How to Become a Labor and Delivery Nurse
Labor and delivery nurses have the incredible opportunity to guide a woman through one of the most transformative experiences of her life – bringing new life into this world. Along with providing care to mothers, these nurses get to care for the newborn babies themselves from the moment of birth onward. The term "labor and delivery (L&D) nurse" does not adequately describe the wide scope of the profession, as the nature of this specialty is about constant change in patients' health statuses and treatment for both mother and baby. Surely there are few jobs that combine the intense joy and responsibility of a labor and delivery nurse.
Practically all L&D nurses work in hospitals as staff nurses. Some facilities have one unit for labor, delivery, and recovery and a separate unit for postpartum care. Others have an all-in-one area where patients go through the entire hospital stay in a single private room. Patients who need Cesarean sections may go to an operating room located in the maternal care unit or go to a general operating suite somewhere else in the hospital. Newborn nurseries may be located in the same area as the mothers or in a different location. Regardless of how a hospital is set up, most L&D nurses cross train and work in all related areas.
Several professional levels of nurses including LPNs, RNs, and certified nurse midwives (CNMs) may all have different roles and responsibilities within this specialty. Depending upon individual state laws, or individual facility policies, LPNs typically have limited roles in L&D specialty areas. They may organize charts, do simple patient care, help with admissions and discharges, or have a technical role in vaginal deliveries or C-sections. RNs, on the other hand, provide comprehensive mother and baby care from the time a patient comes into the hospital until she leaves. Most are also trained to work in operating rooms and nurseries, and specific duties may change day to day.
CNMs may be found in some hospitals. They do everything a staff RN does in L&D but also perform vaginal deliveries and coordinate care of babies during their first month of life. CNMs also work in offices and community health and/or birthing centers, providing a full spectrum of care to expectant mothers. They may perform uncomplicated deliveries in patients' homes, provide comprehensive postpartum care to both mother and baby and have primary care roles in women's reproductive health. In the U.S., CNM-attended births are most frequent among American Indian, Alaska Native, and Hispanic women, according to the latest data from the CDC's National Center for Health Statistics.
Nurses of any level who work in L&D should expect to work shifts, have some irregular hours, and be "on call" periodically.
LPN educational programs take approximately one year to complete and are offered at community/junior colleges or vocational/technical schools. RNs have several educational pathways available including a community college-based two-year associate's degree; a hospital-based three-year diploma program; or a four-year bachelor's degree program at a college or university.
All nursing educational programs have a similar structure that includes nursing theory classes, skills training, and clinical experiences. Prerequisite courses in subjects such as math and English are also a part of RN programs.
CNMs are educated in both nursing and midwifery. A bachelor’s degree and some L&D nursing experience is required for admission to a CNM graduate program, which may culminate in a master’s degree or a Doctor of Nursing Practice (DNP) degree. Both degree programs have similar content and requirements. CNM graduate programs can be completed in two to three years.
LPNs and RNs learn L&D on the job. Most degree programs have a class and/or clinical experiences in maternal and child health, but nursing students cannot choose a specialty as undergraduates. Many L&D departments prefer that nurses have at least some nursing experience before applying, but some facilities may accept new graduates to work in L&D and provide extensive on-the-job training. CNMs receive the bulk of their training in their graduate program.
Licensing and/or Certification
After completing their education, graduates of nursing programs must obtain a license to have "LPN" or "RN" behind their name.
The National Council of State Boards of Nursing in conjunction with the individual state boards of nursing administers an exam, the NCLEX, which candidates must pass to obtain a license.
Aspiring CNMs must already be licensed as RNs to enter a CNM graduate program, but after graduation, they need to take the American Midwifery Certification Board certification exam before beginning their career.
Necessary Skills and Qualities
Nurses have to be organized critical thinkers and skilled communicators. Along with essential RN skills, L&D nurses in particular need to be fast on their feet and contribute within a team environment. Many areas of expertise are necessary including skills in intensive care, medical-surgical, and operating room environments. Today’s healthcare requires mastery of technology while also having patience and compassion when dealing with patients and families. Patient education is a part of many nursing roles, but it is an especially critical skill in L&D. A typical hospital stay for a delivery is only a few days, so these nurses are responsible for an enormous amount of teaching in a very short time period.
Opportunities for Advancement
Nurses with L&D backgrounds have many other roles available to them such as administrators, lactation consultants, perinatal educators, and advanced practice positions including clinical nurse specialists, CNMs, or women’s health nurse practitioners.
The U.S. Department of Labor reports the annual median salary for LPNs in any specialty as $40,380, but annual wages can be as low as $29,000.
L&D RN salaries are on a par with other nursing specialties with a median salary of $64,690 as reported by the Bureau of Labor Statistics Occupational Outlook Handbook. RN salaries may be as low as about $44,000 and as high as $95,000 depending on several factors including work experience, employer, and specific nursing role.
According to the U.S. Department of Labor, LPN job growth is projected at around 22% between 2010 and 2012. RN jobs overall are projected to increase by 26%, which is considered faster than the average rate for other occupations. An aging U.S. population is a major factor in this job growth that may not affect L&D nurses but the large number of RNs who are expected to retire will create more job availability.
With U.S. healthcare policy changes emphasizing efficient and cost-effective healthcare, CNMs (like other advanced practice nurses) will have more opportunities, and the demand will be greater in rural areas of the U.S.