Questions for L&D Nurses.

AggieNurse2B · Nov 16, 2005

I'm no L&D nurse--far from it, in fact. But I went in with my daughter at 21 weeks with spotting, and I got a little more attention than that. Well, I did after a WHOLE LOT of hell raising, I should say. The doctor on call refused to come up there and check me...Even after my very attentive nurse called him several times and insisted that he haul his lazy self to the hospital and do his job. She very discreetly told me that it was my right to request another doctor, so I did. The "2nd string" doc was great, but I can't for the life of me remember if he checked me or not. He did get the US to make sure everything was okay, though. I went home and went through the rest of the pregnancy without incident.

Let me express to you my utmost sympathy for you and your family. I lost two babies before I had my daughter, and (even though mine were too early to be considered stillborn) I understand the pain you must feel. I'm so sorry.

labcat01, BSN, RN · Nov 16, 2005

I'm just a student so I can't help you but I wanted to tell you that I am so sorry that you had to experience that! I think that is a nightmare and I am truly sorry for your loss

JenTheRN · Nov 16, 2005

First of all, I am so sorry for your loss. Second, I can't believe that this nurse was so blatenly negligent. She ignored your symptoms on what should have been sending up big red flags. Please don't let this rest. This needs to be brought up to her nurse manager and probably even higher. Please know that most of us nurses do get busy from time to time, but that is absolutely no excuse to ignore a patient. I always trust a patient, and they usuallly know when something is not right. Again, I just can't believe that a nurse, especially one who works in OB, would totally ignore symptoms that we all know to watch out for. God Bless, and please keep us up to date.

LizzyL&DRN · Nov 16, 2005

First I want to say how sorry I am that you had to go through this. As a triage nurse I can tell you what I would have done. First consulted your prenatals to see if you have any history of placenta previa which could have been the cause of the bleeding. If no prenatals available(which is possible at 22 wks gestation) I would have definetly paid more attention to the bleeding. I would have probably done a speculum exam to try and visualize the cervix and called the doctor. For our hospital, a toco monitor at 22 weeks is the only monitor required because it is difficult to get a heart rate tracing on a 22 weeker. Although I will still try, sometimes you can be suprised at what you can get. If no contractions were being picked up by the toco, palpation of the uterus can also be done to feel the contractions. From reading your story, it sounds like more could have been done. Preterm labor at 22 weeks can be difficult to stop since you don't necessarily have to be completely dilated for the baby to deliver. It sounds like maybe you have incompetent cervix, but you should consult a perinatologist if you decide to get pregnant again. Hope this helps.

PS: I agree with JentheRN, I would not let this rest, I would be speaking to the unit director. That nurse needs some counseling and more training at the very least.

SmilingBluEyes · Nov 16, 2005

First of all, I am so sorry for your loss. Second, I can't believe that this nurse was so blatenly negligent. She ignored your symptoms on what should have been sending up big red flags. Please don't let this rest. This needs to be brought up to her nurse manager and probably even higher. Please know that most of us nurses do get busy from time to time, but that is absolutely no excuse to ignore a patient. I always trust a patient, and they usuallly know when something is not right. Again, I just can't believe that a nurse, especially one who works in OB, would totally ignore symptoms that we all know to watch out for. God Bless, and please keep us up to date.

Said perfectly. The nurse is NEGLIGENT, based on what you said here.

Please, Let me add my sincere condolences to you. I am so sorry for this huge loss.

love for nursing · Nov 16, 2005

I am sorry about your loss.

I am also a nursing student. I believe that I would be reporting this nurse to the higher ups. I would go as far as I had to starting with her supervisor and going as far as the hospital administratior. I would also report this nurse to the state nursing board. I just do not see how a nurse could neglect you like she did, especially with all the blood in the toilet. I always tell my family if you can not get what you want with in reason (especially if you know and can feel something is medically and dangerous occuring), by the nice way to show your true colors and get mean and dirty if you have to.

MMARN, BSN, RN · Nov 16, 2005

GROSS NEGLIGENCE, PERIOD!!! What kind of nurse does that? There was absolutely no compassion in what she did. I am very sorry for your loss, and i say SUE!!!! There has to be something you can do. I may be overreacting, but that was horrible what happened to you. My sympathies and prayers go out to you. I do not believe for one second that she was SOOOOO busy that she couldn't even check you. I may be a mere nursing student, but I know that is just not right. I'm sorry you had to go through this.

Mave.

epiphany · Nov 16, 2005

What a horrible experience for you. I am so sorry. She had no right to treat you that way.

Dayray, RN · Nov 16, 2005

This is horrible. I am so sorry that you lost a child.

Because I wasn’t there and because it's hard to really understand the situation from a single description I can't say for sure that your situation was mismanaged. What I can do is tell you what I would do if I had a patient in that situation.

