Bad night (long)

[L&D_RN_OH]

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.

[imenid37]

O I feel so bad for you and your pt's. It just sux sometimes. Better times are coming. Mostly ob is very happy, but as you know, when it's sad, it's very sad. I had a pt. like yours several years ago. The ob doc put in a Blakemore tube (the kind used for esophageal varices) to stop the bleeding and the uterus was saved. Pt. did have another preg. and delivery after that. i don't think you could've done anything different. You were very kind and attentive, so that will be something pleasant (along w/ her baby ) for your pt. to take from this experience. I am sure she's very sad and maybe angry, but you did everything you could to help her. Now go do something nice for yourself. Take Care!!!

[PSA, RN]

So sorry you had such a rough night.

[Liddle Noodnik]

Originally posted by L&D_RN_OH

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

And everyone says to you I'm sure, "OB must be a happy place to work."

I'm so sorry L& D. Man ....

[SmilingBluEyes]

Oh yes, I have had those nights....several times. Some bad enough to make me want to quit OB altogether and try another area.......

I am so sorry. You did your BEST from what I can tell. Yanno some cases are WTH cases and you can't take on blame for things going wrong. Leave that to the doctors and all their arrogance (some of them, anyhow). Just think this way: if this patient did NOT have a nurse caring for her who was NOT at the top of her game, she would likely have been MUCH worse off. You have NO control when a baby presents in acynclitic position----do you? None of us do---it happens. The bleeding afterward, well it happens. That is WHY we are there to watch them---to recognize the sighs of trouble and intervene, which you DID.

All in all,when said and done, this family will have a couple things to be grateful for, despite labor/delivery going totally out of plan: a healthy mom and baby are with them now. Some cases are tough and don't go as planned. It's got nothing to do with us---just happens.

Take care and I am so sorry about your rough night. I have definately had those----I have cried, swore, hit pillows, all of that. I would like you to take a nice warm bath, with candles lit in the bathroom,and practice deep breathing exercises......really opening up your diaphragm and letting relaxation hit from the toes to your head. Do this until you physically feel more rested.

And go back and face a new shift on L and D when time comes. Far as I can tell, you are very caring and conscientious. Take care of YOURSELF now,the way you do your patients!!!

[kcrnsue]

You sound like such a good nurse. After developing a bond with people, it is hard when something goes wrong. It was not your fault. Things happen that are beyond our control. Try to not beat yourself up about this.