Precipitous birth

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Specializes in labor and delivery.

I am a new grad still on orientation. I work at a very busy labor and delivery unit. I have about another month until I am supposed to be on my own, our orientation is 5 months.

My preceptor is letting me be on my own more and more. On this particular day my preceptor had gone off the unit to run an errand.

I chose to care for a grand multip-3 other kids already. I checked her at 7:30am, she was 5 cm. I requested an epidural for her at that time. At 8am she seemed to really be feeling her contractions so I checked her again. She was still 5 cm. I then found out anesthesia would not be able to come for my patient for a while because they were in a complicated surgical case. At 8:22am the doctor came by and checked the patient again, she was still 5 cm.

At 8:45am, she said she had to urinate. I told her I'd put in a foley since she had hardly any time between contractions and I didn't want her walking or going to the toilet. She refused the foley, I then offered her a bedpan. She refused that and asked if she could use the toilet. Stupidly, without checking her again, I let her go to the toilet. I stayed with her and when she said she had to poop, I made sure it was only poop and not a baby. After much trouble I got her back to the edge of the bed at 9am when the anesthesiologist finally came in.

I had a really hard time positioning her for the epidural, she was contracting so much that she couldn't sit still. The anesthesiologist was rolling his eyes the entire time. I am not sure if he was mad at me or at the patient. At 9:05am she finally is able to lie back in the bed. She yells "I have to push!" I said "No, don't push"-again a stupid thing to say.

I look between her legs and there's the baby's head completely out and with one more push the rest of the body is laying out on the bed. The anesthesiologist calls the coordinator and I grab a towel and start stimulating the baby, he is crying and I lay him on the mom's abdomen while I rub him with a towel. I very calmly say, he's nice and healthy, listen to him crying! In my head, I am saying expletive after expletive. A bit later all the nurses descend on me and I open the table and the doctor comes in and delivers the placenta.

After that, the doctor reams me a new one. Also all the other nurses were really mad too, they couldn't understand why the table wasn't open. The coordinator wouldn't speak to me the rest of the day.

I know I made two huge mistakes (at least). I should have checked the patient before I let her go to the bathroom. I also should have opened the table as soon as I walked in the room at 7:30am.

I am now being told I may not be suited to L&D. This has killed the small amount of confidence I had. Are the managers right, should I get out of L&D? By the way, the baby's face was blue with bruising from coming down so fast.

I graduated from an ABSN program, this is my second career, I am nearly 50 years old, and I am having a hard time with some technical nursing skills-like starting an IV in a wrist vein-I can easily do it in the antecubital but the wrist is hard for me to see or palpate. Is this just normal new grad self-doubt?

Any advice would be much appreciated!

Teensmom

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Specializes in Rural Nursing = Med/Surg, ER, OB, ICU.

Sorry you had such a rough day! It is just a fact that things like this happen when you work OB. There is no way to know exactly how a delivery will proceed. The secret is to be ready for anything. Because of the stress of the day, you are feeling defeated. Shake it off and go on because the mistakes you might have made today will stick in your mind and it won't happen again. Experience (whether good or bad) is the best teacher. Do not let anyone elses opinion affect how you feel about yourself or your skill level. Truth be known, they have all probably made the same mistakes! After you get through another delivery it will be easier to leave it all behind you!:heartbeat

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Sorry about you getting a hard time. These are the stories that make me think..."I'm not sure how I will get through the required LD time before CNM school?".

From one birthing mother's perspective...it sounds like you did a fine job in a fast moving situation. I wouldn't have allowed a foley either. Were you supposed to slow down the birth somehow? It's only a shame the epi was wasted, it sounds like she would have been fine without.

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Specializes in Rural Health.

Mom and baby are fine and that is all that matters in the end.

Mom refused the Foley and the bedpan (and yes, I would've too) so the most logical place to go next was the potty unless she was willing to pee in her bed. I would guess getting her up and moving placed just the right amount of pressure on her cervix to cause the rapid dilation - then the bladder gets emptied and well, ya know, the rest is history. It happens.

She went from a 5-10 in 20 mins. There is nothing you can do to change that.

So the table wasn't set up - I really don't see the large, end of the world deal here. We actually just got stuff from our cooperate office last week that told us to quit setting up tables "early" because it decreases the integrity of the table the longer it's set up. I'm not sure what they deem as early though.

I work nights, we delivery a lot of precip babies and rarely do we even come close to having a table set up. You do what you can and you go on.

