Help! question about complications at a birth

[cathalenem]

Hi

We had a patient Gravida 4 para (now 4) Her first child was born c-section, the rest vbac. Her labor was induced. While laboring she suddenly got short of breath, sats dropped to 80's pulse 120's the baby decelled into the 40's then the fhr was lost for a few minutes.(they prepped for an emergency c-section) The mother was given O2 via mask, repositioned several times. She complained of numbness in one hand and in the face. Also she was having continuous contractions even after pit was stopped. They put fluid up into her uterus and anyway, the fhr increased and the mother recovered and was able to have the baby without c-section by vaccum extraction. The baby was meconium stained but is ok. However, the mother, who is very healthy (a dietician) otherwise is still complaining about her heart occasionally racing and it is documented that it get's in the 110's 120's. I am not an OB nurse and really would like to know why this happened. Any replies would be very much appreciated.

thanks

Cathy M

[fiestynurse]

It is O.K. to induce for a VBAC, with the proper precautions. She had a history of successful VBACs, so she was a good candidate. In the past, inductions were thought to be unsafe for VBACs, but studies have shown this not to be so.

[rn500]

Originally posted by feistynurse:

They resuscitated the baby inutero, with the saline flushes into her uterus. This is a fairly new technique that is being done more and more with great success.

feisty, I have been an L&D nurse for 13 years now, and I'm trying to figure out what you mean by "resuscitating the baby in utero" with saline flushes. Are you talking about amnioinfusion? Or is there some other procedure that I haven't heard of yet? Granted, I've been working in a small hospital for the last couple of years, but I've never heard of amnioinfusion referred to as resuscitation.

Linda

[fiestynurse]

Yes, Amnioinfusion is what I am referring to and it brings the baby's heart rate back to normal, thus "resuscitating" the baby in utero, so to speak. I heard a Perinatalogist use this word when he was explaining amnioinfusion at a seminar that I attended. The procedure was relatively new at that time and not everybody was buying into it. It made total sense to me, especially when he compared it to resuscitating the baby post c-sect. instead. We sometimes explain it this way to patients or inexperienced staff to help them understand why we are not running to a c-section. It is a term they seem to understand. Sorry, I should have explained more.

[ June 01, 2001: Message edited by: feistynurse ]

[klieben]

OK guys, I just had to put my two cents worth in for small hospitals. All are not scarey nor are they bad. People can and do have safe and healthy births in small hospitals too! Our poor new nurse that started all this can learn and be an excellent Ob nurse if she wants to, even in a small hospital! Not everybody lives in a place where they have the option or the desire to work in a big high risk center! I work in a small OB unit that does between 20 and 35 births a month. We staff with 1-2 RNs per shift depending on census, though we do always have two on when someone is in labor, especially high risk. We depend on the surgery staff to do sections, and they are fast and they are done well. At night and on the weekends, we have to call them in from home to do a section, but that just makes us more likely to call them in and then not use them. Face it ladies, how often does a healthy low risk mom need an absolutely stat section? Not too... And we have excellent outcomes. Of course, because we are a small hospital we don't do the really high risk stuff that would necessitate stat c/s more often, and neither should this little hospital our firend works in. Nurses that work in small community hospitals are excellent nurses because they have to be so able to handle a lot. So, if this small hospital is where you want to be because it in in your home, or you don't want to live in a big city (god forbid) then stick with it! But you do have to learn a lot and don't be afraid to ask questions when they come up.

[cathalenem]

To Alaskakat

Thanks for the encouraging reply! Just curious, you live in Ketchikan AK? I had a teacher friend up there years ago from Shonebar jr. high(I know this has nothing to do with nursing) I would like to talk with you more, and also am interested in nursing up in Alaska and your area. please write to me at [email protected]

thanks!

Cathy

[janetrnc]

I agree, small doesn't equal bad. Nurses from smaller facilities can practice good nursing care. We too, depend on OR for C/S, our average is much less than standards. We save time by having the house supervisor open up the packs, the L/D and Nursery nurses transport the patient, get her on the table, hookup up as much monitoring equipment as they can, we keep a fetal monitor in the OR, so when the team gets in, a lot of things have already been done.

[canoehead, BSN, RN]

Hey, if it was PE what explains mother's apparent excellent recovery, and the continuing (and intermittent) racing heart postpartum? Has she been on a cardiac moniter during this time?

I put in a vote for PSVT, it could account for the mom's and baby's symptoms, along with the apparent recovery and ability to deliver lady partslly afterwards. Perhaps observing the mom you might find vagal manuveres shorten the episodes. Has anyone noticed any factors that bring on the racing pulse, like caffeine or stress?

Just another point of view.

I work at a small hospital too, where the OR crew, and the doc, is oncall at home. Any mom's that are high risk (possibly needing a section or neonatologist in a hurry) are referred to a larger centre. Your responsibility with the ones that remain would be to get them to the OR in a timely fashion. If you are working at a small centre you can't be held liable because someone else wasn't on the ball. Make sure the patient needs to wait for the crew, not the other way around. I check for c section prep supplies and paperwork at the same time as I check for emergency equipment, and have the doc's number at the bedside (taped to the back of my name badge). Generally on nights there is only one RN, plus the shift sup for backup, and it can get hairy but I like the independence, and end up with more natural (and enjoyable) deliveries than I saw at a larger centre.

[Mermaid4]

What about spontaneous cardiomyopathy post birth, which happens without warning and for no good reason?

[BETSRN]

I am in the medium size community hospital (without residents,thank God) but the experience that has been described is unacceptable. GET OUT OF THAT LITTLE PLACE! Remember that your nursing license is on the line if your name even appears on a chart with a less than favorable outcome!! We do about 800+ deliveries a year but there are always at least 4 of us on (except if we have absolutely no patients). If you have to crash someone (and there is no scrub tech readily available, then that section takes a minimum of three nurses even before you start. SEe why it is unsafe to be where you are?

[veteranRN]

Could it have been something as simple as hyperventilation creating all the other symptoms?

[Mermaid4]

Yep, my thought as well...And while it is wonderful and possibly necessary to have four people on, it just doesn't always turn out that way. Not to mention at what point of the labor it is or any one of a number of factors that weren't discussed in depth..

[SmilingBluEyes]

I wonder, nearly 4 years later, if this person is still working in the same place? It would be interesting to see how things have turned out.