So Sad... First OB day... Worst day ever...

[FLAtoNYC]

thanks for listening

[Daytonite, BSN, RN]

This is the very reason why people who go into nursing for the wrong reasons don't stay in it. You have to want to help people and nursing has to be a selfless, spiritual need within ourselves. Being nonjudgmental is so important as well. Some nurses just can't handle all that. They need to leave the profession.

Over time you will learn about the heart and perfusion of blood into the blood vessels and why even though the heart may be beating, blood is not circulating and perfusing blood into the organs. It's a cardiology thing. In the CCU during codes we frequently had people whose EKGs indicated that their heart might be beating, but there were no palpable pulses because the heart muscle just wasn't able to pump the blood--no oomph.

Death is never pleasant. I can't imagine that any lecture could prepare you for it though. There is only so much you can get from books and lectures. I've seen many patient's die and been at their side and that includes my own mother. I treat it very respectfully. It is a part of the life cycle. We each have our own feeling and fears about how we will experience our own death. For many years I studied metaphysics and spirituality which is very different from religious doctrine. It has helped me to cope with death a great deal.

I've also seen a lot of different reactions toward patients among the staff. Keep in mind that a great deal of what you might see is the staff venting their frustrations. It might not look too good to a stranger who doesn't work with these people every day. I worked on a step down unit where we had frequent flyers, often COPD patients, that no one particularly liked to take care of and little spats over who had to take care of them went on. These kinds of patients are time-consuming and take a lot out of each of us. It's only fair that everyone has to do their share of care giving with them. It didn't mean that we didn't care about them. In fact, when these patient's were at death's door, we wanted them on our unit because we knew them so well and felt best prepared to take care of them. There were times when we asked their attendings to transfer them from the medical unit to our stepdown where we could do their end-of-life care to the surprise of the medical unit nurses.

[Barefoot_inSD]

Wow, what a first day. I start NS in the Spring so I can't really give you advice except to tell you that I think you reacted normally. Don't doubt yourself in questioning whether or not you can be in this profession. You're human and you have feelings so it was natural the way you felt. I think it would be odd for anyone not to feel a thing, seeing that the child, while looking normal didn't have a chance to live.

You didn't have all the answers but I think you did great by staying with the mother and comforting her as much as you could.

[OnTheRoad]

Just wanted to give you a hug (((((((((((((((((((()))))))))))))))))))))))))

[pkohm]

Wow that's horrible. I could just imagine being excited to see a healthy live birth and then going into that instead.

[UM Review RN, ASN, RN]

How cruel to let you witness that on your first day!!

The situation you describe is why I couldn't possibly do OB or Pedes.

I'm successful in my area but frankly I cannot function with patients younger than 40.

I'm so very sorry this happened to your patient. I think you'll make an awesome nurse because you cared enough to ask why.

[DDRN4me]

((((FLAtoNYC)))) talk about a rough beginning!!

however, as your post so eloquently states; you have learned soooo much from this experience that you do not in books. That is the art and science of nursing. You werent taught what to do for this woman; you did what you saw she needed; and those experienced nurses helped you do it.

I know it may have seemed cruel to have to endure that on your first day, but, do you think it really would have been any easier on another day??? fetal death is never easy to take; even as a "seasoned" nurse.

Talk to your instructors or a counselor (or us) to examine your feelings. and know that you helped that woman through one of her worst days.

Blessings to you as you continue your journey through nursing school.

[justme1972]

First, a HUGE HUG out to the OP.

Second, my thoughts? I felt the staff left you in a horrible position. They should have been there to answer that poor gir's questions, and her questions deserved to have an answer.

There was one thing that jumped out at this post, so I'll hope a L&D nurse can answer it....

I have seen alot of debate on this board regarding going through extensive measures to help these very little folks try to survive, and many nurses share the opinion that the ones that do make it, seemingly without problems, most likely had a missed due date and was further along in gestation than originally believed.

This particular patient had NO PRENATAL care...so why would anyone believe that she was only 20 weeks? Could be 24...could be 16...how would anyone know?

That is what was most disturbing, b/c now that makes me wonder if the baby could have made it.

