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Tuesday
Jun202006

New Orleans L&D Staffing

Separate from the VBAC experience, I wanted to comment on the dearth of personnel at the hospital in which my client birthed.

The doctor, nurse and an LPN (who was only present for the birth and postpartum) were the only folks in the room from the time we entered until I left an hour postpartum.

A short visit from an anesthesiologist in ironed shorts, white Polo shirt, and Nike tennis shoes allowed my mom to have the epidural she desired. Having been called in specifically for my client and another woman in labor, he never gowned. He didn't have an epidural cart, either. The nurse got the "epidural kit" without a pump - I kept blinking at how different this was compared to women receiving epidurals in other areas I've worked in. It took less than 5 minutes for a well-placed and painless insertion of a 2-hour long epidural (not a spinal; I asked) - an enormous difference from mom's last excruciating epidural experience.

As the doctor was gowning, the baby's heart tones began dropping, down into the 80's, so the doctor asked the nurse to find someone from Peds to come in for the birth. As she was walking out, another nurse breathlessly ran in asking for the OB to come for a stat section (I don't use that term - I use cesarean - a grapefruit is sectioned, not a woman). The doctor continued gowning and calmly said they'd have to get someone else. "This is important, too," she said. The undertones screamed, "I can't leave!! This baby needs me as much as the other doctor does."

The nurse continued out the door to alert Peds, but came back saying, in nurse-speak, "They'll be in after the section." Translation: We're alone here.

Our nurse was asked to bring in forceps and she once again left, coming back with a set. They weren't on the table already? Under the table? No vacuum nearby, either? I learned they are not routinely set on delivery tables because of their scarcity. Wow.

Heart tones continued dropping inbetween contractions and we all readied for a depressed baby and as she was born, she was, in fact, depressed.

As she lay on mom's (un-cut) belly, the nurse took the oxygen off mom and gave me the mask to use as blow-by for the baby - I kept the mask close, careful to avoid the eyes.

She needed stimulation - lots of it - and after about 2 minutes (we'd already done and passed the first Apgar), I was asked to carry her over to the warmer to be suctioned. I lifted the flaccid child who'd made cursory tries at breathing, yet who had decent heart tones (yay!) and carried her to the warmer (which I'd turned on as the doctor readied the forceps). The nurse and I stimulated the baby, I attached the suction machine and got it turned on and changed the blankets as she began suctioning. (There was loads of terminal meconium and copious fluid in her stomach and throat.)

I kept expecting the doors to open and a slew of Pediatric nurses or even a neonatologist to come in to check the baby, but no one came. I learned there was no one to come. There was one small team that was needed with the baby in the crash cesarean birth. My client's baby was not the urgent priority.

"Welcome to Third World obstetrics," I was told more than once.

What initially could have been tragic if my client's baby needed a lot more help (we there could have resuscitated to a point) became the newborn's luck in not being removed from mom earlier or removed from the room at all. I know the baby would have been severely roughed up and manipulated had she been born almost anywhere else. Instead, she had her loving midwife and a kind nurse tending to her needs.

What I witnessed was the prioritizing of critical patients. Nurses and doctors learned this skill all too acutely not quite a year ago during Katrina. Their knowledge and experience remains in the forefront of their minds. It was exquisite to watch.

Perhaps if you are a travelling nurse, you might consider a stint in New Orleans. They could use the help.

Reader Comments (7)

Something I might do...the TNurse thing there...hmmmm...

Hh

Wow - I'm not even an OB nurse and this post gave me chills.....

June 24, 2006 | Unregistered CommenterKim

While I'd like to continue working as a traveler, I could never work as an OB nurse. Although I have my NRP, there is something about PKU tests, epidurals, those buggy things that they have on the OB floor, and the way they teach moms to care for the cord, that make me know that L&D is no place for me. yeah i'm weird like that. sounds like a fascinating birth experience.

July 12, 2006 | Unregistered Commenterjen

I would love to volunteer down in New Orleans anywhere (which is everywhere) they need help. It's a shame those healthcare professionals are sinking down there while we enjoy our comfortably staffed units here. I might have to spend a week or two down there this fall.

July 13, 2006 | Unregistered CommenterDan

This sounds just like the L&D floor where I work in a giant hospital in New York.

When we were still planning to move to New Orleans I went to two open houses for RNs this past May.

They both said that their labor units were filled and needed no staff. They offered me physical rehab.

Not my thing.

July 13, 2006 | Unregistered Commentermissbhavens

"chills" is an understatement. I start my labor and delivery rotation as a nursing student in August and Im excited and nervous all at once. However, the thought of caring for otherwise healthy people in need of "interim" healthcare to deliver a child is fascinating to me...

July 13, 2006 | Unregistered CommenterIntelinurse2B

From the comment thread of http://scienceblogs.com/terrasig/2006/07/change_of_shift_nursing_blog_c.php" REL="nofollow">Terra Sig re: the appearance of this post in the Change of Shift nursing blog carnival:

Navelgazing Midwife: You'll have to excuse my wiseacre ScienceBlog brother, Coturnix - his was a joke, esp since I know that his wife is a nurse herself. Your post and your work is an inspiration to me: one of my best recent lab students chose to do a nursing/nurse midwifery degree so that she could press the flesh and make more of an immediate and caring impact than she could in my very dry and impersonal laboratory. Keep up the great blogging!

July 15, 2006 | Unregistered CommenterAbel Pharmboy

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