First Week in L&D

As quickly as I couldn't wait to start on the Labour & Delivery Unit, my first month flew by just as fast. Without time to breathe between shifts I haven't been able to update you all on my first week like I was planning to. So without further delay, here is my first week on the L&D unit ...

My first week, I went in for 3 shifts and met my preceptor, who is really kind and caring to her patients and great at explaining and showing me what to do. It was a super busy 3 days with back to back deliveries. Coming into this basically blind was overwhelming to say the least. It's different reading and studying about procedures, and actually doing it hands-on. Even setting up the room before the patient even actually comes seems overwhelming ... because it's SOO important to have all your supplies and everything ready in the room for when the patient comes in, because when she does come, she could deliver at any moment! You really don't know what kind (how far along in labour) of patient you will get! So having all your supplies - for delivery and for baby care, and in case of an emergency - on-hand is super important. This seems so simple but to someone who doesn't know what exactly you need, you can see why this may be overwhelming. By the third shift I slowly got the hang of it and was able to help out.

What a typical L&D room looks like: bed with stirrups, EFM monitors, a computer to chart at bedside, a baby warmer and supplies closets.

Another thing to mention before I go further is my immense feelings of uselessness in the beginning couple of shifts. Being a new hire, and not having the skill set down yet, when something's going on and they need all hands on deck ... but your hands aren't skilled to help out ... you're just left there standing and wishing you could jump in and help. Something I found helpful is to do what I know, like supporting the woman in labour by holding and rubbing her hand/arm, offering words of encouragement and smiling. I feel like this goes a long way. Yes, I know it sucks feeling so useless but there's always a learning curve when you start something new.

Okay let's get into me watching my first ever birth! On my very first day my preceptor sent me to go see my first delivery and I really didn't know what to expect. I had watched videos online, and I read and studied it but nothing could prepare me for what I saw. My first delivery was a very complicated delivery; there was a nuchal cord (umbilical cord wrapped around neck) and the baby's head couldn't get through the vaginal opening. The doctor took scissors and did an episiotomy (a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery). The sound of skin being cut, and the blood, and the woman's screaming was enough to make me dizzy. I immediately thought ...

What did I get myself into?

I got back to the nursing station and gave myself time to debrief after what I had just seen. 30 minutes later there was another woman about to deliver and I went to go watch again. This delivery was the complete opposite. The woman was in a state of calm, naturally breathing through contractions, and gave birth to a beautiful baby girl. The sound of the baby's first cry gave me goosebumps and I swear I almost started to tear up. What a difference in just the two deliveries! It's true what they say - every woman is different and you have to treat them as their own individual. I watched another 3 deliveries that day.

On my second day, my preceptor had me start to engage more, instead of just watching. I did my first couple vaginal exams (yay!), although it was so hard to tell what was what! It feels like sticking your hand in a bowl of jelly and trying to find structure. Feeling the head was easy but figuring out what I was actually feeling was a whole new ballgame. I was told what I've been told many times over my first few shifts ... it takes time. Yes, it takes time. But I want to be an expert, like, now! It's truly discouraging seeing these awesome knowledgable nurses but I won't let that get to me! I remind myself why I chose L&D in the first place and this motivates me to learn as much as I can.

On my third day, I watched an epidural catheter being inserted by the anesthesiologist and learned how to prepare everything for an epidural (all the paper work and getting all the supplies ready). I saw a shoulder dystocia - this is an obstetrical emergency and happens when the baby's shoulder gets lodged in the mother's pelvis during delivery. I watched a nurse run over and apply as much pressure as she can above the symphysis pubic & do the McRobert's Maneuver (sharply flex legs onto the mother's abdomen) to get the baby's shoulders dislodged and she did it in less than 5 seconds! Amazing! On my third day I also watched my very first C-Section! Good thing I had watched videos of it online and kind of knew what to expect - lots of blood and digging and cutting, as well as removal of the uterus from the abdominal cavity (something I didn't know they did before I watched the videos), or I probably would have passed out! Haha ... But anyway, I really enjoyed watching the surgery and seeing the baby come out of her abdomen. I helped out with baby care - I injected Vitamin K into the baby's thigh (used to help clot the baby's blood) and Erythromycin into the eyes (as anaphylaxis to prevent bacterial infections in the baby's eyes), as well as do vitals and measure/weigh the baby. Another thing I need to work on is counting respiratory rate and heart rate, as a newborn's HR & RR is super fast and difficult to count for someone who is unexperienced.

Anyway that's all for now. I can't believe how much I've learned in just three days and I can't wait until my next shift. This hospital has one of the busiest Labour & Delivery units in all of North America! With a whopping 5,600 births this past year in 2018!