The Labor and Delivery (L&D) Nurse provides specialized obstetric care throughout the intrapartum period, reporting to the OB Charge Nurse or Women's Services Manager. L&D nurses care for two patients simultaneously at all times: the birthing parent and the fetus. This dual-patient responsibility makes the role uniquely complex. Success is measured by maternal and neonatal outcomes: low rates of preventable complications, high rates of patient satisfaction, and timely recognition of obstetric emergencies including shoulder dystocia, postpartum hemorrhage, and umbilical cord prolapse. L&D nurses also play a central role in a patient's most emotionally significant healthcare experience, requiring equal parts clinical precision and compassionate presence.
Conduct and document admission assessments including obstetric history, current pregnancy status, gestational age, and presenting complaint.
Initiate, monitor, and interpret continuous electronic fetal monitoring (EFM) strips, classifying fetal heart rate patterns using NICHD terminology.
Administer and titrate oxytocin augmentation per physician-approved protocols, adjusting based on contraction frequency and fetal response.
Support spontaneous vaginal deliveries by assisting the provider, coaching the patient through second-stage pushing, and managing perineal support.
Assist with operative vaginal deliveries and cesarean sections, preparing the patient, managing anesthesia coordination, and supporting the neonatal team.
Recognize and initiate emergency protocols for postpartum hemorrhage, shoulder dystocia, eclampsia, and cord prolapse within the first minute of identification.
Administer epidural and spinal anesthesia medications in coordination with anesthesia providers and monitor for complications.
Perform newborn assessments including APGAR scoring, cord blood collection, and initial stabilization when neonatal team is en route.
Support breastfeeding initiation and provide anticipatory guidance on newborn care to new parents prior to transfer.
Collaborate with the multidisciplinary team including OB, CNM, neonatology, and social work for complex or high-risk deliveries.
Complete thorough time-stamped documentation of all labor events, medications, fetal status, and provider notifications.
Participate in obstetric emergency drills and simulation training at least quarterly per unit protocol.
Active, unrestricted RN license in the state of practice; BSN preferred.
Current NRP (Neonatal Resuscitation Program) certification required.
Current BLS certification; ACLS preferred or required depending on facility level of care.
2-5 years of labor and delivery or obstetric nursing experience in an acute care hospital setting.
Demonstrated competency in electronic fetal monitoring interpretation using NICHD classification.
Experience with labor augmentation, epidural management, and vaginal delivery support.
Ability to independently manage 2-3 laboring patients simultaneously during routine unit operations.
Proficiency with obstetric EHR systems; Epic OB module experience strongly preferred.
RNC-OB (Registered Nurse Certified in Inpatient Obstetric Nursing) from NCC.
Electronic Fetal Monitoring (C-EFM) certification from NCC.
Experience in high-risk obstetric care including antepartum complications, multifetal gestations, or VBAC management.
Charge nurse or team lead experience on a labor and delivery unit.
Bilingual capability (Spanish or other language) serving relevant patient populations.
Electronic fetal monitoring interpretation (NICHD Category I, II, III classification)
Oxytocin management and labor augmentation protocols
Newborn assessment and APGAR scoring
Epidural and spinal anesthesia monitoring
Obstetric emergency management protocols (PPH, shoulder dystocia, eclampsia)
IV medication administration and fluid management
EHR documentation in obstetric platforms (Epic OB, Cerner)
Emotional intelligence during high-stakes, emotionally charged patient encounters
Calm, authoritative communication during obstetric emergencies
Cultural humility and individualized birth plan support
Collaborative teamwork with OB physicians, CNMs, and neonatology staff
Patient education delivery at varied health literacy levels
Resilience in the face of adverse birth outcomes
Labor and delivery nurses earn $82,000 to $106,000 annually across most U.S. markets, consistent with the national RN median of $86,070 (BLS, May 2023). RNC-OB certification, high-risk OB experience, and night or weekend differential pay can push total compensation meaningfully above the median. L&D nurses who also hold C-EFM certification are increasingly commanding premium rates given the liability implications of fetal monitoring errors. Source: U.S. Bureau of Labor Statistics, May 2023; PayScale, 2025.
San Francisco, CA ($115,000 - $138,000)
Seattle, WA ($107,000 - $128,000)
New York, NY ($104,000 - $126,000)
Los Angeles, CA ($100,000 - $122,000)
Washington, DC metro ($97,000 - $118,000)
Compensation packages for L&D nurses typically include medical, dental, and vision coverage, 401(k) with employer matching, 3-4 weeks PTO, and meaningful shift differentials for nights and weekends. Certification exam reimbursement for RNC-OB and C-EFM is standard at most hospitals. Tuition assistance for BSN completion and MSN programs is common at Magnet facilities.
Cannot categorize a Category III fetal heart rate tracing: Misreading an FHR pattern is one of the most common precursors to obstetric malpractice claims. This skill must be automatic, not effortful.
Has never participated in an obstetric emergency drill: Shoulder dystocia and postpartum hemorrhage emergencies require team muscle memory. Candidates who have not drilled these scenarios pose real risk.
Describes all births as "beautiful experiences" without acknowledging adverse outcomes: L&D nurses will encounter fetal demise, maternal complications, and birth trauma. Candidates who cannot discuss these realities with composure may not be prepared for them.
Unfamiliar with NCC certification pathways: While not all L&D nurses are immediately certified, candidates who are unaware of RNC-OB or C-EFM signal a lack of engagement with specialty standards.
Lacks experience managing the laboring patient through all three stages independently: Candidates who have primarily assisted rather than led deliveries may need substantially longer orientation periods.
Q What does a labor and delivery nurse do?
A A labor and delivery nurse cares for birthing patients and their fetuses throughout the intrapartum period. Responsibilities include fetal monitoring, labor support, oxytocin management, delivery assistance, newborn assessment, and emergency management for complications like postpartum hemorrhage. They care for two patients simultaneously.
Q What qualifications do you need to be a labor and delivery nurse?
A You need an active RN license, NRP certification, and BLS (ACLS often required). Most facilities expect 2-5 years of OB experience and competency in electronic fetal monitoring using NICHD classification. BSN is preferred. The RNC-OB and C-EFM credentials from NCC are the recognized specialty certifications.
Q How much does a labor and delivery nurse make?
A L&D nurses earn $82,000 to $106,000 annually in most U.S. markets, anchored by the national RN median of $86,070 (BLS, May 2023). RNC-OB certification and high-risk OB experience increase earning potential, as do shift differentials for nights and weekends at busy facilities.
Q What skills are required for a labor and delivery nurse?
A Core skills include electronic fetal monitoring interpretation, oxytocin management, newborn assessment, obstetric emergency protocols, and EHR documentation. Equal weight goes to soft skills: emotional intelligence, cultural humility, calm communication during emergencies, and effective patient education across diverse patient populations.
Q What is the career path for a labor and delivery nurse?
A L&D nurses advance to charge nurse, OB educator, or clinical nurse specialist roles (with MSN). Some pursue Certified Nurse-Midwife (CNM) programs. Management tracks include Nurse Manager for Women's Services and Director of Maternal-Newborn Services at larger hospital systems.
Q What are the biggest challenges facing labor and delivery nurses today?
A The U.S. maternal mortality crisis is reshaping L&D nursing. Nurses face increasing acuity with more high-risk pregnancies, staffing shortages that reduce safe ratios, and growing legal scrutiny of fetal monitoring documentation. Equity in maternal outcomes is also placing new expectations on culturally competent care delivery.