I'm so sorry that your coworkers could not be more supportive of you. It really is a shame. Instead of turning this experience into a learning and teaching environment for you, they turned it all around and made you doubt yourself which is highly frustrating for you, believe me, I know.

I wouldn't scrap L&D all together though, not at this point. I would still give it some time. Every single time you do a delivery, you'll learn something new and each time you do one, something different will happen that has never happened before. It's OK. It's called learning.

My suggestion is to put on a new face and have a new day the next time you go to work. Tell your preceptor you messed up and ask for guidance and help and ask her, what would you have done differently to prevent this situation. Also, talk to some of your coworkers and your manager about this. I have a feeling you'll be surprised to learn a lot of your coworkers might have been in a similar situation in the past with a very similar outcome, which is probably why they were so hard on you.

Good luck to you!!!!

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

Hello there and welcome!

I agree with the other helpful posts. These things happen. Seems to me, you did a good job. Please, do not allow negative remarks make or break your career. I had a very tough time in my first year. If I had let such situations (not in my control) or mean remarks from coworkers discourage me, I would not now be a nurse educator as well as experienced l/d nurse today. I am not bragging, I am just saying, the tough times test us, but also BUILD us. Don't let it get you down. Just never be afraid to learn, ask questions and ask more experienced colleagues for back-up whenever you feel you may be in over your head. I still do that after 11 years, because, hey, I will NEVER know everything. I am always learning and still make mistakes.

I wish you well. Thank you for bringing your concerns here. We do not want to lose a good L/D nurse. You are valuable. I can tell you are conscientious and do care. You sound like an asset to nursing and your patients. Do not let negative nay-sayers rent any space in your head.

HANG IN THERE!!!!!!

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Specializes in OB.

Don't take it all on yourself! Precips happen! I doesn't matter if you are an inexperienced L&D nurse or not - 20+ yrs. experience and I had one just the other night. You did all the right things with the baby when it delivered, so don't let those who weren't there give you a bad time. That baby and uterus don't pay any attention to the labor chart!

I can guess from what you said that emptying her bladder made more room for baby to descend and then when she was sitting up for the epidural that baby came right on down. If you think about the position we sit them up in for the epidural it's pretty close to a squatting position - opens that pelvis right up! I make a habit of checking multip women after they get laid back down from the epidural for exactly that reason - it's that common!

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Specializes in OB, CASE MANAGEMENT.

I absolutely agree with Bagladyrn. If they are a multip and they are sitting up for an epidural check them asap when you lay them down or it can and will happen again. by the way hold you head high I guarantee you that every one of those nurses have done something wrong in their career and if they havent it is only a matter of time before they do make one. plus I quit counting the number of precip deliveries I helped with years ago.

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Specializes in ER.

OK, it's a 50-50 shot whether anyone else would have set up the table for a multip stuck at 5cm. Lots of nurses would wait until she started progressing again. Then she went from 5 to baby-out in 30 minutes! Think about that yourself. At what point should you have gotten the psychic message to ring all the alarm bells? Perhaps if you checked her every 10 minutes you would have known, but sticking fingers in that often has it's own risks, and will REALLY tick off your patient. False alarms and long waits make docs just as cranky as missed deliveries, in the long run.

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I can only add my agreement with the other posters.

And precips happen and I've had many deliveries without the table set up.

It happens.

Please don't let anyone steal your confidence - learn from your experience and don't be so hard on yourself.

steph

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As for your coworkers, remember that some nurses have been known to eat their young! (GASP!)

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Where was your back-up when the preceptor was running errands? I might be annoyed with her. She should be going behind you and nudging you to set up the table, etc. if that is what is needed. I had one of these deliveries myself w/ baby #3. I went from 5 to delivered in 15 min. Your co-workers need to park their brooms and look in the mirror. All of us in L&D for any length of time have had this happen. I am upset that the charge nurse doesn't see that the preceptor is the one who made an error in judgement. You are still learning and naturally not as fast as the experienced nurses on the unit. Where were they? Obviously more ready to criticize than help it would seem. Good luck! It is not you from the sound of things. Even an experienced nurse can use an extra pair of ahnds when a mom is going really fast. Don't beat yourself up!!!

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Specializes in Community, OB, Nursery.

Precips happen, and multips can go from 5 to complete in a heartbeat. Please do not beat yourself up for this. What is more important - catching the baby, or setting up the ^$*(& table? Your coworkers would have done exactly the same thing you did, whether they want to admit it or not.

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