Bad night (long)

Have you ever just had one of those births?

When I went into work Tuesday at 5 pm, my pt was at 8 cm. She had been at the hosp since 4 am, after SROM at 2 am. Up to this point, despite being

ruptured, we provided little intervention. She was only intermittently monitored, and had no IV. They had soft music playing, the lights were low, her Mom was

rubbing her back, she moved around as she wanted. It was a very calming

environment.

At 6:30 pm, her cervix was unchanged. Doc wanted fluids started and monitoring and discussed the possibility of a csection if there was no change with the next exam. I should mention that she was 6 cm at 9 am, so things were moving

very slowly. She was exhausted and frustrated and requesting pain meds. I gave her Nubain and let her sleep and only bothered her about every 15 min. or so to keep her turning from side to side. Oh, babe was OP at this point, so we were waiting for her to turn as well.

Anyway, next exam she was 9, but Pitocin was started because ctx spaced out to 4-5 min. after the Nubain. A couple hours later, she was 9.5. Doc said baby had turned. She was given an epidural at this point. She felt like she couldn't go on any longer. She had been at 9 cm for 4 hours. So anyway, she slept and

I continued to wake her to turn her to reduce the lip she had left.

Finally, just a smidgen of cervix was left, so doc had her push a couple

times, then instructed me to push with her. She looked distended to me, so I cathed her for 400 cc of urine. (She was up to the BR right before the epidural)

Anyway, the lip disappeared, we pushed for an hour, baby wasn't moving down. Doc came back in and said baby wasn't moving at all, just getting a conehead. So we were off for a csection. I was so disappointed for this girl, that after so much work, she would be subjected to a surgical birth. I noticed when I

was shaving her, babe looked asynclitic. It was pretty obvious. Baby's whole body looked to be lying cockeyed to the right. I distinctly felt back and bottom on lt side and legs to the right earlier. When did she turn? Was it after I cathed her and the bladder was out of the way, she just slid down wrong?

Off to csection. Mom's finally going to get to see her baby. She's

delivered at 3:54 am after lots of tugging (boy, was she stuck) with a very misshapen head. Not a typical cone head, more like a crooked face. How long would it have taken to mold like that? Would it have just been with pushing? Or was it from being near complete and +1 station for so long?

After all this drama, you'd think the happy family could celebrate. No, the

uterus remained boggy despite multiple doses of Pitocin IV and intrauterine,

and Methergine and Hemabate IM, plus manual massage. After 45 minutes, she lost

her uterus. She went to the main RR still intubated at 5:51 am. When I

left work at almost 8 am, she was still on the ventilator. She is a 28 yr. old

primip. I am so sad for her. I couldn't even face her family after spending the entire night with them. I went into the BR at work and cried after taking her to RR.

Now, I'm left with, what if I had done things different? What if we hadn't

waited so long? Was it the Pitocin, was the uterus just fatigued, was it the previous fibroid surgery? Why did this happen?

And if that wasn't enough, we were sending my pt from the night before home.

She is 20 wks with twins with PPROM. Baby A has no sack.

My nights in L&D have had no sunshine this week.