Pursuing a Career as a Labor and Delivery Nurse

Nurse Types / Labor and Delivery Nurse

Labor and delivery nurses (L&D) are an integral part of the medical team responsible for caring for two patients at the same time: the pregnant mother and child. It’s their job to help moms through their pregnancies and assist with the safe delivery of newborns.

New mothers, especially, depend on the expertise and compassion of their L&D nurses. They need reassurance and guidance on how to handle their pregnancies from conception to delivery.

In this article we explore:

• What is a labor and delivery nurse?
• What do labor and delivery nurses do?
• Where do labor and delivery nurses work?
• What are closely related fields?
• How do you become a labor and delivery nurse in 3 steps?
• What are additional requirements of labor and delivery nurses?
• What are the salary and career outlooks for labor and delivery nurses?
• FAQs

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What is a labor and delivery nurse?

A labor and delivery nurse is a registered nurse who specializes in working with pregnant women and their newborns. They support obstetricians and midwives in caring for their patients.  L&D nurses can work in birthing centers, hospitals, and private obstetrician practices.

In your job as an L&D nurse, you’ll be responsible for meeting emotions with compassion and addressing your patients’ questions calmly and honestly.

What does a labor and delivery nurse do?

Labor and delivery nurses work with obstetricians and other members of the healthcare team to help mothers have a healthy pregnancy and delivery. They monitor vitals and pain levels during delivery to ensure birthing mothers get the support and pain relief they need.

Your tasks may depend on where you work. L&D nurses stationed on the Labor, Delivery, Recovery, and Postpartum floor can assist patients from admission to discharge. Since the newborns room with mothers in this unit, you’ll cover every part of the birthing process, including lactation.

Some hospitals offer childbirth education classes before delivery. L&D nurses certified as ICEA Childbirth Educators can conduct these classes. Though L&D nurses have a lot of autonomy, they still work intimately with a variety of different providers and individuals.

The labor and delivery nurse is responsible for updating and communicating with the patient’s OBGYN/midwife, charge nurse, anesthesiologist (or certified registered nurse anesthetist), lactation nurse, delivery nurse (if there is one), neonatal nurse practitioner (NNP), and the family.

L&D nurses have many roles. They are there for their patients from beginning to end during the delivery process. They aid in procedures that need to be performed before labor, like taking vitals. They are there when the baby is delivered and they educate parents on what they should do now they have given birth.

A day in the life of a labor and delivery nurse

Fewer jobs in nursing can be more rewarding than helping bring a new life into the world. As a labor and delivery nurse, you can go from taking vitals during a pregnancy wellness checkup to assisting with active labor.

Other daily responsibilities can include:

• Administering medications and immunizations
• Assessing patients in triage for preterm labor, active labor, rupture of membranes, pregnancy complications, or co-existing issues
• Assisting in maintaining pregnancy in antepartum mothers
• Charting via electronic medical records
• Circulating in the operating room to assist with c-sections and other emergency obstetric and gynecological procedures
• Collaborating with the care management team, including anesthesiologists, physicians, midwives, lactation nurses, and charge nurses
• Conducting maternal physical assessments
• Managing patients in labor, including early labor, induction assistance, epidurals, and delivery support
• Offering newborn care and assessment
• Providing breastfeeding and postpartum support

Common conditions treated by labor and delivery nurses

Labor and delivery nurses can treat many common conditions of pregnancy and delivery. Many pregnant women experience Braxton Hicks contractions, irregular uterine contractions that can make them think they’ve gone into labor.

Some of the other pregnancy-related issues you can handle as an L&D nurse include:

• Cervical effacement and dilation happen when labor nears. You can monitor patients in labor to determine when their cervix thins and opens.
• Early labor can be scary for pregnant women and requires the skill of a healthcare team familiar with monitoring and stopping it when possible. When early labor can’t be stopped, you may have to assist with a c-section.
• Placenta abruption happens when the placenta separates from the inner wall of the uterus before birth. Babies in the womb are deprived of oxygen when this happens so it must be treated quickly.
• Preeclampsia can cause early labor and death of the newborn and mother. As an L&D nurse, you’ll monitor your patients for signs of this life-threatening condition.

Where do labor and delivery nurses work?

The most common place of work for an L&D nurse is an acute care hospital. Many hospitals have units specifically for the pregnant population. In one of these units, labor and delivery nurses may find themselves working in:

• Triage rooms
• Antepartum rooms
• Operating rooms
• Labor rooms
• Infant nurseries
• Postpartum rooms

Shifts are commonly 8-, 10-, or 12-hours. If a nurse does not work in a maternity-specific unit, they may find that they float around the hospital, working with both pregnant patients and non-pregnant patients.

L&D nurses also work in birthing centers. They are boutique centers often staffed by midwives.

What are closely related fields?

If you like the idea of working with pregnant women and their newborns but aren’t ready for a career as an L&D nurse, you have some options. Some of the closely related fields include:

• Doulas are professional labor assistants who provide emotional and physical support to birthing persons before, during, and after labor.
• Lactation consultants help new mothers navigate through the breastfeeding process, troubleshooting any issues.

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How do you become a labor and delivery nurse in 3 steps?

Step 1 – Become a registered nurse

L&D nurses are RNs who specialize in labor and delivery. Before you can start working in your new career, you must first earn your RN licensure.

Earn a Bachelor of Science in Nursing

There are a few ways you can become a registered nurse. You can earn your Associate Degree in Nursing (ADN) in about 24 months, or a Bachelor of Science in Nursing (BSN), which takes up to 4 years to complete. There is also an Accelerated Bachelor of Science in Nursing (ABSN) for those with bachelor’s degrees in fields other than nursing. 

