No. Don't Move Her Can't You See the Baby Is Coming?

One evening during an eight-hour shift at my place of employment, a local nursing home, sounds of a resident yelling "help, help!" and "come quick!" followed by a commotion broke the silence. Staff on duty reacted promptly running towards the room where the sound was coming from---no one ever knew if it was a true emergency like a fall, someone in pain or a resident waking from a bad dream frightened and fearful. Nurses Announcements Archive Article

No. Don't Move Her Can't You See the Baby Is Coming?

Geriatric residents are major fall risks because of forgetfulness and dementia. A syndrome called "Sundowner's" is prevalent when someone is lucid during the daytime hours but as the evening hours progress they act "bonkers".

Many a time while responding to calls for help, one would find some poor soul lying in a position on the floor that obviously a bone had been broken because it was not humanly possible to turn a limb in that position naturally. Determining which room it was after a room-by-room search it was customary for the person finding which room where the resident was in need of assistance to call out the number so everyone could respond.

One 3-11 shift a C.N.A. responded to one such event but as she called out Room 18 she sounded amused with a hint of laughter in her voice. This was a good sign that maybe no one was hurt. Arriving at the room I saw why she was standing by the bed with a wide ear-to-ear grin covering her face.

The sounds we had heard was the rattling of the side rails accompanied by the words "help" was from a little frail gray-haired old woman named Marge. This poor old soul had it in her mind that her roommate Muriel was having a baby. Muriel had gotten herself turned sideways in the bed with her legs draped over the side rails resembling stirrups on a delivery table. Quite a sight with her privates in full view: we went over to remove her legs from over the side rails and make her more comfortable.

Marge yelled, "No, don't move her!! Can't you see the baby is coming?" Stopping dead in my tracks noticing that most of my staff members had gathered about, standing there grinning and chuckling watching to see how the head nurse was going to solve this dilemma. My answer to her was "Okay dear, you must relax and we will call the doctor right away." Instructing one of my C.N.A.'s to go over to stand by Marge in an effort to calm her with soothing strokes and gentle words. Maybe she might lay back down and relax. This attempt proved to be futile because Marge continued to insist that I do something quick...My composure and professional attitude were nonexistent at this point. Okay...indeed there would be a pretend birth.

First, instructing one of my C.N.A.'s to call down to the hospital nurse to tell her to bring me an OB kit stat so this baby can be delivered properly. Turning to Marge, who continued to be totally convinced that soon this baby would be delivered. I told her that Dr. Roberta was on her way. This had some calming effect on Marge because at least she was not hollering anymore. Fortunately, the hospital attached to the nursing home only had ten beds with E.R. which was seldom busy. A very rural area where any major cases were automatically sent to another town thirty miles away once stabilized for transfer. My friend Roberta, R.N. came running through the resident's doorway with the OB kit I had requested tucked under her arm. Her quizzical facial expression said it all-"You have totally lost your mind." When Roberta saw the old lady with her legs still over the side rails a bewildered look came over her face. Quickly addressing her as Dr. Roberta I gave her a verbal report...This was done in a loud voice for Marge to easily overhear. The patient is 80 years old, full-term pregnancy, crowning, and labor pains two minutes apart, about to deliver a baby, in pretend form of course. Both of us then began pretending to follow the protocol and routine an O.B. nurse might follow to deliver a baby the best that our memories from nursing school would provide. Roberta and I stood in front of Muriel bent over coaching her with Lamaze breathing exercises, "Now, honey deep cleansing breaths and hold, Release on the count of three." Repeating this a few times our patient looked up at us with a blank stare, clueless to what we were talking about because she was as demented as a rock...Finally, "Now honey, one more big push." A couple of times we broke down in quiet fits of uncontrollable laughter. Roberta hollered out, "It's a boy and he looks real healthy!!"

She quickly took a bath blanket folding it up to look like we indeed did have a real baby. Roberta cradled it in her arms exactly like one would hold a newborn baby and turned to one of the C.N.A.'s telling her to take the baby down to the nursery. Together Roberta and I walked over to Marge to tell her that mother and baby were doing well. With a look of relief, Marge's face softened, leaving little doubt that we had been totally convincing because she indeed did believe that a live birth had just occurred.

In the next breath, she said: "I kept telling Muriel not to be fooling around with those sailors, now look what it got her!" She asked what the babies name was with a quick response from Roberta "Oh an all-American name Dufus Wanna Be Real." Roberta had let this fall off her tongue so fast that I almost did not catch it myself. She then reassured Marge that the baby would be adopted by a good Christian family who would take good care of him and raise him right. During the time we had been conversing with Marge one of the C.N.A.'s was able to take Muriel's legs down off the side rails getting her settled in for the night. Roberta and I walked to the doorway stopping to glance back over our pretend "delivery room" one last time that night before shutting the lights off hoping both residents would go to sleep. Once out in the safety of the hallway, both Roberta and I lost our composure and were bent over in hearty laughter. As we walked down the hallway, a short distance to the nursing station, discussing the events of the evening both of us would suddenly break down with an audible giggle. After thanking Roberta for her expert assistance in our delivery effort she stated a rhetorical "Hey, call me anytime. I can always use a good laugh."

