What Labor and Delivery Nurses Want You to Know About Childbirth During Coronavirus
"It can still be beautiful," says Shonna Carter, a registered nurse at Manhattan's Lenox Hill hospital.
I have been a nurse for seven years. I used to work in general surgery but when I gave birth, I was just blown away by what the nurses did in labor and delivery. So after I had my kid, I was like, “I want to do what you guys do.” I’ve been in this job for about four years.
Another reason I wanted to be a labor and delivery nurse is because of health disparities in communities of color with regards to maternal health. “Health disparities” is now a phrase that the American public is talking more about, maybe because of the coronavirus, but as a nurse it’s something you’re attuned to in a different way.
Of course all nurses are compassionate, but labor and delivery is one of the few places where most of your patients are not sick, they’re just going through a natural process. Even so, being in the hospital is anxiety-producing for many people, and childbirth can sometimes be the very first time that people interact with a healthcare system. For nurses, that means there’s a lot of opportunity for advocacy with your patient, for education with your patient, for making women feel empowered in a process that at its best can be very exciting and at its worst can be very disempowering and scary. I’m really happy to support women through that. That hasn’t changed during the coronavirus pandemic, even if some of the more hands-on aspects of the job have.
Supporting and empowering patients has always been our No. 1 job.
In regular life, you come to work, you punch in, you talk to your coworkers about what’s been going on on with them, and then hear from the charge nurse what is going on with the patients. A typical shift is 12 hours. Sometimes we’ll have a slow night and you might only have one patient. On my busiest nights I’ve done three deliveries, which also includes emergency C-sections.
Depending on what stage of labor your patient is in, you’re kind of there to support them, give them all the options that are available to them. The little known fact of most delivering first-time moms is that your doctor will not be there most of the time, until you’re ready to push the baby out, like you break water and push a couple times and a baby comes out. That’s the myth of TV and movies. Pushing is really the hard part about labor, but also the enjoyable part of being a nurse — we’re kind of a cheerleader as our patient is working really hard.
We might push on the patient’s back or hold up a leg, while the partner or doula holds the other leg; sometimes people come with a whole host of friends and family. We count with the patient and encourage them through each contraction, so we are very hands-on while remaining mindful of maintaining fetal wellbeing. We may have to help turn the patient around, administer medication, or give them extra fluids in the IV. We’ll give them ice packs or a drink. If childbirth is like a marathon, we’re like those guys on the sidelines who give you a cup of water.
We have two patients: mom and baby.
After delivery, our second patient has arrived, and during our downtime we support other nurses to care for the newborns they delivered. We take their temperature, monitor their vital signs. There’s a lot of supporting parents, too: reminding veteran moms how to breastfeed if that’s what they want to do. Sometimes it’s the first time they’ve changed a diaper or even held a newborn, so we start with the basics.
I find there's a bit of reluctance to put yourself out there and ask for help as a new mom. People feel they should know it all even though it’s unlike anything most people have done before, but for some reason we put into women’s heads they should already know. So our job involves a lot of empowering patients that it’s okay to not be perfect, they’ll be able to do it. They just need to give themselves time to figure it out.
We’ll never lose focus on our patients, even while trying to protect ourselves.
Now, nurses' conversations have changed to an accounting of any coworkers who have gotten sick, or what new protocols there might be. Different units have had to accommodate for COVID-19 differently, so there’s a lot of comparing notes, like, what are they doing; how are they preventing infection? What are people doing to stay safe? Rather than being worried, most nurses, because we are advocates already, get empowered by that kind of information. The most renowned nurse is Florence Nightingale who famously identified that people were dying of infectious diseases (rather than injuries) during the Crimean War, and she told doctors to wash their hands. Nurses are kind of inspired by that legacy, and our motivation is to advocate for ourselves, our patients, and each other.
Now, everybody’s in a mask when you come into the hospital. We are somewhat used to this as a unit, because we’ve always had to worry about blood-borne illnesses. In the course of labor there’s a lot of blood; we deal with lots of fluid coming our way and have to be protected. But what everyone’s doing differently is wearing their masks all the time. Prior to coronavirus you’d take off your mask and discard it when leaving a patient’s room. Now we leave on the mask for a whole shift. I have access to protective gear, which makes me feel safe, but we are doing things we wouldn’t previously do because there is a national shortage.
Before we were able to test every patient, we were wearing full PPE for the second stage of labor — plastic gown, shield, N-95 mask, and a surgical mask on top of it. I can only imagine while you’re pushing out your baby it’s not entirely comforting to see space-age looking folks all around you. It was never really comfortable for us, either. It gets very hot and sweaty in that gear, it’s actually hard to breathe. I’m impressed by all the ER and ICU workers who wear their N-95s all shift; that can really make you tired, hazy, and even nauseous at times. It’s also hard to communicate because your voice is muffled. We work as a team but when you’re trying to call out orders or vital information in an emergency, it’s not the same as when your full voice is able to be amplified.
