First OB Clinical: L&D!!

So last Tuesday I had my first OB clinical and fortunately my clinical group got to rotate through L&D first (we take turns in L&D, antepartum, postpartum, and high-risk triage/NICU/child-life services, and newborn nursery).

It was beyond amazing. I know I will probably not ever be interested in being a mother-baby nurse in any form, but I am SO incredibly grateful I got the experience that I had on Tuesday and I’m looking forward to what the next 5 clinicals hold!

So we arrived at Parkland at 0545, changed into Parkland scrubs on the L&D floor, and were ready to go by 0630. My clinical instructor asked us who REALLY wanted to see a delivery that morning and myself and 2 other gals raised our hands quickly. Of course I wanted to see a delivery!

My clinical instructor then took me into the patient’s room. I introduced myself, and since the patient was currently resting I logged into the computer and started filling in some of the pertinent info on my clinical paperwork for the day (vital signs, rupture of membranes, uterine contraction information, fetal heart rate information, etc.). Thankfully the information wasn’t difficult to find since I use the same charting system at work.

About an hour later, just as I was finished up with what I could of my paperwork (good timing!), the certified nurse midwife (CNM) comes in and explains to the mother that because she was at 10cm and fully effaced, it was time to start pushing. Eek! The atmosphere of the room completely changed as a few more people came in to help (a medical student, an L&D nurse, and a resident). The resident wasn’t there long…just basically wanted to check on the status of the mom. The CNM really did everything during that delivery – just another awesome role that nurses can play. The medical student and myself held the mom’s legs while she pushed, and the L&D nurse helped her count during contractions and monitored the fetal heart rate and the timing/intensity of the contractions.

The delivery didn’t take long…and soon the baby was born!! I didn’t think the delivery would really effect me since I’ve seen deliveries via video tape before, but it was really a miracle. I mean…to have no baby in front of you, and then, with some hard work on the part of the mom, a baby is brought into the world…WOW. I just can’t explain the feeling. I definitely cried. AND, I GOT TO CUT THE CORD!!

After the delivery I watched the pediatric nurse practitioner and the newborn nurse do the initial assessments of the baby, I watched the CNM massage the mother’s uterus and fundus to help deliver the placenta & help the uterus firm up, I played with the placenta, watched the CNM and medical student stitch the mother’s episiotomy up, and watched the mother and father’s interaction with their newborn. It was an AWESOME morning.

After we had all helped clean the mother and baby up and get the new little family settled, I left the room to finish my paperwork on the delivery. At that point, my clinical instructor found me and asked if I wanted to watch a cesarean section…YES!!!

She led me to a different L&D floor and to my new patient’s room. Again, much the same way as that morning, I walked in, introduced myself, and started my clinical paperwork on that patient. There was a lot more down time between when I met the patient and when her C-section was scheduled; because the patient wasn’t English speaking and seemed to only want to rest, as soon as I did what I could with my paperwork I left her alone and went to lunch with a few of my classmates.

About an hour or so after my lunch break, and after peppering my patient’s nurse with tons of questions (she was awesome!), we went back into the OR to deliver the baby via C-section.

Before I go on, I do have to say that I loved that the L&D nurse that was taking care of this patient was able to go into the OR with her and automatically become the circulating nurse in the OR. And, since I’ve never been in an OR it was fantastic to be able to witness exactly what a circulating nurse and a scrub nurse’s roles are. I don’t think I could ever become a scrub nurse…but I did have to sit there and consider how awesome it would be to have a job as a circulating nurse in an OR! (More options for me to consider.)

After all the prep was done on the patient and in the operating room itself, the circulating nurse called the surgeons in and everything began. The c-section began with a calm, smooth cut…but soon I was amazed at just how rough this particular surgery is. It is NOT like how it is seen in the TV shows where the surgeons make one deep cut and then pull the baby out…instead it is more like hundreds of cuts through adipose tissue, connective tissue, muscle, fascia, and finally through the uterus, all the while the surgeons are pulling, squeezing, and practically manhandling the tissues in the abdomen in order to manipulate the tissue to move the way they want it to so they can get to where they want to go. And then, after all that cutting and cauterizing, one of the surgeons reached their hands elbow deep in lengthwise through the abdomen to reach the baby and slide it out. WOAH!

And again, after the baby was born I watched the pediatric nurse practitioner and newborn nurse do the assessments and give penicillin G, clean the baby up, and then hold the baby in front of mom’s face so she could connect for a few minutes while the surgeons began the process of putting her back together.

All in all I was in the operating room for about 2 hours before my instructor came and found me (around 1530) so we could all go to post-conference and get out of clinical a bit early. But I had SUCH a great time and was thoroughly enjoying watching the surgeons sew the mother back up and observing the OR routine and rhythm that I was disappointed when it was time to go. But hopefully next L&D clinical I will get another chance to observe a c-section – and let me tell you I will thoroughly enjoy it!

One thing that I truly realized while in clinical on Tuesday…L&D nursing is completely different from med-surg nursing. For one thing you aren’t taking care of sick patients, per se (for the most part, anyway), and so it just has a very different tone and atmosphere to it. That, in my opinion, was pretty cool. Secondly, L&D nurses have to be able to be flexible and  thrive on spontaneity…there really is no set schedule on when a baby will decide it wants to be born! So assessments must be made and meds must be given on a time schedule completely dependent on what’s going on with mom and baby at the time.

I am so thrilled about what I was able to witness and experience in clinical on Tuesday and cannot wait until my next L&D clinical!!!