What are the odds that two different potentially catastrophic obstetrical emergencies could happen within just a few days?
It makes me wonder.........
One cord prolapse after SROM, and one spontaneous uterine rupture (no labor), all in a span of just a few days. Seriously! No precipitating factors, and not caused by medical interventions. Just....BOOM!
Wow, wow, wow. I'm constantly amazed at how normal things can turn bad in a moment.
I have honestly only ever seen two uterine ruptures in my 9+ years in OB. Just two! One with no prior uterine incision, one with a prior incision.
Cord prolapse? I can count on one hand how many of those I have witnessed in my years as a nurse.
That's how rare these two events can be. Some nurses never see either event in their career. I'm just so grateful for such fantastic co-workers who pull together in emergencies like these. We can get a baby out in less then 10 minutes, from the time a cord prolapse is discovered. Everyone does their role beautifully.
Best of all? We have some of the most amazing maternal and neonatal outcomes!
I'm so glad to experience not only the good in my job, but also these dire medical and obstetrical emergencies. I believe that these experiences will help me to be the absolute best nurse-midwife I can be in the future.
12 comments:
Wow, I totally understand! Good job!
Whenever I think of those who think homebirth for low risk women is completely safe...
The POTENTIAL for catastrophe is ALWAYS present, which is why I cannot condone delivering outside of a full-facility hospital. Granted, hospitals could be a lot more "user-friendly"...
I'd be interested to hear if that no-labor UR was in a scarred or unscarred uterus. As for the potential for catastrophe...I'll take my chances at home, thank you. Scarred uterus and all. Antigonos' comment reminds me of a Facebook conversation I witnessed the other day between a friend who had a successful homebirth and her former college roommate who is now a CRNA. The CRNA claimed that laboring women should NEVER eat during labor due to the risk of aspiration based upon her experience with two true-emergency stat GA cesareans.
Talk about throwing the baby out with the bathwater.
And, yes, hospitals certainly could be a lot more user friendly.
Yikes! Not good! I have yet to witness a uterine rupture. I hope I never do! I was unfortunately on the recieving end of a cord prolapse. Like you, we have a team that works beautifully together and usually have good outcomes.
Over the past year, I did however have a mom in a MVA & a mom with a dissecting aortic aneurysm. Scariest thing doing chest compressions and cutting into a mom at the same time. Both moms did not make it...one of the babies did. I hope I have no more codes anytime soon!
I have seen a couple uterine ruptures but in approx 6K deliveries that I have been involved in...that is actually very small %. Same with cord prolapse. And one mom that died of amniotic fluid embolism and one that lived. Also 2 babies that died of Beta Strep infection (untreated GBS+ mom) and one mom that died of Strep A (not hospital aquired btw) - uterine infection post partum. I still feel that home deliveries can be safe enough given the percentages. HOWEVER. Personally - would I ever do it? no, I wouldn't-if I were to have a baby I would pick a family friendly hospital- I just couldn't take the risk. Our province has a good number of these and I have worked in at least 4 that are very family friendly with minimal interventions.
Although I have seen too much of what can go wrong... I wouldn't stand in the way of those women who would want to, and given the stance of our government who states that women CAN deliver at home....well...it renders any argument moot here.
The no labor UR was in a previous scarred uterus. Total, sudden, little warning uterine rupture. She presented with complaints of abdominal pain. (Which I might mention, is a very common complaint we see on L&D.)
Did your pt. with the cord prolapse have a c/s?
I had a cord prolapse and it was quite an experience! The house anesthesiologist didn't answer the stat page and the OB said they couldn't wait around for him (I'd already gotten the epi.). I dilated from 5 cm. to 10 when the OB tried to push the cord back in. He had me push, the nurse pushing on my stomach and his hand in almost up to his elbow manuvering my daughter out.
The staff remembered me for all my subsequent births after that.
At Your Cervix: In light of your recent unpredictable OB emergencies, what do you think of free standing birth centers and home births? I think most hospitals are antagonistic to a "best outcome" for mom and baby, and we have a birth culture of "fear," but what about these two emergencies that were greatly lessened by having an OR right next door and immediate access to surgeons? Curious, with your midwife training, what your professional opinion is. Thanks!
I don't have any opinions on this, just curiosity.
I'm a nursing student and I start my senior year on Monday. We finally get to do a clinical rotation in L&D and I'm so excited about it. I just found your blog recently, but I hadn't had the chance to read any of it until today.
Thanks for posting. I think I always thought of L&D as a happy nursing position, because it's where life begins. There are so many things that can go wrong so quickly so it's great to read about L&D from someone who actually works there.
Antigonos, you seem to miss the salient point. My baby is far more likely to suffer hospital related complications and become injured or die, then he is to suffer either of those two rare events in a responsible, attended homebirth. It's a shame you don't get simple math.
Has to wonder if the mom who had the UR with previously scarred uterus was planning a cesarean? I'm assuming that was her previous scarring, but it could've been something other. I've heard the argument so many times that people plan repeat cesareans because they are scared of rupture, yet no one seems to tell them they have a .2-.3% chance of rupturing even before labor starts.
Wow! Less than 10 minutes?! Kudos to your OB unit!
Post a Comment