In many ways, the most important day in our lives is the day we are born. Labor and delivery nurses play a vital role in ensuring that mother and baby get through safely. They are the first line of defense in avoiding preventable birth injuries, including cerebral palsy caused by insufficient oxygen during labor.
A Nurse’s Role
During birth, most of the face-to-face patient care occurs between the mother and her labor and delivery nurse. Patients rely on nurses to:
- Educate them
- Reassure them
- Address their questions and concerns, and
- Take action to protect them if concerning signs appear.
Obstetricians rely on nurses to:
- Carry out their orders
- Monitor the progress of labor
- Monitor the patient’s contractions and the baby’s heart rate patterns
- Safely administer Pitocin (a medication used to induce contractions), and
- Alert them to any concerning findings.
Called to Be an Advocate
The nurse is expected to be a patient advocate. The American Nurses Association’s Code of Ethics states, “[t]he nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” A nurse’s obligation to be a patient advocate requires more than simply faithfully carrying out the doctor’s order and reporting the patient’s status. Nurses must be vigilant in monitoring the progress of labor and, in particular, the baby’s heart rate patterns. Certain changes and patterns in the fetal heart rate are concerning for insufficient oxygen delivery to the baby. A nurse is required to recognize those changes and patterns and to take action to protect the baby from injury including:
- Reducing or stopping the administration of Pitocin
- Giving the mother additional fluids and oxygen by face-mask
- Changing the mother’s position to increase blood flow to the placenta, and
- Alerting the physician.
The Doctor is Not Always Right
The nurse’s role does not end there. Doctors are not always right. Nurses know that. Hospital administrators know that. Doctors know it too. For that reason, a fundamental component of the nurse’s patient advocacy role is to alert the chain of command when he or she believes a patient’s wellbeing is at risk. If a nurse believes that a doctor’s action, inaction, or plan of care is not in the patient’s best interest, she is obligated to raise the issue with the doctor. If the doctor does not address the issue to her satisfaction, she is required to take the matter to her charge nurse or nursing supervisor. If the issue remains unresolved, she must take it to the next higher level until the conflict is resolved.
As patient advocates, it is not enough for labor and delivery nurses to simply observe and chart. They must act. They must challenge a doctor when patient safety requires it. Prevention depends on good nursing care just as it depends on good physician care.