Many people refer to an OB nurse position as “the best job ever.” While the job certainly has its benefits, it also comes with challenges. Contrary to popular belief, the role involves much more than “sitting around and holding babies all day.” Let’s explore the reality of what the role entails, as I walk you through a day in the life of an OB nurse (on a good day.)
The Good, the Bad, and the Absolute Sad
Working as an OB nurse for the past 15 years has opened my eyes to the world in ways that I could never prepare for. It’s also helped prove that all human life is truly a miracle. Each patient and workday is different than the one before.
People often ask, “How old was the youngest patient you ever took care of? What about the oldest?” This is because the childbearing age is so broad. My answer? 11 and 49.
I’m also often asked, “What was your worst day at work?” Well, grab a tissue because this one will break your heart.
I won’t go into lengthy details, but the patient was a young and healthy woman who worked as a teacher. She declined a teaching role to stay home with her baby the first year, and her baby didn’t live. It was an extremely difficult discovery to find that her first baby girl had no heartbeat. To make matters worse, she suddenly hemorrhaged and we almost had to take her uterus. Luckily, this story does have a happy ending.
She came back two years later in tears when she saw me holding her new baby boy in her arms. Miracles do happen!
How It Begins:
I’ve worked as an OB nurse for over a decade, and have always arrived at least 15 minutes early for my shift. This isn’t because I am dying to go to work. Instead, some extra time allows me to mentally prepare for the day’s challenges and devise my plan accordingly.
A good day in OB begins with one patient. For instance, a first-time mom and her husband of two years are madly in love and anxiously awaiting the arrival of their little girl. She is centimeters dilated, her water has broke, and she's becoming uncomfortable.
As an RN in labor and delivery, you will gain hands-on experience on checking how far someone is dilated. In addition to dilation, we check the effacement and station. From there, we can move on with our assessment. However, this won’t begin until we hear the baby’s heartbeat.
When a mother comes to us in labor or at another time in the pregnancy, we attach them to the external fetal monitor to retrieve fetal heart tones and contractions. Just like the interpretation of an EKG, we observe the fetal heart rate variability to distinguish how healthy the fetus is. This is an ongoing assessment conducted throughout labor and can change the care plan in an instant. This ever-changing environment is one of the many stressors of OB nursing. You are required to be on your toes at all times, ready for anything to happen.
You aren’t just caring for one person’s life - you’re responsible for two.
Once I discover that the baby’s heartbeat is within a normal range, I proceed with admitting my patient into the computer system. I gather as much information as I can about her health, her pregnancy, and her medical history before she becomes too uncomfortable. If she also requires an IV and blood-work to be sent to the lab, I place the IV and send off blood work. I also notify the doctor about her arrival and ensure that orders are received. In the meantime, I am charting away.
When I find that the patient’s lab values are normal, she may request pain medication. I have an order for pain medication and check her cervix. As she’s now 5 cm, I administer 5mg Nubain IV. I let her know it may not last long, and the epidural may help her relax more. Like many first time moms, she wants to give herself a chance to feel contractions.
I start to help her through contractions, focusing on breathing with her. As the mother moves through contractions, I adjust the baby’s monitor, frequent vital signs, and support the husband as much as I can. I start to move her in different positions to help rotate the baby and allow her labor to speed up. Eventually, the patient asks for an epidural for her pain. I notify anesthesia, instructing the patient on how to sit and what to expect.
While I know the anesthesiologist will provide this information as well, I also know that patients often trust nurses more. I gather medications, paperwork, and supplies for the epidural before leaving the room, saving time for the anesthesiologist and preserving my patient’s comfort.
I help the patient sit appropriately for the epidural, which takes about 40 minutes. I then begin frequenting vital signs in case her blood pressure drops, which is a common occurrence during this stage in the process. Since today is a good day, this doesn’t become an issue.
While I monitor my patient closely, I set up her delivery table for the physician and double check for resuscitation equipment in case the newborn needs it. On a good day, the baby looks fantastic and there’s no need for it.
I call the OB physician to provide an update. The physician would like to break the patient’s water. I add extra padding to the bed to prevent a waterfall of leakage under the patient’s numb body. The water breaks, consisting of clear fluid. The patient is 7 centimeters dilated and would like to rest.
I grab myself a glass of water and my chart and inform my charge nurse that the patient is almost ready to deliver. While I’m hungry for lunch or dinner, I know that I don’t have the time. I shove down a graham cracker, and my patient calls out for a Popsicle. I ask her why she can’t sleep, and she explains that she “feels like she has to poop.” I check her and discover she is 10 centimeters, and indeed ready to start pushing.
I let the team know that she’s ready for delivery, and the doctor comes to the bedside with another nurse. My patient pushes for 45 minutes, and we delivered a healthy baby girl. The infant is placed skin to skin for one hour. I help latch the infant on to breastfeed, and the baby is fed for one hour.
While doing that, I am also conducting vitals and a fundal massage on the mother every 15 minutes for two hours to make sure she doesn’t bleed too much. I shut off her epidural at delivery, and she starts to feel her legs again. After I note that she is safe, I help her to the restroom for the first time and provide ice for her swollen perineum as well as lidocaine spray.
I educate on regular amounts of bleeding, and how “normal” her perineum is. The patient voids a reasonable amount and is guided back to a nice clean bed that I prepared while she was performing peri care and putting on a new gown.
She goes back to sleep as I conduct vitals on her baby every half hour and on her after 2 hours of recovery every four hours. I discontinue her IV, allowing her to eat again. At this point, she is completely exhausted.
Just when I begin to feel caught up, the charge nurse calls and lets me know that another patient has arrived. She's a single mom with a history of struggling with drug addiction, and is currently experiencing preterm labor. (But remember, today is still a good day.)
All Mothers Are Mothers
The 12-hour shift is far from complete, but my body is. However, I managed to help the young mother deliver a preterm baby. During her labor, I guided her through the contractions and helped her get some rest after her epidural. I provided her with Popsicles and extra support. After the baby is delivered, I help her breastfeed. I walk her through the rehab process, emphasizing the importance of getting sober. I also teach her about her “normal” perineum and regular amount of bleeding.
My patients come from all different backgrounds, but the majority desire to be the best mother they can. My job is to guide them in the right direction and share the support they need to get through their labor. Even the most standoff patient needs to be comforted during labor.
While the job is constantly changing, one factor remains constant - the importance of quality treatment. You will gain much more from the job by taking things one patient and situation at a time.