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Discussion

Getting over a bad outcome

I'm a newer L&D nurse just about to hit my 1-year anniversary. I had my first birth with a bad outcome recently. When I say bad outcome I mean a birth where baby was born severely compromised, requiring resuscitation and transport to a facility that could provide a higher level of care. I've handled other obstetric emergencies (not many but a few) but they've all fortunately ended with fairly positive outcomes. In this case, the baby had a prolonged deceleration that landed the mom, a G1PO 41 weeker without other risk factors into the OR for an emergency C-section under general anesthesia. Apgars 1/3/8 and baby shipped to another facility almost directly following birth.

I have replayed the scenario over and over in my head, talked to my supervisor, charge, the OB who did the case and everyone says there is nothing that could have done to prevent it and that we did all we could for them in the moment. It's still unclear exactly what caused the deceleration. We will be having a debrief in a few days and are doing a risk cause analysis to figure out what went well, what didn't, and how we can improve.

I've been back to work since, but still struggling emotionally with it. I'm a woman of faith and have been praying, journalling, talked with my family and the people I work with about it. I finally have a nice stretch of days off before I have to go back and I'm hoping with some space and rest I'll feel a little better.

Is there anything that helped you in healing from traumatic births/bad outcomes? I would love to hear any other tips or insight from people on how to navigate it. Thank you!

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    Sounds like you are doing the right things, talking to colleagues and supervisor about it. Talk about it as much as you need to. It will take time. Time is a great healer and with time comes perspective too.

    Unfortunately birth is not without bad unpreventable outcomes, whichever facility you work in.

    I'm sorry you've gone through this. Everyone who has worked in OB/GYN long enough has been through a similar experience and you constantly question yourself and ask 'what could I have done differently?' It is especially hard when things like this happen in your first few years as a L&D nurse.

    Treat yourself to something you've wanted for a while or a weekend away. You have done enough. You are enough.

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    I'm so sorry this happened to you, sending hugs! This may sound callous, but what honestly gets me through bad outcomes is knowing that no matter what we do, it is impossible to eliminate all risk in OB. There will always be bad outcomes, even if you practice to the utmost degree of evidence based-practice (which is rare in the U.S.). It's so sad, but it's the truth. It sounds like you did everything possible with the tools you had at hand.

    There is an element of mystery in birth that we will probably never solve---what makes women go into labor when they do? Why do babies with crappy strips sometimes come out pink and screaming and perfectly healthy? Why does the opposite occasionally happen? Why does a crack addict have a perfectly healthy baby and a family that has tried for years to get pregnant have a full term IUFD? I accept that it's out of my control, I send my best love and positive energy to the family, and I go to sleep at night knowing I did the best I could.

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    Hello Lovely;
    I hope by now you are feeling better. Try not to beat yourself up. As a woman of faith, we know that we can only do what we can and that the rest is not up to us. One never really knows why these things happen and the RCA is procedure to identify areas of improvement, such as communication and efficiency. It's not intended to look for fault or to blame anyone. The baby could have just been floppy from the general anesthesia.
    Always do your best and when things do go well, rest easy. Your confidence in yourself will increase. Don't ever stop being human.
    Be well.

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