It was change of shift, and I was just starting out my shift on L&D. *Annie and her husband *Frank (*names changed*) had also just arrived on L&D. Annie had noticed some vaginal bleeding, and she and her husband were concerned about this, so they decided to come in to be evaluated.
Annie had a known history of a partial, but stable, placental abruption. I walk in the room to find two nurses valiantly trying to establish an IV site and maintain fetal heart tones.
**thump...thump...thump**
The fetal heart monitor is kicking out a too slow rate ~ about 80-90 beats per minute. Oxygen is on and one of the nurses turns Annie on to her side.
**thump.........thump..............thump**
Even slower.
I jump in and deftly insert an 18 g IV site, pulling various tubes of blood off of the line, then hook up IV fluids.
**thump..................thump............................thump**
Slower and slower.
We race Annie back to the OR. Her poor husband Frank, bless him, understood the implications of what was happening.
Everyone is rushing around in the OR, working to get Annie transferred to the OR table, catheter placed, instruments at the ready. Annie looks around, about ready to burst into tears. I'm on the phone with the NICU, telling them we have a STAT c/s for an abruption, hearts are down.
I walk over to Annie, get down close to her ear, gently touch her arm and hand, and whisper to her:
"My name is ____. I know it's very scary right now, but we're doing many different things at one time to help get your baby out. You're going to feel the catheter go into your bladder in just a second here - it's going to burn and hurt for a minute. Cold gel on your belly as we listen to your baby's heartbeat - listen to that! It's up again at 120 beats per minute. That's very good!"
Annie nods her head, tears welling in her eyes. "His name is Matthew."
"The baby?" I ask her.
"Yes, his name is Matthew."
"Annie, we're going to work very quickly now to get Matthew out, and we will take very good care of him and you. You're going to go to sleep in a just a few seconds here, but I will be with you and Matthew the whole time."
"Save my baby," she says, as we tightly grip each others hands.
Cold antiseptic solution is splashed on her belly as Annie is quickly put under general anesthesia.
**incision!**
**membranes ruptured - bloody fluid!**
**baby!**
An immediate lusty cry is heard as baby Matthew is born.
Audible sighs of relief can be heard throughout the room as Matthew is dried off and assessed by the NICU team.
Frank, now a proud new papa, is escorted into the OR to greet his new son.
**smiles**
A very positive outcome for a situation that could have been much more dire.
Times like these make me feel very honored to be present at the amazing miracle of birth.
Happy birthday Matthew!
22 comments:
The words you said to momma brought tears to my eyes. Thank you for taking the time to connect with her. If this situation ever came to me, I hope someone would demonstrate such compassion for me.
Well done! :) I would have loved working with you! :)
Wow, how scary, but how wonderful that the family had you connecting with mom and a wonderful team to help them.
On a different topic, I have a question for you, as if you have time, I know! Trying to decide between home birth and birth at a birth center attached to a hospital. What are the problems that could potentially come up at home that would happen so quickly it really would have been better to be at a hospital, the serious situations where there is simply no way to predict early enough and do a transfer? If you have the time to answer this, I really really will appreciate it! By the way, thank you for taking the time to blog and share/educate women on this very important topic!
Thank God for a good outcome...my last abruption did not turn out so good. =(
Love that you took a moment in such chaos to speak with her and let her know what was going on. Sometimes we forget to do that when we are all running around frantically trying to save a baby's life! Wish you worked with us! =)
Johanna: the things off the top of my head that could happen, where you would need immediate access to an operating room: cord prolapse (rare, but very life threatening to the baby), placental abruption (may or may not have signs that this is happening, in time to get to the hospital), vasa previa or rupture of placental blood vessels (major hemorrhage, baby will die if not born immediately).
(Not to scare you - these things are very rare!)
A dear friend of mine and her baby nearly died recently from a placental abruption. She was driving in her car alone and thought her water broke, looked down and saw blood just pouring out. She wasn't far from the hospital so she drove herself there. They put her in a wheel chair and raced her upstairs from ER to L&D, leaving a trail of blood the whole way. Terrifying experience but she and baby are fine.
I love what you said to the mom. I also had an abruption, though I was already in L&D when it went full-on. It had been a small, stable one for about 12 hours, and then the nurse came rushing in, telling me she'd been watching the monitors at her station while she was eating lunch, and it looked like I was having an abruption,so she needed to feel my uterus to see. She had already paged my doctor, who arrived within ten minutes, and they got me to the OR with time for an epi, so I was awake for it all, including watching the suction reservoir fill up with my blood, not being able to swallow, (and almost needing intubation), seeing my baby for exactly one second before they rushed her off to the NICU, and hearing my doctor say to the assisting doctor about the placenta "Wow, look at that. It just came right out." My nurse stayed with me the whole time and reassured me and held my hand until my husband was allowed in.
