Nurses’ Roles in High-risk Pregnancies and Deliveries
By Jennifer Larson, contributor
Frann Teplick, MSN, RN-BC, CNS, wears a lot of hats in her nursing job.
As a perinatal clinical nurse specialist with UC San Diego Health, Teplick is an expert practitioner who cares for women experiencing high-risk pregnancies. She’s a quality manager and researcher. She also is an educator, working with other nurses to make sure they are familiar with the latest evidence-based research on high-risk obstetrics.
Teplick is part of a multidisciplinary team of OB nurses, labor and delivery nurses, neonatal nurses, physicians and others; everyone has a different role but the same goal—providing the best care for women and their babies at a vulnerable time in their lives.
That’s what nurses in the field of high-risk obstetrics do, said Elizabeth Rochin, PhD, RN, NE-BC, vice president of nursing for the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). During a stressful time, they blend their knowledge and clinical skills with compassion to provide care and support for women experiencing high-risk pregnancies. They support their families, too.
Patient-centric care is vital throughout the care continuum.
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When high-risk pregnancy patients are admitted
“Nurses must be able to provide compassionate care in the face of a patient’s shock and disbelief,” Rodin said. “When a patient initially goes in for a visit, and something’s wrong and they’re admitted to an antepartum unit, the feelings that that high-risk antepartum patient can experience can be very overwhelming. They range from isolation to boredom to uncertainty.”
“Those sensations can be dramatically exacerbated if there are other children at home that this mother is caring for,” she continued. “A high-risk obstetrics nurse is so essential for providing that support and encouragement at a very uncertain time.”
Opportunities in antepartum units and beyond
A growing number of hospitals now have antepartum units, where women can be admitted for care during a high-risk pregnancy. This affords a number of opportunities for nurses looking to work with this type of patient. Teplick works with an antepartum unit at UCSD Health’s Jacobs Medical Center, where she is able to spend time with patients at the bedside.
There are also opportunities to work with high-risk pregnancy cases beyond inpatient units.
Jessica Felts, RN, MSN-ED, CPN, is a manager and nurse coordinator for the Arizona Fetal Care Network at the Phoenix Children’s Hospital. She works closely with expectant mothers who are pregnant with babies given a congenital diagnosis that will require specialized care at or after birth. As part of her job, she connects mothers with subspecialists who can treat their babies after they deliver.
Felts might accompany a family on a visit to a neonatal subspecialist and then have a thoughtful debriefing with them afterward. She connects with hospitals to help them prepare for high-risk deliveries. And she’s on call for patients’ questions and concerns.
Regardless of their specific job environment, nurses caring for women with high-risk pregnancies say that each day on the job is unique.
“Just when you think you’ve seen it all, a patient comes in with an uncommon disease or disorder, or a disease or disorder that’s presenting in a different way, or they have an unusual family culture,” said Teplick. “There’s always something different. I learn something every day.”
The ultimate payoff
Teplick still dons scrubs most days because, even after 30 years of being a nurse, she still relishes the opportunity to attend a delivery.
“Every time I attend a delivery, I still get goosebumps,” she said. “It’s bringing life into this world. It’s so satisfying. It’s just a great feeling.”
Felts agreed that it always feels wonderful to greet a new baby after she’s worked so closely with the mother. “The most rewarding thing, to me, is to meet and see the families after the baby is born, and to see how that baby is doing and witness how much of an impact we made,” she said.
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Caring and coping in times of loss
As any experienced OB nurse, labor and delivery nurse or neonatal nurse can tell you, it’s always hard to experience a loss. Thus, self-care is very important for these nurses, said Julie Aiken, DNP, RN, CNE, AHN-BE, chief executive officer of Ameritech College of Healthcare, who worked in a maternal-fetal high-risk antepartum testing unit for several years.
“In order to provide competent, compassionate, individualized care to grieving patients and their families, nurses must first be willing to recognize their own sense of grief,” said Aiken. “Families look to the nurse for support and understanding during a time of loss, and it is imperative that nurses learn positive coping skills and providing nursing care that is sensitive to each individual.”
Want to specialize in high-risk pregnancies?
Nurses interested in this field might consider getting a few years of experience as an L&D nurse, which can be very helpful, said Aiken. In this environment, a nurse can learn to interpret fetal monitoring tracings and recognize patterns that can lead to labor and birth complications, among other skills.
Teplick was a labor and delivery nurse early in her career and became interested in the high-risk cases. She also felt called to learn more about educating other nurses to care for these patients.
Specialty certification and ongoing education are also extremely useful, said Rochin, who recommends taking advantage of the resources offered by professional associations. AWHONN, for example, offers a fetal monitoring education program for nurses. Membership and participation can also open doors to networking and connecting with others, which can be helpful for educational and job-seeking purposes.
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