In 2010, the Institute of Medicine (IoM) set a goal that 80% of registered nurses (RN) hold a BSN degree by 2020. The IoM established the criteria because nurses with BSNs achieve better patient outcomes.

If you’re already an RN, you can complete an RN-to-BSN program that allows you to continue working while pursuing a higher level of education.

Pass the NCLEX exam

Once you have your bachelor’s degree, you must pass the NCLEX-RN exam to begin working as a nurse. If you already have your RN licensure and fast-tracked to your BSN, you can skip this step.

Everyone else should prepare to answer a minimum of 75 questions on the exam. The most you’ll be asked is 145. If you fail the test on your first try, you can retake it again in 45 days.

Step 2 – Accumulate experience

After you complete your BSN and become a licensed RN, the next step in your journey to becoming an L&D nurse is to accumulate relevant experience in your specialty.

Some RNs look for any nursing position that uses their RN knowledge and skills. Others seek out labor and delivery opportunities. The option you choose depends on your individual goals and schedule.

Helpful skills and experience

Seeking out an obstetric experience once you’re an RN is ideally the way to go if you want to make yourself a more desirable candidate. You’ll have the chance to apply the knowledge and nursing skills you acquired during your BSN program in bedside patient care.

Look for opportunities that help you build the following:

• Critical thinking and decision-making abilities. When birthing persons go into labor or experience pregnancy or delivery complications, you must think quickly to achieve the best patient outcomes.
• Strong communication skills. Whether you’re teaching a birthing education class or collaborating with other members of the healthcare team, you’ll need to be well-spoken to be effective in your role.

Changing specialty to a labor and delivery nurse

Most L&D nurses come from a medical-surgical background. They’re used to prioritizing patient needs and working in a fast-paced, stressful environment. If you’re currently working in med-surg and want to change your nursing specialty, ask to shadow on L&D floors to get some experience.

Connect with hiring managers in birthing centers, hospitals, and other maternity healthcare facilities so when positions open you have a direct line to the person responsible for filling it.

Step 3 – Obtain certifications

There are many certifications many labor and delivery RNs may choose to pursue, either to further their education or to achieve a competitive advantage in the job application process. Some examples include:

INPATIENT ANTEPARTUM NURSING (RNC-IAP)

This core certification is for nurses who want to work with the mother before birth. This can include dealing with challenges before the baby is born. This exam is offered through the National Certification Corporation.

NCC CREDENTIAL IN INPATIENT OBSTETRIC NURSING (RNC-OB)

This credential can be earned after a nurse has a minimum of two years of OB experience. The test is a competency-based exam that tests OB-specific knowledge. Once earned, the credential must be renewed every 3 years with required continuing education credits completed as well.

CERTIFICATION IN ELECTRONIC FETAL MONITORING (C-EFM)

This examination is intended to test the specialty knowledge and knowledge application related to electronic fetal monitoring and interpretation of that data. This certification is maintained on a three-year cycle through continuing education. 

NEONATAL RESUSCITATION PROGRAM® (NRP®)

An NRP certification program combines online testing, case-based simulation, hands-on simulations, and debriefing. The different testing environment(s) should focus on leadership, communication, and teamwork skills in emergency neonatal situations. An NRP certification is valid for two years.

CHILDBIRTH EDUCATOR CERTIFICATION

This certification is for nurses who have a heart for making sure the parents are ready for the birth of their baby, and what come afterwards. They work with parents on mental and physical health to ensure a positive parenting experience.

INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT® (IBCLC®)

New mothers may have a difficult time nursing their babies. That’s when a lactation consultant comes in. This certification allows the nurse to help with the lactation process. IBCLCs are required to recertify every five years.

What are additional requirements of labor and delivery nurses?

If you have professional credentials, you must follow the guidelines for renewing them established by the credentialing agencies. Most require retaking an exam to prove competency. Others may mandate continuing education to keep your skills aligned with L&D nursing best practices.

What are the salary and career outlooks for labor and delivery nurses?

The U.S. Bureau of Labor Statistics (BLS) predicts a growth of L&D nurses to be 6% between 2021 and 2031.

According to the BLS, the average annual pay for a registered nurse is $82,750. According to data from Incredible Health, the average salary for a labor and delivery nurse is $90,541. Learn more about labor and delivery nurse salary.

These numbers are not specific to the labor and delivery specialty, nor do they account for geographical location, nurse level of education, traveling nurses, or any additional credentials or certifications the nurse professional holds. Each of these factors can have a significant impact on nurse salary.

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Job satisfaction

All nurses can find themselves in stressful situations from time to time. Labor and delivery nurses are no exception. The list of things that can go wrong during a pregnancy or birth is long and complicated. L&D nurses must maintain a calm demeanor even under the most precarious situations.

Some of the challenges you might face in this role include:

• Assisting in a complicated delivery that threatens the life of the baby and mother
• Delivering a preterm or stillborn baby
• Supporting birthing persons and their families during medical emergencies of the mother or baby

Despite the sometimes-demanding environment, L&D nurses have some of the highest satisfaction levels of all RNs.

Next steps

The world of L&D nursing is a highly specialized position in which the nurse has the sweet privilege of being able to care for women and their families on some of their very best days. It is not uncommon to find that many nurses who land in OB are extremely passionate and never leave the area of work.

You can choose to go back to school and obtain your Master of Science in Nursing (MSN) or Doctor of Nursing of Practice (DNP) in order to move up in your career and take on more responsibility. 

If you believe you share this passion, obstetrics and women’s health may be an area that can bring you joy for your whole career.

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