to do anything. We try to get them involved. We always encourage them to cut the umbilical cord, except when the delivery is a C-section."

Dads who are skittish often get job assignments from Drake. "I have them get ice chips or watch the monitors," she says. "We'll also ask them to hold [one of their wife's legs] during delivery, all of that helps."

Some dads are so involved in the pregnancy and delivery that they share in their wife's pain. "It's like they are having the baby, too," Drake says. "The French have a word for this – couvade."

In her work, Jeannette Brown, charge nurse of the antepartum unit at St. Mary's in Richmond, helps moms who are having problems with their pregnancy and are required to stay in the hospital. "It's a different type of OB nursing. You really build a connection with these patients, especially the ones that stay for a long time," she says, noting that one patient stayed in the unit for 83 days. "You get to know these patients and their families."

Being in the unit is stressful for soon-to-be moms. "A lot of people feel like they have lost control because of the bed rest," Brown says. "We try to make it less stressful for them by making their room their home while they are here."

Nurses in the unit – St. Mary's has the only freestanding antepartum unit in the Richmond area – learn about fetal monitoring as well as how to comfort patients. "They have to learn to keep the patients and their families calm," Brown says. "We laugh and we cry with the moms. It's a very special unit."

Nursing care centers on the patient and the baby. "We let them guide when they want things done," Brown explains. "We don't wake them up [early] unless we have to do some testing or an ultrasound. If they are in the hospital around the holidays, we make it feel like it really is their home. We encourage them to decorate the room."

Patients in the unit can have outside businesses come in to do haircuts, manicures, pedicures and massages. The unit also has wireless access and DVD/VCR players in each room. "These are the little things they miss out on because they are in the hospital," Brown says. "We also have lots of baby showers in the unit."

Whether it's working in the antepartum unit or in labor and delivery, nurses in the units often have to deal with family dynamics. "You can't make any assumptions about the families," Drake says. "You really have to dive in there and get to know them very intimately, very quickly."

Birth can be very stressful for any family. It can bring out the best and the worst in people. "If you think 'As the World Turns' is a soap opera, real life in labor and delivery has that beat," Drake says.

When it comes to family situations, nurses have to be the patient's advocate. "You need to make the environment optimal toward the mother's physical and emotional well-being," Gibson says. "If that means asking a family member to go for a cup of coffee or to check on the kids at home (after having discussed it with mom), that is OK. Our focus is to provide the best birth experience for that mom that we can."
Brown, Bush, Gibson and Drake all agree that they wouldn't want to work in any other area of the hospital. "The rewards are too numerous to list," Gibson says. "What could be better than seeing a new baby take a first breath or handing [the baby] over to his mother for the first time or to see the father look at his child for the first time?"

Drake agrees, "I get to see a birth, to witness a miracle almost every day. That beats a desk job any day."