First of all I would ask questions. I would ask about your contractions and if you had had a baby before. Being that you have had other children I would be very concerned about the way you described your contractions. Someone who has already had contractions is less likely to overreact to cramps or braxton hics. So a g3 p2 telling me "these were feeling more like the real thing" would concern me.

I would ask about bleeding. I would look at the blood but just your report of it being large amounts would be enough to set off bells with me. I always trust a women’s report that bleeding is large. It does happen but very rarely do women freak out about small amounts of blood. So if someone says they aren't bleeding much I would be more inclined to see for myself but if they are saying that its allot I would take that as truth.

Also your report of a history of fast deliveries would make the situation more urgent. From the way you describe the situation it sounds like you were really scared and that would also make me more concerned.

While I was asking you questions I would be putting you on the monitor. I would put a toco on but in addition I would try to put the baby monitor on. It can be hard to get a 22 weekers heartbeat on the monitor so if I couldn’t find it that way I would use a Doppler. With a 22wk uterus it is really difficult to pick up contractions on the monitor. So I would be feeling for contx and judging your reaction to them.

All of that should happen in 2-4 min (the time it would take for you to have one contraction while I was palpating. No matter what my findings I would have at least called the resident to do a speculum exam to see if your cervix was opening. What I would be trying to decide is how fast I should have them get there, weather or not I should give you terbutaline before I call them, if I need to check you myself and if I need to get things ready for delivery.

As I said before it's hard to judge the situation over the Internet. From what I can see here, I probably wouldn’t have given you terbutaline because of your bleeding. I would have called the resident 911 to do a speculum exam and an ultrasound to see if you were abrupting. I also would have started your IV and finished your history.

What the speculum exam does is let us know how close you are to delivering. The ultrasound might be able to tell us if you are abrupting. An abruption is when the placenta prematurely separates from the wall of the uterus. This causes bleeding and that irritates the uterus causing contractions.

It sounds allot like you had an abruption (once again I can't say that for sure over the Internet). If that was what happened there wasn’t allot that could have been done. All of the medicines we give to stop contractions do so by relaxing the uterine muscle. In the case of an abruption we may be able to stop contractions. However the contractions aren’t the real problem, it's the bleeding and the loss of oxigen to the baby. If we stop the contractions the bleeding is going to continue and will likely get worse because the uterus is now relaxed and not putting pressure on the bleeding vessels. Also even if we stop contraction for a little while they are going to keep coming back when the medicine wears off. So we don't do anything to stop the contractions.

If you were not thought to be abrupting we would have given you meds to try to stop the contractions. Sometimes we can stop the contractions and other times we can't.

When a patient abrupts at 22 weeks we just monitor to make sure the mother doesn’t loose too much blood. Sometimes the abruption will resolve it's self, some time's we do a C/S if the bleeding is too heavy and other times the baby just delivers.

I’m not sure how much it varies for area to area but at my facility 24 weeks and over is the line where we have to resuscitate. Sometimes it is left up to the parent’s weather or not we resuscitate under that. Other times if it is obvious that resuscitation would be fruitless our neo won't resess. I can tell you that outcomes for very premature babies are hard to predict but I still wish that you had had some choice in the matter.

The things that make me think you were abrupting are your description of bleeding large amounts and the fact that your placenta delivered with your baby. But once again I can't say that for sure.

I am so very sorry this happened to you. I am even more sorry that things were handled in a way that has left questions in your mind. I wish I could say for sure what happened and tell you weather or not things were done correctly in caring for you. The one thing I can say for sure is that things should have been explained to you better and you should have felt that everything that could be done was done.

Also I want you to know that this is not your fault. Both preterm labor and abruptions happen on their own. There is nothing that you could have done to cause this. Also there is nothing wrong with your body. We don't know why they happen in most cases. Sometimes it can be due to the implantation of the placenta when it is first forming.

It is important that you allow your self to grieve for this child. Talking about and questioning the things that happened to you during that time are both healthy and normal.

Once again I'm sorry if there is anything I can do or questions I can answer please let me know.

gypsyatheart · Nov 20, 2005

What an excellent post, Dayray! To Blade&Lily'sMom, I am so, so sorry for your loss. Please read Dayray's post carefully, he sums the situation up perfectly. It is really hard to say what happenned, but I do believe you should've been treated w/more compassion and the nurse, IMO, needed to be paying more attention to you and listening to what you said.

Just know, that it may have been inevitable for you to lose this pregnancy, as hard as that is. From your description it's hard to say, and depending on if you were abrupting....at 22 wks...that's a tough spot to be in.

Regardless, I am so sorry, you did everything you possibly could. Please allow yourself the emotions and time to deal w/this loss.