Our hands-on work has changed a lot too. First, because patients can only come in with one support person. Plus, we are having to triage which patients may have, or have been exposed to, COVID-19, so there’s a lot more caution and even skepticism initially because there had been reports of patients not disclosing that they or their partners had been exposed. We want to engage with patients in our usual hands-on supportive way, but doing so could be putting ourselves in harm’s way. Now we’re testing every patient, but that still takes two to four hours to come back, so — because we’re in NYC — we are operating as if anyone could have it.
But it’s important to know that doesn’t change how we feel about our patients and helping and uplifting them. Labor and delivery is the happy place. People aren’t coming there specifically because they have COVID-19, which is the majority of patients coming through the emergency department now. We aren’t totally protected from what’s going on, but we are still focused on the labor and delivery process. Everyone is focused on maintaining the excitement and joy that comes from labor and birth.
Our hospital never stopped allowing support people into delivery rooms. So when there was a mandate to limit them elsewhere, we were the only game in town and got about 20-30 calls a day of new patients asking if they could deliver with us. Now it seems back to the normal ebb and flow of patients, but we are getting people out of the hospital quicker than usual. We send everybody home in 24 hours if they’re stable and the baby’s okay. Before, for a vaginal delivery you stayed two nights and for a C-section you’d stay three.
VIDEO: How COVID-19 Has Impacted Pregnancy And Childbirth in America
We can't wait to give our patients a hug.
We’re really doing our best to make sure that the delivery of your baby is still a very exciting and happy process despite what’s going on. We’re trying to be mindful that we all have to protect ourselves and protect each other, but it can still be beautiful, exciting; we’re still excited about babies being born. In that sense, honestly, I feel personally very fortunate to be in this unit.
Emotionally I’m still able to be as supportive as usual, but I have noticed myself being a little more thoughtful about my physical interactions. Particularly if your patient’s getting an epidural, you’re kind of holding them as they go through that or massaging their back. You’re physically engaged, face-to-face, and they’re breathing very heavily — that is a source of anxiety because you want to be there for them but you don’t want to do that at the sacrifice of your family. I’d say all of the teaching and advocacy that nurses do is the same, it’s really just the touch — which is an integral part of nursing — which has changed.
I also used to be much more proactive about visiting patients that I knew were delivering right as I was getting off shift, because if I didn’t get to see you actually deliver your baby at least I got to see you the next day and ask how it went and give you a high five. You used to just stop by and give them a hug, which you don’t do anymore. I think people on the unit already want to get back to normal; the problem is it's unsustainable to maintain that level of paranoia. Some of the things that people used to do will probably return just by nature — like I’m a hugger so I don’t think I’ll ever stop wanting to give my patients a hug if I’ve been with them for a long period of time, it’s just a question of whether that’s socially responsible or not. We work in medicine so we always want to do what's best practices in the hospital and in the world; once they say it’s okay to touch people, most people are going to want to touch people again.
We have families, too.
We put our patients and their families first, but we are also people going through this with our own families. As a result, many of us have had to negotiate how we talk about our day with our own partners and kids. Some nurses have sent their families away. Coworkers with older children often have to reassure them they will be safe. After taking care of a patient with COVID, I debated if I should even tell my husband, as he was already anxious about me going to work.
As far as coming home: The ritual from opening the door and greeting my kids with a big hug is changed. Now, nobody is allowed to come near me until I take off all my clothes at the door and seal them up in a plastic bag, and I take a shower. The hardest part is like yelling at my 2-year-old to stay back. All you want to do is be happy to see your family, give them a hug and a kiss, and you have to tell them to get away from you. My 5-year-old understands more but there’s still not a consciousness of the dangers. There's still a desire to hug and touch me. So that has been difficult.
I don’t take for granted that the coronavirus isn’t the reason why our patients are with us but it has changed how I communicate to my family so I don't create more stress. I can only imagine how difficult it is for the ER and ICU staff with all the devastating loss they have to deal with. I’m not really that religious, but now every time I hear a code being called or the words “anesthesia” or “respiratory stat” I say a little prayer.
I still take the train trying to observe social distancing although it has been surprisingly crowded in recent weeks, and you’re just wondering why everybody is out. It can be frustrating to see people on the train and feel like they’re just prolonging this for everybody.
A lot of the nurses talk about how on night shift you used to be able to finish your shift and do grocery shopping for your family and come home and get a nap. And now, if you’ve worked with confirmed positive patients you go straight home; if not, and you do run errands after shift, it’s like you’re standing on lines and physically and mentally depleted and still managing the same things that you had to prior to coronavirus to be the regular support for your family. For example, on Sunday I woke up at 4:30 p.m. I went to work at 8, and then I didn’t get home until 11:15 on Monday because I went grocery shopping. It’s draining.
I sleep here and there. I sleep when I can. I’ll sleep for half an hour when putting the kids to bed; I want to say maybe 5 hours a day all together. I usually help the kids get ready for nighttime while my husband makes dinner, and that way we can still have a little time in the evening before I go to work. I would venture to say most night nurses have weird sleep schedules because we work have to try to catch our sleep during the day when everyone’s awake. I used to have at least three days where the kids were in school or daycare, and now since they’re in the house I can’t really sleep the way I used to during daytime. That sort of goes for everybody with kids in their house — you used to have a break because of school and now nobody has a break.