It's been almost 24 hours now since my last shift and I am still overwhelmed by the events of the day. Some background ... I'm a new grad in L&D and am on my 10th week of training with a very knowledgable and skilled preceptor.
The day started great with a primip at 7cm when we arrived and delivered several hours later after only an hour of pushing. My preceptor let me run the show and I asked her to only step forward if something I did (or did not do) would caue harm to the patient. She didn't need to tell me anything and it went smoothly ... the doc even told me "good job".
We recover this delivery and move on to the next patient. This patient has been passed around to three different nurse by the time we get her so we ask all nurses involved for report and background and proceed from there. Loveyly primip with a supportive husband and family. She went into early labor at 35 weeks and was given Nifedipine only to have it cause a horrible rash. Docs apparently decided to let her go ahead and labor and she is not 35 6/7. She goes from 4 to 7 with a little help from some Pit (only ever up to 2mu) and Stadol. Stadol knocks her out between UCs but she breathes beautifully with each UC. Her GBS status is "unknown" and I ask if we hang abx prophylactically and my preceptor tells me that if the doc wanted it, he would've asked for it. Doc comes by at 1730, SVE 7/100/0. She gets another dose of 2mg of Stadol and I'm in there every 15 minutes reading the strip and charting and talking with pt and family. At 1815 she's breathing well with UCs, denies rectal pressure. At 1823, mom comes running out saying she's pushing just as we notice the change on the strip at the nurses station. We go in, my preceptor asks her to roll over and when she does there is a baby crowning. I throw gloves on and put my hands down there why directing to her pant like crazy. She can't and she's pushing this baby out. I have the head out as the doc runs in and delivers the rest. He does not stimulate, cuts the cord, then passes her to us as my preceptor calls the NICU to come. They get there at 2 minutes of life while we are stimulating and trying to count a heart rate. My preceptor had stopped stimulating the back so that I could count a HR when NICU arrives and they yell at us for not stimulating this baby. Baby is taken to NICU with apgars of 5 and 7 and weighs 3lbs 7oz.
I am at this point cleaning up mom while trying to chart. Doc is at nurses station upset with my preceptor and me for not notifying NICU sooner and for not telling him she is GBS unknown. We pull out P&P and sure enough, an unknown should be treated with abx. We should not have assumed he knew about her GBS status, that was a big mistake. He's upset about the NICU thing but we called them AFTER we got him in the room (Doc should be there before NICU was our thinking) and it all just happened so fast that it was hard for me to process the situation. NICU is bitching to everyone that will listen that we should've called them sooner.
Whew! If you are still reading, thank you, because I am still overwhelmed and probably have forgotten some details. I guess I've learned to NEVER assume that a doctor knows something as important as GBS status. And NICU should be notified of an impending delivery way ahead of time so that they know what they are running to. I don't know what I'd do different ... thank God I set the table when she was 7cm ... I really didn't expect her to even deliver on my shift. And I sure didn't expect a baby that small.
Comment, opinions, advice is welcome ... I'm so glad we have this place to share ... just writing all of this out has made me feel better. Days like this are scary for me as a new grad and I am so thankful that I wasn't already on my own ... 16 weeks of training doesn't seem like enough anymore! I know I'll be a great L&D RN someday but today is not a day that I feel that way.
