postpartum emergency situations

rn/writer, RN · Sep 16, 2007

Is this because we are just go getters and overstepped out bounds, or realized that the staff that was up there had deer in the headlights looks and things needed to be done.

It's probably because L&D nurses have far more experience with emergency situations than postpartum nurses do. This is more about experience than ability.

A routine labor can turn scary very quickly. Cords compress. Babies come out breathless. Moms hemorrhage. These kinds of situations demand immediate intervention.

On the postpartum floor, we run into challenges, too, but they usually occur over time. We look at subtle cues to spot a trend. The same people who may appear to be deer in the headlights are usually very good at spotting tiny changes that tell us a patient is going to require some extra attention.

That said, we sometimes have a mom who tries to try to bleed out on us or one who faints or a kiddo who starts to turn blue. We can move pretty fast then.

I work in a teaching hospital where we have residents around the clock. We also have a Rapid Medical Response Team that can respond to any unit quickly. On my postpartum unit, we would jump into action by calling these folks and providing emergent care within our capabilities until they arrived. After that, we'd do whatever they wanted us to do. Fetch OB meds (not typically on a crash cart), start IVs, deal with O2, etc. At no time would we just stand around paralyzed.

The hospital where I work has 4500+ deliveries a year. That's a minimum of 9000 patients (moms and babies). I'm guessing that L&D would see 98% of the emergencies. Labor, delivery, and recovery, especially after a section, are the components that involve the most risk. We don't get the patients until they are stable.

With that in mind, it comes as no surprise that L&D nurses would be more at ease in handling a code-like situation. It's a matter of training, familiarity, and practice.

Any suggestions? What are your thoughts?

It's usually a good idea to have a debriefing session after a scary event, if for no other reason than to smooth ruffled feathers back into place. Often, something can be learned to improve the response next time. If you truly feel that the reaction from the postpartum nurses was lacking, perhaps you could tactfully introduce the idea with the thought of finding out what might help them to function better. If you can do this without pointing fingers, you might find that they felt helpless because they weren't sure what to do or maybe they feared that they would get in the way. The best thing to do is ask how the situation looked through their eyes. Maybe they need to run practice scenarios to achieve an improvement in their comfort level. Maybe they need a flowchart with designated duties. Non-judgmental communication might illuminate the questions and the possible answers.

On a personal note anyone ever put in a foley in someone when they are sitting up. I can say I have it only took 4 people (I didn't have a choice, she couldn't lay down)

Can't say I've had the pleasure. Bravo for performing well under pressure.

cassioo, RN · Sep 16, 2007

I work in a smaller level 2 community hospital and we rotate between L&D and PP so whoever can responds. We have 17 RN's on the unit and 3 of us are ACLS but for the most part we all work days.

ABQLNDRN · Sep 16, 2007

I am a postpartum nurse, and on my floor, we are quite able to handle emergency situations. In fact, there was a code called on a non-patient mother in our NICU, and WE were called for the code. The only reason I have ever had to call an L&D nurse for anything in an emergency situation was to bring Hemabate, as we (for some unknown reason) don't have it in our Accudose.

What was the reason for the code (or, as the case was, to call the L&D docs)? Did the patient have a massive amount of blood clots and/or retained placenta? I have seen a 1500cc hemorrhage for this reason in the past. Such a situation requires immediate medical intervention. Maybe the nurse (or whomever noticed the bleeding) reacted by hitting the code button. A massive hemorrhage can be scary.

On my floor, we do run code drills. I think everyone should, perhaps with the exception of those who actually see codes all of the time. Complacency kills.

mugwump · Sep 17, 2007

she was in respitory distress (don't know why), They were thinking about intubating in the room we did manage to get her to the units where they did intubate her.

rn/writer, RN · Sep 17, 2007

I wonder if she had a pulmonary embolism. This is one of the leading causes of maternal death following childbirth.

Elvish, BSN, DNP, RN, NP · Sep 17, 2007

We have had 2 cases of pulm edema in the last couple months that I have witnessed, along with the usual pp hemorrhages (if there is such a thing). It is really scary. We don't call L/D unless it is a breaking antepartum, in which case we hope they are in L/D by the time they deliver anyway.

But we are a big teaching hospital & have residents who are usually awake at all hours, and nurses with years & years of varied experience among us. So we are usually pretty well able to handle what comes up, though we have never to my knowledge cathed someone while they were sitting.

allnurses Guide · Sep 17, 2007

I'd love to have more staff available - sounds like you did a great job. I also commend other posters who know what to do and do it.

I worked in a small rural hospital until recently and the L&D nurse is usually the PP nurse too. It is only a few steps from L&D to PP. We all respond to emergencies.

Can't remember ever trying to put a foley in someone sitting up - I'll bet it was a challenge.

steph

zencmt510 · Oct 4, 2007

I work in a level 3 hospital and it is a teaching hospital as well. We have a critical care events yearly and we simulated different situations where it is hospital based/real life events. We recorded it in video and we criticize on how every one participated in their roles and if there any changes to be made or mistakes to correct. Our postpartum department do have the same yearly critical events as to place everyone in good competency. I've been to many different scary scenarios in labor and delivery; it's a not smooth ride and i bet it is the same in icu/tcu/nicu and such.