Bad Week...

[fourbirds4me]

Had a phone call about 0330. Pt stating she had woke up around 0130 with a severe HA and that she was being followed for PIH and what should she do. Of course I advised her to come in ASAP. I reviewed her prenatals and hx. She had been coming in twice a week for NSTs because of AMA and PIH all labs had been fine and she had a reactive NST and 8/8 BPP 2 days prior. When she presented to the desk her face was very puffy also c/o epigastric pain. She reported + FM. Based on that information I collected a CCUA and sat her down on the edge of the bed and did BP's in both arms (150/90's) before applying EFM.

What happened next is basically my (and probably all of us) worst nightmare. Could not get heart tones. This was confirmed by US (particulary nasty tech who also assigned the 8/8 BPP... but that is another story). The pt and family were devastated. I was also there with them for the delivery the next evening. I just want everyone to know that we have no idea how much power and influence we have in people's live until situations like this.

I know this was a total against the statistics case and there was nothing else we could have done for this couple. However, I find myself losing confidence in our US department.

Also, one of the new nurses said to me that she had learned her lesson. She would always apply EFM before doing anything else. I tried to explain to her that you had to go by what the presenting complaint was and set priorities accordingly. But of course am questioning myself about that too. But again would be questioning myself the other direction if she had seized while applying efm....... not that the heart beat dissappeared in the 5 min it took to get a urine and a BP... or that the outcome would have changed if it had.

Anyway... am rambling now... just needed to decompress...

[SmilingBluEyes]

I think you did everything appropriately. I am so sorry about their loss. Devastating. I am sorry we have to get involved in painful situations like this. (((((hugs))))) you have my thoughts and sympathy. Hang in there. Hopefully, tomorrow will be better.

You were right to talk about it---even if it is to us. Smart move.

[Audreyfay]

Even if the first thing you had done was to call in the OR team when the patient called you from home, the outcome would have been the same. I had a tough time dealing with fetal demise when I worked in OB. Take care of you. :kiss

[SmilingBluEyes]

We all feel helpless and sad at the occurence of a demise. Everyone feels this way.....

All you can do is pick up the pieces and learn what you can-----and know you did all you could for your patient. My heart breaks in situations like this. I hate this part of OB so much.

[USA987, MSN, RN, NP]

I am so sorry...my heart goes out to the family as well as you.

[babyktchr, BSN, RN]

You are right, it is a nightmare..for everyone involved. Glad you came here to decompress.

You did everything right. No one could've anticipated a demise...seems the mom was getting sick very quickly, and as we all know, hypertensive issues can present suddenly, with little warning.

Remember, dead babies can move. Moms perceive motion when, in fact, the baby has died and they feel it moving when they change position. It was a lesson I learned very early in my OB career.

Do take care of you. It takes a lot out of us when there is a loss and having to deal with the parents and how you feel yourself. As nurses, we look to heal others, but seem to always forget about ourselves.

My thoughts and prayers are with you and the parents of this little one.

[JaneyW]

I wouldn't question anything you did. You acted exactly right. The baby might have been gone for a while before she developed the pther symptoms. Like ktcher said, moms can feel dead babies move--kind of a rebound effect. I have also had a full term demise where I thought the baby was moving as I was trying to find heart tones. It was just the body coming back at me when I pushed down on her abd.

This will stay with you a very long time. I still think about that family often. There are often no answers.

[RosesrReder, BSN, MSN, RN]

So sorry you had a terrible week. Hope it gets better.

[NurseNora, BSN, RN]

I get mom's vital signs before, or while, putting on the EFM. The baby is there or it isn't. Moms have very little tolerance for having their VS taken after they realize you can't find the baby's heartbeat. And the results you'll get will be strongly affected by the patien'ts emotional state and not truly relfect her status. I learned this lesson the hard way.

You did the right thing. Be gentle with yourself.