labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Thursday, April 10, 2008

Hey, I Belong Here, too!

It's been interesting being a student midwife among nurses. The nurses at my clinical site, for the most part, don't realize that I am also a labor nurse. There have been a few nurses who have taken an interest in who I am and start asking questions. The others eye me with suspicion. These nurses make me feel unwelcome; when I sit at the desk I'm often told I am in "their" workspace. They set up delivery tables without any gloves or protective equipment for me.

One incident sticks out above the others. A laboring woman is flat on her back, the monitoring devices on her belly in the same spot they've been since she got her epidural hours ago, and her baby has a deceleration. I was at a point in my clinical learning where it was difficult to switch to the student midwife from the experienced labor nurse. I was ready to jump in and start resuscitating measures but told myself to hold back a few seconds because two nurses were right there as well. The primary nurse just stands there looking at the monitor. The helper nurse says, "Think it's maternal?" Meaning, is the deceleration just a pick up of the mother's heart rate, something that the fetal monitor can do depending on its location on the abdomen, the fetal position, and if the fetus is moving. The other thing is that maternal pulse on the external fetal monitor has a different sound quality as a fetal heart rate; fetal heart rates have a galloping sounds whereas maternal pulse has a more low whooshy quality.

So they chat back and forth about it likely being maternal and so Primary Nurse starts moving the external fetal monitor around the mother's belly, looking for a "better" spot for detection of the fetal heart rate. Of course she doesn't find a better spot, because it was originally in a good position.

"It's not maternal," I said, and both eyes darted over to me. "She needs to turn on her side." There are several uterine resuscitating measures for a deceleration, with a position change being the first maneuver.

"I know," said Primary Nurse. Which to me it sounded more like: "I. Know. Bitch." And yet she didn't make any move to do so.

I had this woman turn over to her left side, asked for her IV fluids to flow wide open, and asked where the oxygen mask was. Suddenly they sprang to action, and secondary nurse paged my preceptor. By the time she got there the baby recovered, and later that day this mother had a nice birth. But was all that resistance necessary?

The nurses will always defer to my preceptor when asking for the plan of care, or what supplies or medications are needed, and the preceptor will tell them to ask me to help reiterate that I am a legitimate person there. I've noticed one nurse has since included me whenever I am around, having got the clue.

What surprises me about this is how off-putting this staff can be. I guess I am spoiled where I work because I don't see this type of behavior. Perhaps there is only 2 nurses I work with that could come off this way, but they lean towards being bossy rather than rude.

Have I mentioned that I am so sick of being a student?


Myra said...

The feeling of invisibility is very well known to the student nurses around here, too. I can only imagine how much more it would sting when you are the student midwife.

In any case, I am hoping that the nurses at my first place of employment will be more welcoming to a new RN than I've seen nurses be to us students.

One can hope.

Anonymous said...

What is the next step if the O2 and IV and left side don't work? My last birth had a decel during a cervical exam, and the nurse put me on my left but the decel just stayed. I had not wanted to be in bed and the cervical check was for permission to take a shower...and then the nurse would not let me up. When the decel stayed, she called the OB. I told her I was getting up, and she said no and fought me. I got up anyway and monitor read 80 then 124. I think being flat on my back was the cause, and the nurse kept trying to get me on my back and made me push on my back noting decels when this happened though not as bad as the first. She also said it could be maternal. If I hadn't gotten up and had the monitor read a better heart rate, what was next?


Labor Nurse said...

We would try another position; switch to the opposite lateral position, or hands and knees. This usually does it but if not then a cervical exam is done to check for an occult prolapsed cord or if the decel was a result of becoming fully dilated. If none of these things do the trick, and the woman is not fully dilated and the deceleration continues, off to the OR we go.

Angi said...

Until the nurses at the hospital where all my moms deliver began to get to know me, and see me as something other than "someone else in their way", I got the same treatment. It was a horrible belittling feeling. I'm sorry you're going through it.

On the up side, you'll be ABOVE those same bitches in the food chain soon enough. Then you'll have to decide whether to take the high road or outright make them pay. Either way, I hope they end up feeling like shit too.

Blessings to you.