Being a Labor and Delivery Nurse During COVID

Written by Melissa Schenkman, MPH, MSJ

For Jessica Woon, RN, being a nurse is not only her life’s calling, it’s a family affair.

One she shares with both of her siblings who like her chose to pursue a life of service in the nursing field. All three were inspired as young children when they watched their mother go through extensive treatment for breast cancer. As the banded together to help their mother, the people on her healthcare team who they saw made the biggest difference in her life and in comforting their family: the nurses.

Each has gone on to become a nurse who in their respective fields comfort the families of their patients, as they once were as children, something that took on a whole new level of meaning during the COVID-19 pandemic.

Jessica Woon at three-years old “practicing nursing.” Her love of caring for others started early!

As Woon and her sister and brother went to work each day, they feared for their patients’ well-being and for their own, given the uncertainty in the early days before vaccines. The global pandemic in just its first 12 months cost the lives of 3,561 US healthcare workers, the largest percentage of COVID-19 deaths, 32%, being those who were nurses.

“Fortunately, we all walked through the pandemic together, but unfortunately being that we are all from the same family, it made everything much more difficult because you’re not the only one,” Woon shared.

Like many on the frontlines, Woon still feels the impact of her experiences during the pandemic’s initial two years and the uncertainty of the mutations to the COVID-19 spike protein that we still face today, especially since COVID-19 coincided with the kick-off of her professional career.

She was a less than a year into being in nurse when the pandemic hit.

Preparing for the Unknown

Woon first knew she wanted to be a high-risk Labor and Delivery (L&D) nurse when she was in her junior year of nursing school in college. She was on her clinical rotation for women and children and began the day with a mom who had a very traumatic loss.

It was very difficult to watch. At the time, she had never seen anything like that, but she also recalls that she had never seen bravery, strength, or grief like that before either. She had seen nurses comfort families who were grieving in the past, but not like the L&D nurses did.

“The way the nurses acknowledged how sacred death was, it was unlike any other place in the hospital. Then, hours later, we turned around and took care of a patient who was a midwife and had an unmedicated, quick, beautiful, spiritual, magical birth,” Woon said. “I felt like I could honor both, and there really wasn’t a way to do that in another place, but labor and delivery.”

She worked her way up from being everywhere all at once as a nursing assistant helping with deliveries and triaging with emergencies to securing her a job right after graduation. The staff was very supportive and kind of became like her family—something she needed in such a sensitive field where she would do things like hold a baby as it was passing away. Experiences like this were not something that her friends at 22 years old outside of nursing could relate to or process. Little did she know how vital her amazing team would become during the pandemic.

Around January 2020, eight months into her career, her team started being briefed about COVID-19 at their morning huddles at the nurses’ station. They would hear about new protocols, the educational components, and what higher ups were saying. Half of the group thought it was all media hype at first and the other half were terrified.

“Unfortunately, birth is scary enough in this day and age in the hospital. There’s already a loss of autonomy that people feel,” she said. “So, then to be birthing in a pandemic, I can’t even imagine. I often think it was scary for us, but I say it was much scarier for them.”

Protocols on how to ensure healthcare provider and patient safety changed at least every week, which for Woon meant that she and her fellow Labor and Delivery nurses had to change how they practiced each week. This involved wearing layers of protective personal equipment (PPE) and COVID testing every patient. Soon, they began to just assume that every patient possibly had COVID-19 because pregnant women were at such an increased risk of getting the virus, and the nurses knew that it affected labor.

“We knew that affected the patients’ placenta and so it caused a lot of really high-risk situations. I specifically remember at one of the hospitals where I worked, we had at one point eight pregnant women in the ICU all on ventilators with COVID and in preterm labor,” Woon said.

Jessica Woon, RN, at her graduation from nursing school, which was less than a year before the COVID-19 pandemic hit.

COVID would cause preeclamsia (high blood pressure), which would cause a loss.

“We saw elevated liver enzymes in both preeclampsia and COVID. So, when someone was diagnosed with preclampsia, we would COVID test them, and find they were also COVID positive,” Woon said. “It was so difficult to differentiate and figure out the correlation between the two. But we saw that COVID affected people’s livers, lungs, and their placentas because your body is so smart when you’re pregnant, and it often will shunt nutrients and blood to important places.”

There were multiple instances where Woon and other nurses had to perform bedside C-sections in an ICU room because a mom was actively dying.

“And for some reason,” Woon told us, “That mom’s extremely smart and almost sacrificial body was keeping that baby alive.”

Adapting to Changes

A scenario like this is hard enough as it is, but visitor restrictions preventing laboring mothers from having any family in the room, made things even worse.

Nurses tried to provide as much additional comfort as they could, adapting to this new, dual role of clinical and family-like caregiver, all while wearing PPE was an extreme challenge.

For Woon, her PPE included a white fluffy mask, a big face shield, a blue, plastic gown, shoe covers, and a hair cover.

“So, can you just imagine coming into deliver your baby and that’s the person who greets you? A person who is dressed up like an alien. How horrifying,” said Woon about the challenge of connecting with her patients.

But her and her fellow Labor and Delivery nurses across the country did not have a choice. They have had to adapt to the increased focus on infection prevention measures and hygiene protocols, some still in place.

What was it like to wear all of that gear for 12-hour shifts?

You could barely drink or eat because you could barely take your PPE off out of fear, Woon told us.

“We were scared of getting it from one another. It was a battle every single day you came to work.  You were hoping and praying this is not the day I get COVID,” Woon said.

