How to Become a Labor and Delivery Nurse
Labor and delivery nurses have the incredible opportunity to guide women and their families through one of the most transformative experiences of their lives – childbirth. Along with providing routine and emergency care to mothers, these nurses are often responsible for the initial stabilization and care of the newborn immediately after birth. The term "labor and delivery (L&D) nurse" does not adequately describe the wide scope of this branch of the nursing profession. L&D nurses must be quick thinkers, good communicators, and rapid assessors to treat unpredictable shifts in the health of mom and baby with compassion and safety.
L&D nurses work in hospitals as staff nurses on a labor and delivery or women’s health unit. Some facilities have one area 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. This is becoming a more common practice today. Patients who need Cesarean sections or other pregnancy-related surgical procedures 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 are usually located in the same area as the mothers. In some hospitals, L&D nurses may be required to work in all areas of women’s care including labor hall, post partum, and nursery, but this depends on the facility.
Several professional levels of nurses including LPNs, RNs, and certified nurse midwives (CNMs) may work 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 like gathering supplies or setting up equipment. The role of the LPN is in far less demand than in years past. In fact, many hospitals across the country are no longer hiring LPNs. 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, but they are usually not working as staff nurses. Most midwives start as staff RNs before going to midwifery school. A CNM performs vaginal deliveries and coordinates care for 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 and are usually in collaboration with a physician. The role of the CNM will vary from state to state. Some midwives 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, but their reach continues to expand.
Nurses of any level who work in L&D should expect to work shifts, have some irregular hours, and are "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, 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. Nurses who complete a BSN program are also trained in leadership, budgeting and delegating.
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 including hands-on clinical time - most programs will require several hundred hours of experience before graduation, and CNMs must pass a national certification exam and abide by the laws of their state to practice.
Learn more about the advantages of each of these different degree paths by visiting our nursing degrees guide.
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 and may only get a brief look into the field before they move to another area of study. 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. Nurses should expect a lengthy orientation with an experienced nurse when they start L&D, plus plenty of classroom time for fetal monitoring, neonatal CPR, advanced CPR for adults (ACLS) and other courses. 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 administer the NCLEX exam which candidates must pass to obtain a license. Some hospitals are also requiring nurses who work with mothers and their babies to obtain national certification. Nurses may pursue certification once they have worked 2,000 hours in their specified field and met any other requirements of the certifying organization. Certification carries more weight today because hospitals are striving for magnet status - an award issued by the American Nurses Credentialing Center (ANCC) to facilities that demonstrate outstanding nursing care and clinical outcomes. While not all nurses are required to have national certification, carrying the title can help you win a job over a nurse who doesn’t and boost the reputation of your employer.
Aspiring CNMs must already be licensed as an RN to enter a CNM graduate program. After graduation, they will need to take the American Midwifery Certification Board exam before beginning their career. CNMs are required to maintain both their RN and CNM licensure to practice.
No matter what the specialty, all RNs are required to maintain continuing education credits each year and keep their license in good standing to practice.
Necessary Skills and Qualities
Nurses have to be organized critical thinkers and skilled communicators. Along with essential nursing 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 laboring mothers and sometimes complex family dynamics.
Patient education is a fundamental part of many nursing roles, but it is an especially critical skill in L&D. A typical hospital stay for a delivery is only 2 to 4 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.
If you would like to gain the necessary education to become a labor and delivery nurse, we highly recommend that you check out our free School Finder Tool located HERE.
The U.S. Department of Labor reported the annual median salary for LPNs in any specialty as $42,490 in May 2014, but annual wages can be as low as $31,640.
L&D RN salaries are on a par with other nursing specialties with a median salary of $66,640 as reported in May 2014 by the Bureau of Labor Statistics. RN salaries may be as low as about $45,880 and as high as $98,880 depending on several factors including work experience, employer, geographic location, and specific nursing role.
Meanwhile, the BLS states that nurse midwives earned a median salary of $96,970 as of May 2014.
According to the U.S. Department of Labor, overall LPN job growth is projected at around 25% between 2012 and 2022, but this may not be specific to labor and delivery or hospital work. RN jobs overall are projected to increase by 19% over this same period of time. Both of these rates are considerably 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. According to the BLS, job opportunities for CNMs should grow by 29% between 2012 and 2022.