As a nurse, we often have to do things that our patients do not like, in order to keep them safe and healthy. Do patients like taking their rainbow cocktail of medications as dessert? No. Do they enjoy having a catheter thrust into their urethra’s when the bladder scan shows that there would soon be an explosion of urine otherwise? Definitely not.
Besides the occasional Nurse Ratched’s, we as nurses don’t enjoy doing the things all patients hate. Being the bad guy really sucks, but someone has to do the dirty work and it’s definitely not going to be that Doctor you just met five minutes before. Nope, that doctor gets to sit behind the window and write orders that they know you’re going to hate, and then at your next appointment pretend it never happened…
But I digress.
What I am trying to say is that there are reasons why we do the things we do, especially in labour & delivery. And then I started thinking to myself, “Hey. I bet a lot of pregnant women and new moms don’t actually know why we are doing.” And while as a nurse you are forever to be providing patient teaching and explanations before a procedure, hell, sometimes there just ain’t time in emergency situations. It’s also a little hard to focus on what we’re saying when you’re in active labour!
Here are some things that nurses do in labour & delivery that many patient’s dislike, but are very important to keep mom and baby safe!
OK, so you’re in full-blown labour which is pretty evident right now, so why do nurses have to touch your belly in order to feel how strong your contractions are? I know the last thing you want during labour is someone touching the very thing that is causing you excruciating pain, but there are a couple of reasons for it:
- It is the only way for us to feel how strong a contraction is by how indentible the fundus (top of uterus) is when pressed. Being placed on an external monitor (the straps that go around your belly), cannot tell us the strength of the contraction. We need to be able to tell whether your labour is progressing and it is less intrusive than a vaginal exam every half hour.
- Only an intrauterine pressure catheter (a device placed into the amniotic space) is better at quantifying contraction strength.
- If you are being induced, nurses need to monitor your contraction pattern closely to ensure they are not too long, too close together, or with not enough resting tone between contractions (AKA hypertonic uterus). This intervention is to prevent uterine rupture. So, pretty important.
- If you are not on the external monitor, in order to figure out the frequency and duration of your contractions. A regular contraction pattern is imperative to the delivery of your baby, and will determine whether or not you will need some extra help to speed them along (augmentation with medications or rupture of membranes).
Make You Stay Still During Your Epidural
You may have asked for the epidural because of the excruciating pain that you are having, but you probably weren’t thinking about how exactly that epidural is going to be placed in that magical space that blocks only the bottom half of your body.
Generally, you have to sit or lie in the position that the anesthetist shows you, and stay in that position even during your contractions. Though you may hate us nurses at the time, we will help you stay in that position by reminding you over and over and holding your shoulders just so. Sorry, but I’m sure you will thank us later when your epidural works on both sides and didn’t take forever.
Not Give You An Epidural
I have heard things while out in public such as “my nurse wouldn’t give me an epidural” or “I was too far along so they wouldn’t give it to me”.
Correction #1 is that your obstetrician/ family doctor is the one who must order an epidural. Once the doctor is told that you want an epidural, it is out of our hands.
Correction #2 if you were too far along, it probably means that they thought you had a high probability of crowning during the procedure which you would enjoy even less than pushing or that the epidural wouldn’t have even had time to take effect. Please don’t blame us!
Only Allow Clear Fluids During Active Labour
Policies can differ from hospital to hospital, but our patients can have a regular diet up to active labour, then only clear fluids. But this wasn’t put in place to starve pregnant moms, but rather to protect them from complications and possible death from aspiration during an emergency caesarean section. According to the American Congress of Obstetricians and Gynecologists (ACOG), modest amounts of clear fluids can be taken in by labouring moms. Vomiting is also quite common during labour, so just taking in clear fluids can help with that as well.
To make sure that you have enough energy for labour & delivery, try to have a good meal before coming into the hospital. And make sure you tell your support person to go out and get you the most delicious thing you can think of when it is all said and done!!
