My first precipitous delivery - freaked out!

Specialties Ob/Gyn

Published

Specializes in L&D.

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....

I guess everything is a learning experience.....

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Your story is one of hundreds that I read and commit to memory from this website. Thanks.

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Thank you for sharing. I almost had my baby in bed twice because no one really believed I was about to have a baby.

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Oh my, bless your heart. That sounds really scary; you got my heart pumping just reading it! While a lot of things COULD have gone wrong, you handled it the best you could and it all worked out. I would think the pressure of pushing would be more than enough to push out the balloon. Try not to be so hard on yourself and be thankful mom and baby are doing great. Just take this as a learning expierence.

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I've seen Foley's pushed out before; no complications after. Babies come when they come; it won't be your last precipitous delivery. Nurses don't generally do exams where I work, but I'm not afraid to put my fingers in to see if the baby is coming. It sounds like you did everything right; support the head and call for help.

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Specializes in LTC.

Sounds terrifying, but it also sounds like you did a fantastic job!

Congratulations on catching your first baby.

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:yeah:I probably would have freaked out if I had been in your shoes. Good job!!!

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We have one doctor who leaves the foley in during the delivery, and I've had several deliveries where things were happening so fast there was no time to d/c the foley.

I'm perplexed as to why RN's don't do VE's in some of your facilities. How can you accurately assess your patient's progress, escpecially if they're an induction or being augmented. On our floor the RN's are the eyes and ears for the MD's and keep them updated. Is it because you have residents readily available to assess patients? I'm intrigued.

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Specializes in L&D.

Thanks for sharing! I think you did the priority thing - catch the baby. But now I will think about the foley cath when encountered with a precip delivery. Don't know that it would have occurred to me before hand, but I haven't started working on the floor yet, and all other births I have attended (except the three in nursing school) have been sans epidural (I was a homebirth/birth center apprentice). My first precip delivery was actually in the ER parking lot in nursing school, which is a funny thing considering my background. I think it helped me get the L&D job :) But of course, she didn't have an epidural!

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I'm perplexed as to why RN's don't do VE's in some of your facilities. How can you accurately assess your patient's progress, escpecially if they're an induction or being augmented. On our floor the RN's are the eyes and ears for the MD's and keep them updated. Is it because you have residents readily available to assess patients? I'm intrigued.

I'm not the OP, but in our facility we have residents who do the checking. That has always bothered me, so I made it my business to learn how to check a patient.

ETA: In our facility we are trying to get away from using routine Foleys for epiduralized patients. We try to get patients on the bedpan first. Our CNS produced a study that showed that even repeated straight caths are less likely to cause infection than a Foley.

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My nurse delivered my 3rd baby... in almost the same way (except no epidural - not by choice, lol). The midwife on call (after I told her repeatedly that I have fast labors), broke my water and started pitocin. Then LEFT THE HOSPITAL! That was at 9:10am, my lil' munchkin was born at approximately 10:45am, because no one looked at the clock to be sure of the time. ;-) As the patient, my main and only thought at the time was having a healthy baby. I'm sure your patient felt the same way :redbeathe

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