OB in the ED

  1. Alright this is just a quick question for the ER nurses here. Last night I had a really busy shift on OB, which is where I normally work. At the hospital I work at patients can only come in through the ED which I guess is pretty common (and much more safe), each time someone comes in for maternity, the lady from registration calls me and tells me that my patient is on their way up. Many times (unless the ED is really busy) a few minutes later I get a phone call from a nurses telling me what the patient is doing... my question is why do ED nurses get so nervous and upset by pregnant women. I understand thats not what they deal with everyday, but when the patients water breaks while she's waiting for the registration women to help her, she's not going to have her baby that minute usually. I get phone calls all the time saying "OMG her water just broke, what do I do, I don't know if we're going to get her up there in time, we're calling the resident." I try not to, but every once in a while I giggle, and just politely tell them that to bring the patient upstairs. (I work in a very small hospital, it takes about 2 minutes to get from the ED to maternity) I understand that for people who aren't around OB all the time it's a little scarey, but the number one thing to remember is to stay calm just like you would for every patient (even if her water broke and almost splashed your foot) usually the Mom is so embaressed that when people start getting nervous she starts to get really nervous. The thing I try to keep in mind is that whether or not we want it to happen (patients that are really early) or not, if the Mom is in late labor, the baby's coming whether you like it or not... with our with out you. Sorry, I just needed to tell someone how I felt even if you don't agree, I just get so much more stressed out when the ED is calling me four or five times to tell me that the patients water broke and she's going to have a baby... we know, just get the patient to the unit. Hope you all are having a great day!!
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  2. 20 Comments

  3. by   traumaRUs
    I think its just the inexperience in L&D that most ER RNs have. I never liked L&D myself and during my 10 years in ER, still didn't want to birth no babies. Unfortunately, I birthed three because:

    1. First girl was 15 and coudn't be pregnant, it had to be her appendix - this from very worried parents. Mother then was upset that girl didn't wait until she was a little older.

    2. Second was very similar case, only girl was 12!

    3. Third was lady in her 40's who said that she had to have a BM. Well, something just made me look "down there" as I helped her on the bedpan and low and behold there was a baby!!!

    Sweated bullets with each of these. Yet, I could handle horrendous traumas, full arrests, MIs, CVAs, sudden deaths without batting an eyelash.
  4. by   JeanettePNP
    (sorry trauma) Pet peeve of mine: The mother births the baby. The caretakers assist. Thank you.
  5. by   lovemyjob
    So mom can take care of the shoulder dystocia while the caregiver stands to the side with a warm blanket......to assist.


    I can see why someone who has little experience with OB could be very anxious about a mom potentially birthing in the ED. Moms registering, water breaks, cord get compressed under the head/butt (depending) and things go downhill. The potentials are endless.
  6. by   JeanettePNP
    Yes, the caregiver assists the mother with shoulder distocia so she can birth her baby safely.
  7. by   HappyNurse2005
    LOL, i'm a L&D nurse, and we've occasionally had precip deliveries in the ED.
    which shouldn't happen....
    if a woman is over 20 weeks pregnant, she walks up and tells the registration person/triage nurse (there's a desk and directions) and her complaint is noted, due date and doctor noted and OB is called, and we tell them to bring her up to OB triage. of course, if said complaint is "a broken foot" then she'll stay in ED. Respiratory distress-stay in ED, we'll come put her on our portable monitor.