My daughter, born at 32 weeks, is now almost five and healthy. I'll never forget the nurse who saved her, and me, and I'll never forget her kindness and calm efficiency. She made an unthinkable situation a little more bearable. I know your words to that mom will not be forgotten either. Thank you for being the kind of nurse who takes that two seconds that make a world of difference to the patient.
I feel that often times, the mom is overlooked during the emergency. She has these complete strangers telling her to do this, do that, and are poking her with needles and a catheter. They're lifting her gown up and exposing her for the world to see. She's in a cold, sterile environment with lots of noise, surgical instruments, and medical equipment.
It is downright FRIGHTENING for a woman to be in that situation. She's scared for her life, her baby's life, and her husband has been separated from her.
I can only imagine what a woman must feel like in this situation. How hard is it for one person to be that calm in the storm?
Even in an emergency, we (care providers) cannot forget that there is a very scared woman in the center of that emergency.
This is not the first time I've done this for a woman in situations like this. And it won't be the last time.
Adressing the mother is an incredible thing you have done. It is often forgotten in a crisis and might end up with a traumatized woman.
I was brought to the ER by an ambulance after childbirth and have been experiencing postpartum hemorrhaging. I was extremely anxious and did not by any means understand the critical situation (trip to the hospital was due to unexpected, unwanted, unassisted childbirth, not the PPH in the first place). I was feeling fine (though my vitals and CBC were really concerning - but what did I know). There was a young resident and 20 nurses, most of which just starring at me, not doing anything (probably waiting for a code to be called). A history of child abuse made me unable to tolerate any vaginal exams etc. I was terrified and firmly refusing treatment and awaiting the arrival of my midwife which I trusted and which was on her way to the hospital where she was originally supposed to delivery my baby. The staff was really frustrated and upset and almost verbally abusive with, pushing me to get their hands between my legs, only telling me that I was not fine (which I felt I was, thus not really buying it). No explanation, nothing. They had to wait for quite a while not being able to do any intervention except IVs since I was petrified and insisted of the staff to leave. If one of the 20 nurses that were standing around would have been taken a minute to calmly talk to me (next to me at the side of the bed and not with her hands ready to slam into my vagina), explain the situation and what was supposed to happen and try to get me take some deep breaths (not sure if that would have been possible, physically) I might have calmed down enough to absorb the situation I was in and to get through the necessary procedures with her talking me through them. Nurses and the resident had been informed about my child abuse trauma by my husband upon arrival who knew about my inability to cope with exams, thus it is not that they did not know where my fear came from. This would have been ways more fruitful than standing around, doing nothing as I did not allowed to be touched anywhere except my arms.
BTW, my husband, also not informed at all about what was going on, told me that my CNM was on her way and that I should keep refusing treatment until she was there as he knew she would be able to calm me down and make the events less traumatizing. Little did he know how critical my situation was.
Though this event has happened long ago, I still am awake each and every night, not being able to sleep and my mind racing through the events of that night, feeling re-traumatized.
What you did for this woman, even though it seems like a relatively small thing is priceless. Please keep up with what you are doing and think about the women as well. They are mostly forgotten about in today's birth culture in the US. You really make a big difference for each an every one of them when you do that! Thanks!
dang it, AYC...you made me cry. Tears were squirting as soon as I got to "His name is Matthew."
My former OB lost a baby during the same scenario, while I was pregnant with my 6th. Almost the exact same scenario with the exception of the happy ending (my friend worked on the unit and told me when I expressed to her dismay at this OB suggesting I schedule a C-section for no reason).
So happy to here all was well this time!
@Anonymous with the horrid ER experience: I'm so sorry to hear that no one - NO ONE - stopped and thought to actually talk to you about what was going on, and what to expect. I could not imagine having all of those people trying to descend on you without at least saying something about what was going on.
All I can do is put myself in the woman's shoes: how would *I* want to be treated in the same situation?
Very touching story. And SO important to remember to talk to the mama. Great job!
My daughter was born by emergency c-section in August for non reassuring fetal heart tones and faluire to progress, really more faliure to wait and being told to push before baby was ready. That is besides my point.
I had a real rough labor, my epi was not working from the minute they put it in. I told my nurse she did not listen to me. I had been in pain for three days straight and no body could tell me what was going on. Towards the end of my labor I was begging for it all to be over with, I was exhusted, scared and in pain. When my daughters heart rate dropped and I was told I needed a section the nurse said to me "Be happy you are getting what you want."
