My Manifesto

                A person will never truly understand the value of a labor and delivery nurse until they are in that situation where the birth of their child lies in the hands of some very skilled and compassionate individuals.  The role of the labor and delivery nurse is crucial for having a healthy delivery both for mom and baby.  I have experienced this firsthand when I had to rely on the skill of the nurse when I gave birth.  She provided me support, encouragement, and a healthy baby!  The labor and delivery nurse is responsible for monitoring the mother to ensure that she remains healthy intrapartum (during labor) and postpartum (after birth) and monitoring the baby both intrapartum and postpartum.  The nurse must communicate with the doctor or nurse midwife, the doula (labor coach), the family of the patient and any other people involved with the birth.  The nurse is responsible for obtaining the mother’s health history, monitoring the fetal heart rate during labor and the mother’s contractions and recognizing when there is a problem and what sort of interventions are necessary to get the mother and child through labor and delivery safely.  The nurse must know when to prepare the mother and child for surgery if necessary.  They are also responsible for starting IV’s, administering medication and giving injections.  The nurse creates an effective plan of care to deliver the baby safely and care for the mother encompassing many different aspects including, but not limited to: patient safety, compassion, cultural sensitivity, knowledge, skill, experience, ethics, patient advocate, and patient education.  Only compassionate and caring individuals can become nurses; people who really want to make a difference.  Having a child is one of the most meaningful times in a person’s life and the labor and delivery nurse is there to make it even more special and make sure that everyone involved remains safe. 

                The need for labor and delivery nurses started to increase after the baby boomers of post World War II.  Doctors needed more assistance in the delivery and operating rooms as well.  Labor and delivery nurses are required to be able to make a decision in a moment’s notice because that could be the difference between life and death for a mother and newborn.  Again, the role of the labor and delivery nurse encompasses actions on many different levels.  The role of ethics in nursing is extremely important.  For example, the labor and delivery nurse, although they may know the plan of care that should be followed, must always hold of the principle of autonomy.  This means that the patient is the ultimate decision maker and should not be influenced to make a decision, only informed of the facts.  If a mother in labor does not want to follow what the health care provider suggests than they make their own decision and cannot be forced to do anything they do not want to do.  The nurse must uphold these ethical principles.  The nurse must be truthful and hones to the patient and do only what is in the best interest of the patient.  The nurse must not impose his/her beliefs upon the patient.  The nurse must also obtain consent when necessary and must inform the patient of risks and possible outcomes of certain procedures.  The nurse must also provide privacy for the patient and respect the patient’s confidentiality.  It is never acceptable for a nurse to discuss a patient or the child of a patient to anyone other than the appropriate family members and other health care personnel caring for that patient.  This can be difficult for a nurse to follow if they see something out of the norm that they just want to tell someone about.  The nurse has to be a trustworthy person because they have access to a large amount of information and they see people at their best and worst times.  There are huge consequences if a nurse breaks the code of ethics that they are taught to follow.  This includes losing their job, their nursing license, and even legal consequences.  Nurses must be very careful to remain ethical.

                Another area that affects the principles of nursing is cultural sensitivity.  The labor and delivery nurse must be educated and aware of the practices of other cultures and how to treat individuals of other cultures.  For example certain religious cultures have customs they must follow when it comes to healthcare and the birth of children.  For example in some cultures a woman is not used to having multiple people looking at her naked or examining her.  This also may be something the husband is not comfortable with and it is the responsibility of the nurse to determine these different cultural expectations and be able to conform to the needs of the patient and her family.  Another example is pain.  Different cultures view pain in different ways and the nurse needs to be aware of a woman’s perception of pain so that she is able to make the birthing experience a positive one.  Because nurses are seeing a more diverse population in the hospital is important that we are educated on the beliefs of different cultures.  In nursing school there are several lectures that address these beliefs and if the nurse has never cared for an individual of a certain culture, it is her responsibility to do some research so she can provide the most effective care while keeping these cultural norms in mind. 

                The role of client educator and advocate is also one of the most important aspects of nursing aside from the actual skill and care.  Many clients do not understand the lingo of doctors and other healthcare professionals and the nurse should always be there to answer questions the client has.  If the nurse cannot answer the question, they are responsible for contacting the doctor so they can come back and clarify and issues the patient has.  The role of client advocate is so important in a hospital because many times clients feel pressured to go along with something they do not want to do and the nurse must be there to ensure that the client has a say in the care they are going to receive.  Specifically for a labor and delivery nurse, they must be able to provide education on topics such as newborn care, breastfeeding, nutrition for the mother, and touchy subjects such as baby abuse, particularly Shaken Baby Syndrome.  The nurse is responsible for giving the client information and resources if they need help.  For example they can refer the mother to a lactation consultant if they are having difficulty breastfeeding or a program such as WIC for women, infants, and children if they are low income and need nutritional supplementation.  The nurse can make a big difference in the life of a new mother or family with a new baby.  This is a scary time for everyone if they have never had a baby before and the nurse should be the first one to provide them with the necessary tools they need to raise a healthy child.

                In conclusion, the role of labor and delivery nurses spans across a wide range of responsibilities.  The nurse has to be a caring and compassionate individual because having a child can be the most important time in a person’s life and the nurse must truly care about each and every individual mother, newborn, and family member.  I cannot imagine having a nurse assigned to me while I was in labor that did not truly care about my safety as well as a safe delivery for my baby.  I can see how a bad nurse can make for a negative birthing experience that one may never forget.  I will never forget my labor and delivery nurses because of how outstanding, knowledgeable, and supportive they all were.  There is nothing more encouraging after twenty-six hours of labor than a change of shift and a new nurse entering the room saying “Let’s get this baby out!” And an hour later there came my daughter!   That is what I remember the most from my experience giving birth.  I was lucky enough to have a healthy child, but there are times when labor and delivery are not as successful and problems arise.  It is even more important in this case to have a skilled nurse.  It is also important that the labor and delivery nurse pick up on cues from new moms about what they are having difficulty with and to be able to support them and refer them to the right places.  If a mother is having difficulty breastfeeding she needs to get help or else she will have a hungry baby which will in turn upset and frustrate her.  It is important that the nurse can refer the mom to a nutritional program if necessary so that they child can get the adequate nutrition they need to grow because there are so many malnourished children in this world that do not have the resources to get food, milk, and iron-fortified formula for infants.  Many people are not aware of these programs and for a low income family they can be lifesavers.  The discipline of labor and delivery nurses can provide a framework or resources for new parents and prepare them for having a new baby.