“As a new grad and nurse, you’re still trying to get your feet underneath you, understand your role, and advocate well. To do that in an ever-changing pandemic, it was insane.”

Navigating the Emotional Terrain

Nurse Woon and one of her fellow nurses wearing their “full head gear” during the beginning of the COVID-19 pandemic.

From new grads to nursing veterans, the emotional and psychological toll of navigating patient care that involved witnessing isolated births and separated families was huge.

“I just remember being exhausted. I was exhausted keeping up with the information, and trying to ease my patients’ anxiety while I had my own anxiety,” Woon said. “I was exhausted by not knowing what I could do and what I couldn’t do, and when it would mean I got COVID.

Many struggled and still do struggle with burnout from the long hours, stress, and short staffing that exists. In some instances, the nursing teams had women come in who ended up needing to be intubated, sedated, paralyzed and who lost their babies.

One patient she will never forget: A mom, who incredibly delivered her baby under those conditions, was told her baby was alive before she was intubated. Unfortunately it passed away while she was under sedation and her family was allowed to be in that room.

“It felt like such an important situation to honor this baby, as with any loss, but here we did not know if the mom would survive. So, we created memorabilia with photos, footprints, and everything,” Woon said. “We held that baby, and we cried. It was something you never forget.”

The resilience and compassion demonstrated by L&D nurses like Woon and her team during such difficult experiences is nothing short of amazing, and something that they carry with them every day.

Woon’s nurse manager, who openly shared her struggle with burnout, was very supportive of Woon and her fellow nurses. Every member of her unit was fortunate to be offered therapy through their employer to work through what they saw.

“It was a huge resource for a lot of us to be able to talk through it, but sometimes the best therapy was talking through it with your coworkers,” Woon said.

The trauma bond formed amongst nurses not only helped them get through trying times, but also is a bond that has served to positively impact patient care long term.

Collaborating with a Multidisciplinary Team

Teamwork was one of the most vital and today, is one of the most important healthcare lessons learned from the pandemic. When done effectively, healthcare professionals working together can make a world of difference in patient care.

“It was really powerful to see both the obstetricians and the medical ICU teams, and all of the nurses from both teams working seamless together in rooms,” Woon remembered.

She points out that the teamwork developed during the pandemic is vital to continue outside of it, as on a regular basis the rates of loss in pregnancy are higher than a lot of people realize.

One in four women’s pregnancies end in a miscarriage, Woon told us, and about 21,000 still births occur each year in the United States. The topic is just so taboo, she said, and not talked about.

And knowing that you have a multidisciplinary team behind you that knows how to work together flawlessly is so important for patients, as much as it is for the nurses, like Woon, who want to provide them with the highest quality of care.

Nurse Woon and one of the many babies she has helped to deliver.

Facing Personal and Professional Challenges

While it can be really difficult to be a nurse to begin with, Woon found that having to educate people not only at the hospital, but also outside of it about vaccines was exhausting!

 “A lot of women were really afraid to get the vaccine while they were pregnant, before they got pregnant, and even in postpartum. But what we saw, and there is actual evidence for, is that the COVID-19 vaccine protected the immunity of pregnant women and their babies,” Woon said. “Plus, it could protect you in labor, your placenta, and your overall wellbeing and strength.”

Not only did the evidence about vaccines provide a continued sigh of relief and peace of mind to her when it came to patient care for those who chose to get vaccinated, but when her and her fellow nurses could get vaccinated themselves, she says, “It was like throwing a party. No doubt the best day ever.”

It meant she could see her siblings, parents, and her now, husband, who was in dental school at the time in another state. She’s probably had five COVID-19 vaccines since.

On a solely professional note, one of her biggest challenges has been watching the end of additional funding to pay nurses which coincided with the end of the pandemic’s designation as a “global emergency.” In the US, the maternal mortality rate is at an all-time high, and money still plays such a large factor in care and who you have at the bedside.

Looking Ahead

The road ahead for nurses looks very different than when Woon started nursing school. The trust of healthcare workers has changed a lot due to the pandemic, and she thinks that it has become apparent to a lot of nurses that hospitals work around money.

“I think there were a lot of nurses, at least on L & D, who were ‘lifers.’ They had been on the unit for 15, 30 or more years and they were never leaving because that was their family. I don’t see that anymore,” Woon said.

She tells us that the burnout is real, and that unfortunately, there is not a lot of investment in nurses anymore. At first there was incentive pay at hospitals because there were a lot of travel assignments, but now that those have decreased and people are going back to be full time at specific hospitals, large medical centers are not giving that additional pay. The result: short staffing and a lot of nurses not staying at the bed side.

As for the pandemic rules, some are being kept and others no longer seem to matter. One of the most interesting ones and “backwards” ones Woon finds is with COVID testing.

Even though L&D nurses are working with an immunocompromised population, if a nurse tests positive for COVID, they have to use their own paid time off to stay home—something that does not exactly make some people want to test or be forthcoming about the results. A bad system for both patients and nurses.

As we continue to move forward the prognosis for moms and their babies, even with COVID, is a lot better, she acknowledged. There are different medications that can be given intravenously that can effectively treat them.

While the road ahead may look different and comes with uncertainty, our YMyHealth community and many members of the public around the country are very grateful and appreciative of L&D nurses, like Woon, for their contributions both on the frontlines of COVID-19 and in the battle against our high rates of maternal mortality that lies ahead.

The story below is a part of YMyHealth’s COVID-19 Stories from the Field series. We will continue to share personal stories from millennials who are essential workers, caregivers, and those close to them, as long as the pandemic continues.

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