RN Struggling After Neonatal Death

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Specializes in Labor and Delivery; Newborn Nursery.

I work night shift on an OB unit. I was hired to work NBN, but have since been trained to work L&D as well. Lately, I have been working more L&D. We do not keep vent babies, nor do we deliver before 34 weeks unless it is an emergent situation and the children's hospital about 60 miles away is always notified and usually on their way.

We delivered and coded a 32 weeker a few nights ago d/t a suspected (and later confirmed >50%) concealed abruption and DIC. The code went perfect in my opinion. We were prepared for this baby. got her intubated, peripheral line started, (pedi did not start umbilical line... but that's another story) chest compressions, fluid boluses (D10w and NS), blood transfusion, epi x3-4 doses, etc. We had a heart rate (I was not the one who auscultated) for approx. 10 minutes, then sometime after intubation we lost it and never got it back. We had been coding her for about 50 minutes when children's transport arrived. they pushed some epi and continued efforts for about 10 minutes although I am sure this was to appease us. They and the shocked and tearful and genius young male OB called it.

I have worked many IUFD cases and have had a handful of codes as well. I have never had a baby born alive and not make it to either recover with us or be transported though.

I feel like we killed that baby. I know this is "normal" but I am sick over it. I almost resent parents now who are whining about their babies being fussy, or spitting up, etc.

As far as I know, my hospital does not have a person I can talk to... and we were not debriefed after this code. We have not had a live birth then infant death in years I'm told (I've been there for going on 3 years now...hired fresh out of school).

How do you all cope with situations like this? I know what I'm feeling is normal, but it's all I can think about.

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Specializes in Public Health, L&D, NICU.

First of all, my prayers for the parents, and for all the caregivers. My very first job out of nursing school was at a small L&D with no NICU, in a situation that sounds very similar to yours. We went through a couple of very similar things. One night, after a particularly harrowing shift, I came home and insisted to my husband that I could not do this, dead babies were not what I signed up for, and I was going to quit. He insisted I keep working (I'm sure our precarious finances had a lot to do with his encouragement), and so I kept going. And it got a bit easier. I know you feel responsible. And I'm sure you know without me pointing it out that you weren't there alone, that all of this shouldn't rest on your shoulders. Know that the others that were there with you are probably going through their own inner turmoil. Despite our best efforts, sometimes babies die. I know small hospitals often don't have help in-house, but do you have access to some sort of Employee Assistance Program? If you could go talk it out with someone, it might get easier sooner. Keep going to work, keep doing your best, and one day you'll notice that you haven't thought of it in a while. The next day will probably be even better.

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Specializes in Labor and Delivery; Newborn Nursery.

Thank you monkeybug. Today was the worst day so far.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

All I can offer is some virtual hugs to you - not in OB but infants/children 0-18 months I know how some deaths can rip you apart. It's good to acknowledge the grief and vent it with people who understand. Some things are unavoidable but keeping an open heart allows you to feel the joy, too. Be gentle with yourself. You didn't kill the baby, you and your co-workers poured your all into saving her. Very best to you. ♥

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Specializes in Nurse Manager, Labor and Delivery.

A good OB manager should set up some sort of debriefing with the team involved...at the very least should be contacting you to see if everything is ok. This should be a flagged event and I am sure that the chart and case will be reviewed. It sounds like you did everything you needed to do. Its easy to say, but don't beat yourself up. Be confident in your care. Could you suggest to your manager that you would like some sort of debriefing? Even if you just go over chain of events and just talk. I always followup ASAP after an event like that.

Do something good for you. Eat some chocolate, go get a massage. Take a long walk on the beach, something that will remind you of the beauty that we have around us. Be kind to you. What you dealt with it traumatic even for the staff. I always look at it this way....be happy you have reactions to it. Its when you don't that you should be worried.

Good luck yout to you...

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Can you talk to a hospital chaplain, or if you don't have one on-staff, to one of the local ministers who comes to visit their parishioners?

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It sounds like you did everything you could have for that infant. 32 weeks is young. You did the best you could. I would review the code and try to learn from it. I've been in L&D for 20 years - it doesn't get any easier when you loose an infant. Try to concentrate on the good and loving parents, the beautiful deliveries and the healthy infants. Don't be afraid to cry. I agree with the above post-chocolate helps-as does icecream.

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Specializes in L&D.

At one point in my career, I used to have to remind myself through the whole drive to work, every day, that who lives and who dies isn't up to me. I am not the Final Authority on that. I can do everything right and someone may still die. On the other hand, I've seen patients do well who have had many things done improperly.

My only responsibility is to do my best and accept that the final outcome is up to God.

A debriefing is a good idea. What did we do? What would we do the same way again? What would we do differently next time? No blaming or finger pointing. Just a chance to learn from a situation. And a chance to talk about your feelings.

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Specializes in L&D.

Also, you only code for about 10 min without a heart rate. So, when the transport team arrived they wouldn't have worked on the baby longer than 10 without a rate. We recently hade a code with Apgars of 0/0/2. The doc was ready to call it at 10 min but there was a heart rate. The baby is still alive, but I'm not sure that our outcome was better than yours this baby will never have a very good quality of life. As I said in the previous post, you do your best but the outcome is out of our hands.

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It sounds like you did everything you could have for that infant. 32 weeks is young. You did the best you could. I would review the code and try to learn from it. I've been in L&D for 20 years - it doesn't get any easier when you loose an infant. Try to concentrate on the good and loving parents, the beautiful deliveries and the healthy infants. Don't be afraid to cry. I agree with the above post-chocolate helps-as does icecream.

I agree with nursehuffandpuff, review this case and learn from it. Don't beat yourself up, there are certain situations in life where you don't have any control over.

It is hard to cope with this. It's ok, you all did the best you could.

My suggestion to you is take a couple of days off, go and enjoy nature. Embrace your love ones. Pray, that really helps. Share this with a close co-worker. Vent with them.

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I would ask for a review...not for blame, but to find out if anything could be done different next time. This baby would most likely have not survived even if it had been in the NICU, because of the layered factors.

A couple of things jump out at me, one I may or may not be correct on, but the docs need to understand (and many that don't work in a NICU on a regular basis do not) that a central line is your BEST friend when coding an infant. Peripheral is second best, but if a central line can be started it should be started.

I am NOT saying that would have made any difference at all, but I am very curious as to why the ped choose not to start a central line.

Also, I live in an area that has a NICU but we constantly get transports from about an hour away from outlying facilities. If there is any time at all, they have the NICU transport team either at the delivery or the mother is transported to deliver at the main facility where a NICU team can be present...."on route" is not preferable, in case something should go downhill.

I would speak to the hospital chaplain...that may help. You all deserved a debriefing.

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Specializes in NICU, PICU, PACU.

You all can ask for a debriefing, especially if an autopsy was done. It sounds like you all did what you were supposed to do.

Your CNS and Unit manager can arrange this for you so you can tie up all the loose ends. We always question ourselves if it isn't obvious. And I know what you mean about resenting the "normal" parent things, we deal with that in NICU a lot. You just want to shake some of them and say, look in the bed next to you... You are so lucky! Perfectly normal! Hang in there!

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