Put in an IV
Let’s get this straight: there is nothing that a nurse hates worse than to miss when trying to put in an IV – especially when the patient is a pregnant woman having contractions every 2-3 minutes lasting 60 seconds. There are many reasons to have an IV put in: If you are actively bleeding, dehydrated, in preterm labour, to give pain medications or antibiotics if you are group B strep +… We don’t enjoy hurting you, and I promise we try to get it done as quick as possible.
Put in a Catheter
It used to be standard procedure to place a catheter immediately before all surgeries or after an epidural, but if your labour is progressing quick it may not be needed. However, if we are noticing decelerations of your baby’s heart rate and think it could partially be due to an overextended bladder in the way, we will insert one in a heart beat.
On the plus side though, if you are getting a catheter put in you most likely have an epidural or are going for a ceasarean section, which means that you shouldn’t feel it being put in.
Ah, the dreaded vaginal exam… The uncomfortable procedure that rivals the much-despised speculum exam. While they are awkward for us at times (hello, there’s a reason why we always talk about the weather) and can be painful for you, there are many reasons for them. Some examples include:
- To decide whether to admit the patient in active labour or not
- To check your progress in labour to figure out if you need an induction or augmentation for various reasons
- To make sure that a piece of cord didn’t fall through the cervix after your water broke (AKA cord prolapse)
- If a patient states she wants to push, to make sure there isn’t cervix in the way that may become inflamed and thus prevent baby’s head from descending if the mom pushes
- Before giving medications to make sure there is time for them to take effect, including the epidural
Checking the Fetal Heart Rate… Often
Even during a low-risk labour & delivery, there are still policies in place to perform fetal heart rate checks by doppler every fifteen-thirty minutes after the end of a contraction, and every five minutes while pushing. Why?
Because there are many things that can cause changes to your baby’s heart rate, and as nurses we need to know if it’s too low or high so we can intervene appropriately. If it’s too high, it could be due to an infection or dehydration in mom which are both treatable things. If it’s too low, there are many other things we can try: Re-positioning, applying oxygen, giving fluids via IV, etc. We check the fetal heart rate regularly so that we can hopefully notice emergency situations early and prevent negative outcomes for both you and baby, so that means we will be coming to harass you in the shower, tub, in your room, down the hall – wherever you are!
The McRobert’s Manoevre and Performing Suprapubic Pressure
If you have a big baby, he or she may need some extra help being released from your pelvic outlet. You will know that this has happened to you if baby’s head comes out, but his shoulders do not. You may also notice some extra activity in the room, since baby’s position is most likely pressing on the cord, not allowing it to perfuse properly. One nurse might yell to get a step stool and stand on it while pressing sharply down on your abdomen, while another two nurses (or whoever we can get, really) lift your legs up and the doctor is moving baby back and forth down there, trying to free baby. You may think we are trying to twist you up like a pretzel and reach into your uterus, but do not be alarmed – Oftentimes these procedures work like a charm and your baby will come out unharmed.
Give You an Intramuscular Injection After Birth
When your baby’s top shoulder is freed, you may notice a sharp pain in one of your thighs like a bee just pinched you – but don’t swat it away! The nurse is giving you an injection in your muscle that will help your uterus contract down and to prevent excess bleeding after birth.
Perform Fundal Massage and Checks
Along with the regular vital sign checks postpartum, your nurse will also be checking the top of your uterus (fundus) to see if it is firm and low in the abdomen. This tells us that your uterus is contracting down nicely, which often rules out the chances of having a postpartum hemorrhage (PPH). If your uterus is “boggy” (not firm), then the nurse will probably start massaging your fundus. This can hurt like hell, but it works very well to reduce bleeding.
As nurses, we often have to be the bad guys when it comes to performing procedures that patients do not like. But at least now you all know that we do them all with the best of intentions and will hopefully forgive us… Eventually.
Happy labouring, Mamas!