Monday, December 5, 2011

Nurse Assisted Deliveries: Heidi Creston

Babies come when they want to, not necessarily when we want them to. Every labor and delivery nurse and OB provider are well aware of this fact. Nurse assisted deliveries happen daily.

The primary reasons for nurse assisted deliveries are:
  1. Physicians are over extended.  They have more than one patient delivering at one time or are  covering OR and/or ER as well as OB.
  2. They are not on site due to office hours.
  3. Precipitous Deliveries (baby comes quickly).

Labor and delivery nurses are specially trained to monitor and keep close observation on a patient's status in order to notify the OB provider in a timely manner. Most patients are kept on continual electronic fetal monitoring. The pattern on the fetal strip provides information concerning both fetal and maternal status to include how soon delivery may be.
Sterile vaginal exams or cervical examinations to monitor dilation is another skill that L&D nurses are trained to perform. Nurses also educate their patients to report any signs of increased pressure.
It is always preferable for the OB provider to be present for the delivery, due to the increased risk to the patient (possible birth complications such shoulder dystocia), but in the event the provider does not make it, labor nurses are trained to deliver.
The L&D staff will make every effort to contact the provider, they will stop any measures taken to induce labor (turn off pitocin, instruct patient how to breathe thru contractions), provide support, and set up for delivery.
If the delivery is imminent, the nurse will guide the patient in her delivery, guiding the head, checking for nuchal cord. A nuchal cord is when the  umbilical cord is around the neck.  In some cases the cord can be untangled by hand.  Tight cords need to be reduced, clamped and cut.
Nurses also must be careful of other body parts being entangled by the cord as well. Delivery of the body is usually rapid once the head and shoulders are out.
If there are no complications with the infant, nurses will usually leave the baby on the mother’s chest with an uncut cord for 3-5 minutes. Nurses do not attempt to deliver the placenta, but if the placenta delivers spontaneously they place it in a container for the provider.
After delivery, if the provider remains unavailable, the nurse will clean the perineum and assess for tears and bleeding. Given the situation (excessive bleeding) the nurse may restart the pitocin, give a dose of methergine or hemabate, provide continuous fundal massage, and or perform a vaginal sweep. Upon arrival of the provider, the nurse will give them a full report.
Although most deliveries are uneventful, there are many things that could go fatally wrong with the delivery itself or during the post partum period. These include but are not limited to: malpresentation (ie: breech, compound limbs), cord prolapse/cord accidents/nuchal cords/body cords, placental abruption, and post partum hemorrhage.

Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.
Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished.


  1. What an awesome herritage Adelheideh has. :) I
    appreciate the uniqueness of military nursing. I
    was an Air Force for 4 years. It was a great time,
    and I learned a ton. I'm now enjoying being a
    mommy, postpartum/newborn nursing, and
    writing children's stories. It's great to find
    people with similar passions. :)

    Jordyn, I love your website! To find one devoted to medical
    accuracy in writing is incredible. I can't tell you how many
    times in a medical show/book I find myself yelling, "That's
    NOT possible!" or "No way a doctor would be doing that,
    he'd order a nurse to do it!" By the way, Medical thrillers/
    suspense (especially Christian) are my favorite. I can't wait
    for your book to come out! :)

  2. Tanya and Elisabeth: So glad you're finding the site helpful. Tanya, Proof will debut June 1, 2012. You could probably be the first to pre-order it over at CBD!!

  3. Hi Heidi & Jordyn. Your post is coming at a good time for me. I'm working on a story that takes place in 1903 where a character goes into labor in a market place/store and is unable to make it to her home to deliver. My heroine will have to help her deliver the baby until the doctor can arrive.
    I'm assuming home deliveries were still common, preferred, in 1903. Does anyone have any suggestions of where I can verify this?

    Also, I'm trying to confirm if a woman who had been trained by a doctor, would still need to go to school to be a nurse - or would most doctors accept her training under the doctor, in the event she had to work elsewhere, away from the first doctor. I hope this makes sense! I am having a hard time finding enough research to back up what I want to happen in my story.

  4. Christy, My... you are up awfully early in the morning!

    Thanks for leaving your question. I'm going to link a couple of sources. Read through them to get a feel of childbirth in the US-- one source is from Australia but I think is still helpful.

    The nursing question is interesting. One way to research this would be to do some reading on the history of nursing licensure. I'll include a link for that as well.

    Let me know if these are helpful or not--- Jordyn

  5. Thanks so much Jordyn! I'll definitely take a look at these :)