one of my biggest fear happened.. in need of some words of wisdom

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i have been L&D nurse for 3 yrs (1 yr on maternity leave). Everytime i sent a pt home because they are still in early labor or cervix is closed i always check when did they came back or when they delivered and so far it has been good until now.

this happened just recently. Pt G3 walked in at 2230 appearing to be in labor, put on EFM contraction every 4 mins apart, (which has been the same since 1400 that PM based on previous NST). Cervix was still close but midline. Told pt she can go home since she only lives few mins from the hosp. come back once pain becomes uncomfortable or once water breaks. dad asked how many mins of contraction it should be, since its been 4 mins apart for few hours already i told them, 3 min then they come back on top of the above reason.

pt left at 2310 to be exact aand delivered at the hotel 3.5 hrs later at 0230. (she said because she wanted the jacuzzi there)pt came back with a baby delivered by dad. placenta has not delivered yet. Altho they did not made a complain the incident was in the paper.

During the NST i kinda pick up that the dad wasnt too pleased of coming back n forth if its still early in labour which was why i told them "oh she is in labor already and she should know its the real thing since last delivery was only a year ago (that lasted 6 hrs of labor based on hx.). and when they came back with the baby and mom n stretcher with the paramedics. one of the nurses from another floor overheared that dad saying - " i am so sorry, i am so sorry" which gives her the idea that she probably told him to go back to the hosp but he waited. too long until delivered.

now - i felt so terrible. the paper and her interview made me look like a stupid nurse. she did not mention that her cervix was still closed when she was sent home.

it did give me huge lesson on this. not just to look at the cervix but other things as well be considered. my co-worker assures me not to sweat about it and parents should take responsibility too. but its different when it is you involved.

hayyy... felt soo terrible now.

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Specializes in Nurse Manager, Labor and Delivery.

Oh dear heart, this has happened to me and I am sure it has happened to many out there. You evaluate what you observe and feel and see. You report this to the provider. YOU did not send the patient home, the provider did (at least I hope so). You act on the orders of that person. It is up to the provider to make the decision to send a patient home. I probably would've done the same exact thing in the situation you described. This "stuff" happens and of course it makes it into the papers, and you always look like the bumbling idiot. What the papers do not report is what really happened. I have to review these cases and really, if you did everything you were supposed to, then really nothing can be done about it. I like to put a spin on it with the patient that they had the best thing happen and make dad the hero. Works most of the time....lol.

I don't know how many times I have sent a patient home with sleep meds and pain meds and tell them either you are going to have a phenomenal nights sleep or you will deliver....either one you win. It's all in how you present it.

Don't beat yourself up. There will always be one that gets away....

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i don't see a problem, healthy baby delivered and mom is fine, doesn't really matter where or who did the delivery.

everybody knows papers don't usually tell/know all the facts and it's not really about news, it's about sensationalism/entertainment.

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Dont beat yourself up! I had a hospital birth and a homebirth - and you probably did her a favor!! :lol2:

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Specializes in Hospital Education Coordinator.

well, I do wish you would use your magic wand next time so you can faithfully predict to the minute when things will occur.

You did your best and no harm was done.

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Specializes in home health, dialysis, others.

This is just 'one of those things'. Labor has never been an exact science. (Old saying - First babies come whenever they want, all others take 9 months!)

And, mctina, this is truly not your worst fear - precipitous labor, abruption of placenta, strangling on cord, death of mom or infant during labor - - those are much worse. You are more embarrassed/humiliated than anything, and I can understand it.

BTW - must have been a very short ride if the placenta had not yet delivered!

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I don't understand why everyone gets so bent out of shape over home-births. If there are complications, it's one thing, but I am sure the majority of women are perfectly capable of having their baby on their own (if they so choose). The media just has to play on people's fears...

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Specializes in Professional Development Specialist.

For starters YOU didn't send her home right? The doc or MW did, like pp said. Second the baby was born fine and healthy right? That shouldn't be your biggest fear, not by a long shot! :D

The only thing that disturbs me is that your coworkers are telling you it was the pts fault.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You are NOT alone. In my first year, my preceptor sent a patient home who was not making cervical change only for us to see her come back with EMTs on a gurney with her baby in her arms a few hours later. This nurse had 30 years' experience and felt HORRIBLE. It's happened to many of us. Don't be so hard on yourself. If we could predict and know for sure when these babies would be born, we would all be RICH. You did your best.

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Specializes in L&D.

It happens. I tell patients that I can't guarantee they won't be back in an hour. I also ask if they feel safe going home. If they don't, I'll let them walk for another hour and check again. If she still says she doesn't feel safe going home, I'll call the doc back and perhaps get an order for therapeutic rest (10mg of Morphine IM sometimes works wonders), or transfer the call into her and let them talk.

I don't usually suggest that they wait until the contractions are 3min apart. Labor contractions continue to get stronger, they don't stay at the same intensity. Sometimes women just have a sensation that "something is different" now.

But no matter what you say, or what you do, from time to time, someone you send home will come back delivered. You'll kick yourself and try to figure out what you did wrong, what you missed. Most of the time there's nothing. Until they develop that crystal ball, it'll happen.

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pt left at 2310 to be exact aand delivered at the hotel 3.5 hrs later at 0230. (she said because she wanted the jacuzzi there)pt came back with a baby delivered by dad. placenta has not delivered yet. Altho they did not made a complain the incident was in the paper.

Sounds like they had plenty of time to get back if it was 3.5 hours later.

I can't help thinking that if you had kept her, she'd still be sitting around 3.5 hours later waiting to dilate. She went to the hotel, sat in a jacuzzi, relaxed and her body dilated. It's amazing what being in a comfortable environment can do. I wish I had gotten sent home with my first labor. My contractions were 3 minutes apart but I was only 2.5cm dilated. 10 hours later I was in the OR for a c-section (failure to progress).

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I always think it's funny when people get in a tizzy over these accidental home births. There are women out there who push for hours and hours who think these women who just POOF suddenly have a baby should count themselves lucky! :D

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