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More than a labor and delivery nurse

Michelle Villasenor - Everyday Extraordinary

Courageous nurses comforting mothers during a pandemic

Elective surgeries and procedures were being canceled to reduce capacity in the hospital, but the labor and delivery department staff still had a crucial job to do in the middle of a pandemic. You can’t tell a pregnant patient to stop her labor—giving birth is one of the few medical services outside of the emergency room that can’t be rescheduled.

Patients still had to deliver at the hospital where they and their newborns would have access to specialized care. In any other time, close contact with patients—and their families—is just part of the everyday job. But with the imminent threat of COVID-19, caring for laboring women took an extraordinary amount of courage and ingenuity.

“Pregnant patients need knowledgeable, compassionate and highly trained nurses,” said Cynthia Ledesma, the executive director of inpatient Women's Health Services.

Although there were dedicated COVID-19 units in the hospital, the expertise of nurses, providers, and other support staff made it safer for pregnant and postpartum women and their babies to be cared for in Women’s Services. On any given day, staff in Women’s Services were caring for several COVID-19-positive women and their babies

During a time when other units were closed and many of their staff reassigned to care for COVID-19 patients, the team in Women’s Services were operating at full capacity. At certain times, infection control safety protocols prevented laboring patients from having a support person, so the nurses in labor and delivery knew what they had to do.

Michelle Villasenor, a registered nurse and Stork One maternal transport specialist, felt both excited and scared to be on the transport team, especially in ambulances and aircraft where social distancing is impossible. Villasenor has lost count of the number of times she’s been in close contact with COVID-19-positive patients, some of whom were extremely sick. Some of them were unable to have a partner or family member with them for comfort. So Villasenor compassionately became their support person, bringing pregnant women to University Hospital for highly specialized obstetric care.

“Patients were worried and wondering ‘Am I going to be by myself when I deliver?’” Ledesma said. “We decided we couldn’t let patients feel that they would labor and deliver alone behind a door. We felt that women needed an advocate and support person with them.”

Recognizing how urgently patients need the support of their loved ones, the staff in Women’s Services figured out how to safely allow one bedside visitor. That solution brought a huge sense of comfort to the patients—but it also increased the risk of bringing COVID-19 infections to the area.

In response, the department added gatekeepers to its staff—employees who stood outside labor and delivery, antepartum, and postpartum rooms and communicated via walkie talkie with the people inside to limit entering and exiting as much as possible. Gatekeepers also transported lab samples and helped staff and visitors put on and remove PPE to prevent the potential spread of the virus.

For COVID-19-positive patients, staff creatively developed a way to administer medications from outside the rooms. Pitocin, for example, needs to be adjusted several times per hour when inducing labor—which would frequently expose nurses to the virus. This innovative approach minimized the number of times a nurse had to enter and exit the room.

In a time that seemed to have no clear answers, the Women’s Services staff worked collaboratively with patients to make the best decisions for everyone’s physical and emotional safety.

“The best place for a pregnant woman to go is Women’s Services, and there wasn’t always a one-size-fits-all answer,” Ledesma said. “I had a strong team and physician support that helped brainstorm different ideas. I’m proud that I have people wanting to participate in the process, instead of shying away from it.”

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