    Though, fairly recently, there was a woman who came in with abdominal pain. Didnt say she was pregnant so went to the ED. She was pregnant, term and ready to deliver. no time to run her up the 3 floors so they called the residents and a nurse down.
  8. by   Sugar9486
    I guess I should have been a little more specific, a downfall of mine. I'm talking about the Mom who has had a normal pregnancy, no problems thus far, has called her OB and told them she is on the way, she gets into the ED and her water happens to break right at that time (you would think the odds of that were low, but it happens all the time to us, I think Mom's realize that they are in the hospital and start to relax a little bit and thats why it happens in the ED... We have around 100 births a month.. not very many, and I only work 2 or 3 days a week because I'm going to school, and I still get phone calls like this from the ED like 3 times a week) as far as all of us know, she is a normal pregnant Mom in labor and the ED is going crazy... Yeah, complications happen, and thats no good, which is even more of a reason to bring the Mom to Maternity ASAP instead of talking to me about he amniotic fluid on the floor. I agree that The Mom gives birth and the caregiver is the one that assists... yeah shoulder dystocia happens but usually thats because the baby is too big, and at that point there isn't much that the OB doctor can do either
  9. by   LeesieBug
    One thing to consider is that the nurses are feaking out not because they CAN'T handle the situation, but because they don't WANT to !:wink2:

    Honestly, I think this just boils down to the fact that it is natural to be uncomfortable with things you don't normally handle, that you did once or twice in nursing school clinicals (however many years ago). Just like ED nurses can get called to med surg for things somethimes that they are not comfortable with.... Or the fact that with a patient having a million drips going and on a vent, a CCU nurse will be more comfortable handling the pt than an occupational health nurse or a rehab nurse....or an OB nurse

    I don't really think there is a whole lot of mystery to your question. Although,
    I'm not sure about the freaking out part... I don't think i have ever seen a nurse in our ED freak out...in the way you are describing, anyway.
    Last edit by LeesieBug on Jan 21, '07
  10. by   Sugar9486
    I figured that would be the answer, but I was just wondering if there were any strange things in nursing school that made you scared to handle it or whatever. The thing that always gets me though is when the nurse in the ED says well her water broke, she's going to have her baby right now, we don't know if we can get her up there I'm going to call the OB resident... ok the OB resident along with the rest of the residents live in appartment that are not in the hospital, it takes them 10 minutes or so to get dressed and get in... what I keep explaining to them is (9 times out of 10) their OB doctor is here, he is expecting her, just bring her upstairs.. getting her upstairs is quicker then bringing in the OB resident. Then when she gets upstairs they check her and she's 3 cm and her waters broken.... I love the ladies and men in my ED and they do a great job, but sometimes I wonder when it comes to OB patients thanx for all your imput
  11. by   JeanettePNP
    I did not have to go through the ED when I gave birth. We were told to use the ER entrance if we were coming in middle of the night but to go straight up to OB. Wouldn't it be simpler to direct women in labor straight to the OB floor rather than tying up ER nurses?
  12. by   Sugar9486
    Quote from ChayaN
    I did not have to go through the ED when I gave birth. We were told to use the ER entrance if we were coming in middle of the night but to go straight up to OB. Wouldn't it be simpler to direct women in labor straight to the OB floor rather than tying up ER nurses?

    I also forgot to add that I work nights, so yes during the day we have patients go straight to the floor (well at least for now, out hospital is talking about not letting anyone past the second floor (Main Floor) unless they are accounted for on one of the other floors) but during the night only the ED entrance is open sorr about that
  13. by   lovemyjob
    Who on this site actually thinks the doctor/nurse births the baby?

    No one.
  14. by   hispanicpanic
    As an ER RN who has worked triage on countless occassions I can tell you that it really doesn't have as much to do with being scared of the baby being born with us as it is a matter of resources. Similar to a critical pt which pulls many resources from a busy ER we in the ER do not have the equipment to monitor the fetus appropriately and safely. Because of lack of proper equipment this situation also pulls an ER nurse into that room and prevents her from juggling the multitude of tasks required of her for all of her patients. The ER Docs don't care that the woman behind curtain 2 is having a baby, why haven't you given the medications he/she ordered to bed 4?!?! I've worked ICU/BICU and now ER. I float to pretty much all floors and the one thing I've realized is that until you spend a shift mirroring an ER nurse you can not imagine the multitasking and constant reprioritization that must go on...and never stops. Unlike the floors are department is never full.

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