Becasue my epi was not working I had to be put out. Prior to being put out no one not the doctor or a nurse cared to see if I was ok. I layed on the cold OR table and silently cried to myself.
Coming out of my c/s I had difficulty breathing and needed to be brough down to the main hospital recovery floor. No one told my husband this had happend. No one told me what I had, we choose to be suprised. It was 4 hours after and in my hospital room that I found out I had a daughter.
I struggled for months, and even struggle now with the fact that I had a c-section. I think that if I had, had a kind, caring nurse such as yourself things might have turned out diffrently.
It is because of my experiances that I have decided to become a nurse. Someday I hope to be the nurse that I did not have in one of the most terrifying yet exciting experiances of my life.
Thank you for sharing this story.
Amanda - I'm so sorry that you went through such a difficult time with your birth. You should also contemplate writing a detailed letter to the hospital administration. Inadequate pain relief, when you ask for an epidural and receive one, is intolerable. No one telling you what was going on in your c-section - also intolerable.
I'm very, very sorry that you had such a negative experience with your birth. xoxo (hugs)
The day that you wrote this, a micropremie was born due to a placental abruption. Unfortunately it didn't have a good outcome. Still, I felt honored to care for this patient in her time of need.
Although, I am still having a hard time, a few days later.
Keep up the great care:) You inspire me.
I really enjoyed this blog post. I am a new graduate nurse and I start the most coveted of jobs (which I've been assured all through my schooling NO new grad gets!) at a busy L&D floor next week. I had a very positive natural childbirth experience in a hospital almost 7 years ago, which set me on my path to becoming an L&D nurse. I have been a doula since then and have witnessed many friends and relatives have poor nursing care, so I have seen first hand exactly the kind of nurse I will NOT be. Reading about how you focused on this mom and made her experience a priority brought tears to my eyes, and I saw a flash of the type of nurse I plan to be. How did your coworkers react to your actions? I've seen many nurses be callous about how scared a woman can be about something "that's just not a big deal" and I wonder if you ever get a hard time from people who think you are too much of a softie?
Deconstructing Venus: some nurses get used to the "routine" of how things are done on the unit, and do forget that there is a very scared person that is on the operating table! However, and I didn't mention this in the post, one of the other nurses present at the c-section had looked at me and said "thank you for taking the time to talk to her" right after she was put under general anesthesia.
So, yes, other nurses do notice and care too. It's just often overlooked during the hustle and bustle of the emergent situation.
It is so important to take care of the mother's emotional needs in such a situation. There are many researches that state that a 'traumatic birth" (can be a routine birth in the eyes of the provider, with complications that can be controlled easily) leads to an increased chance of PPD and even PTSD. Both has an effect on how the mother can take care of the baby and the bonding.
I wonder why there is not a nurse assigned routinely to comfort/inform/educate the mother. The emotional health should be seen as a part of the overall health outcome of the mother (or patient in general in an ER setting) during the hospital stay and should be part of the main care plan.
I think many doctors and nurses are not really realizing the short- term as well as long-term psychological effects that their care can have on the patient, even if it seems a routine intervention for them.
Taking the particular vulnerability of sexual abuse victims (which is a large group though most remain unidentified) in the labor & delivery setting into consideration, it becomes even more important to avoid re-traumatization (a thing which again only very few providers be that doctors or nurses are aware and familar of). An emotionally stable and not traumatized mother is of high importance for the well being of the baby.
You are doing a wonderful thing for those mothers. I hope your example will teach many more to make this a priority in addition to the actual medical care that needs to be provided.
Wish this topic would become a more visible part in the education of nurses, CNMS and MDs to improve the overall healthcare that is provided at hospital settings.
I'm so relieved that Matthew and his Mom lived. I lost my baby when pregnant and when she said "Save my baby", I knew her fear.
I love that you went to his Mom and told her what was happening and that you would be with her the whole time.
Thank you for this. I have been recently talking to many CB Professionals about how to STILL make a woman feel confident of the decisions happening/being made while in emergency settings. I will be linking to this soon.
oops, at wonderfullymadebelliesandbabies.blogspot.com/
I had almost the exact scenario with my first birth with the exception that I was able to have a spinal block instead of general. My baby spent 6 days in NICU but has been perfectly healthy since. I was under the care of a CNM at the time and she was AWESOME. She coached my husband on supporting me with the need for a c/s (which she knew was not my plan), she stayed right with us the entire time, and even took pictures of the birth (after asking for our camera since neither of us were thinking of pictures). She and her back-up OB came to me the next day and the first thing they told me was that I was a great candidate for VBAC with my next birth. Two years later, I had that VBAC with the same practice. So thankful for people like you and her that care enough about their patients to meet more than just the physical needs.
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