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Lindsey McGraw

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Specializes in ICU/ER.

reminds me of the time we had a senile pt who kept insisting we cover the klenex box cause it was getting cold--she was referering to the klenex box as a baby, the baby was crying, the baby was cold, the baby wants burped etc etc. At bed time the CNA put the klenex box in bed with the patient and "tucked" them both in when the patient said "why do I need to sleep with a stupid klenex box, I dont have a cold"

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My goodness that is hilarious! I mean, we are being taught in nursing school that the best way to deal with a person's dementia delusions is to go along with it but, man, I had no idea how involved it can get! Hahaha!

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Specializes in Geriatrics/ALZ, MDS/CPC.

I completely understand. I work in a LTC facility w/ an Alzheimer's locked unit. Ya gotta do what ya gotta do to calm them down, even if it means steping into their word for a little while. :nurse:

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Specializes in Med surg, Critical Care, LTC.

The story was entertaining, however, I was always taught to re-orient demented patients. This could have backfired on you, what it the patient wanted to see, care and feed her "baby'. What would you have come up with then?

I can see going along in some instances with small things like "your family will be her in 1 hour, even if it's 3 hours away, I can see giving them laundry to fold so they can "help" us with our chores - this just seems bordering on abuse of the patient for the saff's enjoyment.

I hate being the nay Sayer, but that is my opinion.

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Specializes in LTC, Acute Care.

racing-mom4, I went to bed last night giggling about your story about the Kleenex box.

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That was good!!! I am graduating in April and I want to work at a LTC facility. Thx

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Wow, that was funny!! It shows that you and your staff are caring to even go along with it, especially take it that far. This is one of the perks of nursing. You can't make this stuff up!!

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Specializes in OB, HH, ADMIN, IC, ED, QI.

If the "expectant" patient, Muriel wasn't loudly involved in the incident, I would have told Marge that we had time to get Muriel to a safe place where appropriate equipment and care could be given her. Then I'd have covered Muriel's private parts, taken both her legs down at the same time, with the CNA holding one and me the other. It's more important with rickety legs, hips and backs to do that at the same time, to avoid back and hip problems).

Leaving another staff member (just one unless Marge was trying to get out of bed) to calm Marge, I'd roll Muriel's bed out the door and into an empty room (if there was one). Once Marge fell soundly asleep, having been told that Muriel was OK, Muriel could be taken back to her room.

As with any critical incident, it's necessary to keep as few people as possible in the area. The more personalities, the more opinions can be given, disagreements occur which embellish fabrications.

Trust in staff is a sacred responsibility! Lying is never the answer even if temporary molification seems important. Geriatric patients who seem looney most of the time, do have lucid moments occasionally.

Recall by patients, (even if it's not apparant, that frequently occurs) that reality hadn't been the nurses' goal when handling awkward situations can erode trusting relationships. Paranoia thrives in such conditions (which as we know, is a problem for many geriatric patients).

The reason I'm making this point, is the old adage "Oh, what a tangled web we weave, once we practice to deceive....." Marge would have continued her upsetting behavior when no baby's presence was addressed, and with our need for comic relief, the story could have gone on and on until eventually the deception and subsequently distrust would happen. It could be that she or a woman close to her had an emergency birth long ago, and the issue had gone unresolved for Marge. Once day arrived, a social worker/psychologist might have gotten to the root of it, and finally helped her reach resolution.

Muriel must also be tactfully and carefully handled, or she could also get much more upset, when all she may have wanted was a bedpan or to get out of bed. Her real needs weren't addressed, and more anxiety could have been caused by the deception. Can you imagine how it would be for yourself, if at an advanced age, you were told to do Lamaze breathing as you were about to give birth? First do no harm.........

By diving into our patients' delusions, we're not much more in contact with reality than they are. If you haven't seen the movie, "Nurse Betty", get it. It's frightenly possible!

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that was a good story, thank you. why not step into a pt happy place to keep them happy? why should we yank them back to reality and the horrors of it?:monkeydance:

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i loved it! :heartbeat:yeah:thanks for making my morning!!!

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Specializes in Hospice, ER.

I've used all my "therapeutic communication" techniques with these types of patients. Sometimes, it's better to just go along with them. Not every patient can be oriented to reality.

I thought this story was great. Thanks for the laugh!

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