From The Other Side
What I've been finding interesting now that I have been working a few months on the labor floor is the differences in nursing care. Now, having been that bedside labor nurse for many years, I clearly understand the value in a good nurse. I'd like to think I was good at bedside labor nursing care, but now I often wonder what the providers I worked with prior to becoming a midwife thought of my nursing care.
But here is an example of what I mean. I was attending the labor of a young girl who I had seen for most of her prenatal visits. I had gotten to know her fairly well, and knowing that she didn't take any prenatal classes or even bother heading to the library to check out some books on labor, I knew she would definitely need a lot of support. She happened to arrive just as my call shift was beginning, which is the same time as the nurses' change of shift. So basically, she was getting the same provider and nurse for the duration of her labor and birth.
The nurse she was assigned to was Nurse Nikki- a personable younger nurse with decent experience but.... had no clue that the little nursing things are just as important to women in labor as having certifications in fetal monitoring interpretation and the ability to act quick in an emergency.
Nikki spent little time at the bedside, and hung out at the nurse's station most of the morning. When I could, I would leave this young laboring woman's room so I could finish postpartum rounds and frequently found Nikki sitting in the nursing lounge eating a snack or sipping coffee. Once my rounds were done, and I could focus on the woman in labor, I stayed by her side in the room. She had plenty of family there, so perhaps this is why Nikki felt her nursing care was not needed, but the woman frequently reached out to me for reassurance and help with each contraction. When she entered transition and started to be fearful of what was happening within her body, all she could do was say my name out loud while laying as still as a stone. Basically, the young girl needed professional, comforting support.
Then it became time to push, and Nikki was no where to be found. The first few pushes were very strong, but she became scared and fought the urge. I had pressed the nurse call button in the room to get Nikki in there, because I believe the nurse caring for the woman needs to be at the bedside for pushing. Perhaps it's just me, but the second stage of labor is an intense time that needs both the nurse's and provider's full attention.
Anyhow, about ten minutes later Nikki shows up. I tell her we started pushing about twenty minutes ago (basically so she can write that in her documentation). And then she wheels in an extra stool and plunks herself down by the monitor. She stays rooted there for the entire second stage. Even when the patient has pooped a significant amount (on the chux pad), moved around while pushing, and subsequently smeared it all over her butt cheeks.
So why didn't you just clean her up, Labor Nurse CNM, you ask?
I had been, but at this point I was gowned and gloved- and despite the fact vaginal birth is not a sterile procedure, I was not going to reglove with new sterile gloves a dozen times. It's wasteful, and at this point it only makes sense for the nurse to do this. I mean, is it wrong of me, a former labor nurse, to think the labor nurse's duties include cleaning up poop from pushing women?
And then there is Nurse Eileen. She was caring for another of my young primips in labor who was much like the first woman. Eileen stayed at the woman's side for just about her entire labor, with exception of an hour long nap the woman took after an epidural placement. She reassured the woman each step of the way. I could see that this girl really appreciated Eileen's care, and even shared the baby's name with her when they kept it a secret from everyone else. And the woman was kept clean and dry after her water broke and during pushing.
Now, I don't think Nikki thinks her nursing care is sub-par. I don't think she thinks that she ignores her patients. But I wonder what she thinks when she's sitting at the nursing station while all her coworkers are always stuck in the room?
