My pt was being induced with her 4th baby today. The OB and I suspected she could be fully from her tracing, but the pt was comfortable with an epidural and not complaining of much pressure and the OB told me she had to go discharge a pt on postpartum. I asked "Are you sure you don't want to check our patient first?..." (we don't do our own exams).
She said she'd be back in 5 minutes and left.
I went into the room and a few min later, the pt all of a sudden said "the baby is coming". I threw on some gloves lifted up the blanket and she was right! The head was about half out. I pulled the emergency bell and the husband went to grab a resident while I supported the head. The resident got there in time for the posterior shoulder delivery. All in all it was fine - No lacerations, apgars 9/10.
The part I felt awful about was that her foley was still in and then while pushing, either I tugged on it in a panic or just the force of her pushing (Or a combination. I really don't know - it all happened so fast!) pushed it out with the bulb still inflated! Ouch!! I cringe thinking about it. I had the OB look her her urethra and she said it was fine. 2 hours after delivery I got her out of bed to void and she peed a good 550 cc for me, no issues or pain. So hopefully it's fine (?). I'll go check on her tomorrow in postpartum.
I guess I should have just not touched it at all as she was pushing (though it may have still come out inflated just from the force of her pushing). If there was time, I could have cut the tube with scissors which would have deflated it, but there was definitely no time for that.
Anyway - the whole thing just left me so keyed up and anxious and guilty - I felt like I was going to throw up!
The OB felt really guilty for missing it (Honestly she never should have gone to postpartum. And now I feel guilty for not insisting harder that she stay, even though I know that's part not really my fault)
The Pt was fine with the whole thing though. I think honestly she thought it was funny.
I'm just still a little traumatized b/c on orientation they told us a horror story about a nurse who pushed with a pt with her foley in and the pt ended up incontinent or something (I don't remember details - all I know is it traumatized me and has made me super careful about foleys. They freak me out!)
I just keep having flashes of damage I could have done to her body or the baby with that delivery.
Everything seems ok so far.... Praying it stays that way....