[Finallyat40]

In answer to your question about dates on the baby, the physician/midwife can ballard a baby after delivery and get a fairly accurate gestational age.

Why can't a 20 weeker be saved? First off, as you were told, their little bodies are so immature, even though they are fully formed, they are not ready for the real world. There is no et tube small enough to intubate a 20 weeker, who most likely weighs less than a pound, their skin is still gelatinous, which, in a short period of time will lead to overwhelming sepsis, their tiny little brains are at GREAT risk of intraventricular hemmorage, in order to monitor them, leads would have to be applied to their skin, which wouldn't stick because of the gelatinous nature and would only pull skin off, their lungs are formed, but very tiny and have no surfactant, so they would require maximal ventilatory support. These are but a few of the reasons a 20 weeker can't survive.

As for the 21 weeker in Florida who was discharged and looked great....don't believe everything you see.....

As a NICU nurse, I cringe when I see an early 23 weeker come in.....they are in for such a fight and so many times (9 out of 10), if they survive, they end up with major deficits that will follow them for life.....there always are the exceptions to the rule....but it's so hard for me to see us tortue them on an hourly basis, realizing we're doing more harm than good.

I'm sorry you had such a hard clinical day, I don't believe that you should have been shielded from that though....there are so many nurses who go into L&D thinking it's all sunshine and daisies, not considering the stillbirths, or worse yet, the early deliveries with no hope. That is a reality of the practice and I guarantee you, you are better for it!

Jamie

[Conrad283, BSN, RN]

From the sounds of it, I think you handled yourself pretty well. Death is never easy for anyone, child or adult. Nothing prepares you for it and you can rarely expect it. However, it is a part of nursing and the nurses do a big part in the process of death in the form of comfort and that's a huge part, and I think you did a great job.

[eldragon]

First I want to say that absolutely, you were thrown to the wolves with this case and handled yourself like a trooper.

But my frustration lies with that 22-year old woman who had no prenatal care on her third high-risk pregnancy.

Instead of the mother asking why the doctors couldn't do anything to save her baby, she needs to ask herself why she didn't get to a doctor the minute she realized she had missed a period and might be pregnant. This exact same thing has happened twice before, yet she makes no effort to save her third pregnancy?

Correct me if I'm wrong, but there is a procedure that can be done to close the cervix and keep it closed until she is nearing delivery.

I'm sorry you had to go through such a heart-wrenching event, but much of the blame lies with the mother, who after experiencing this twice before, should know enough to prevent it from happening again.

Otherwise you are just witnessing a live abortion due to neglect.

On one of my student clinicals we had a young woman come into the hospital in active labor - high on crack cocaine. She also had no prenatal care, unless you count the time she presented at another hospitals ER, with a kick to the abdomen, at about 6 months.

The woman screamed and yelled during her labor and wouldn't let students in there with her. She yelled and cussed at the doctor, also. She wouldn't let the nurse check her cervix when it was required, and we all just stood around and listened to her screaming her ass off, until the babies head started to crown.

Long story short, her baby weighed about 3 lbs and tested possitive for crack. The mother continued to be rude and beligerant to the staff and even accused us of letting her suffer through the labor because we hated her. For hours after the baby was born, she never asked how he was.

Of course I don't know how the story ends, but the baby was put into the care of CPS. Some neurological tests done while in the hospital suggested that he might have significant brain damage or an underdeveloped brain or brain stem.

And the blame lies on the head of the crack-addicted mother, who walked out of the hospital unscathed but left a tiny, wounded baby - forever in the care of those who never harmed him.

There are alot of sad stories out there.

[babynurselsa, RN]

THis is a tough one for anyone. Especially someone without any experience at all.

It sounds like you did a great job being there for this mom.

They can get a fairly eccurate gestational age on a baby by ultrasound. A 20 weeker is going to weigh more like a half of a pound. As previously stated there is not equipment small enough to support of sustain these little ones. An infant born at 20 weeks will not have actually developed alveoli yet. All that is at the end of the bronchioles at this stage are buds that by 23-24 weeks begin to develop into alveoli. This is why the cut off of viability remains where it is.

Their skin is so gelatinous and friable at this age that so much as a touch causes bruising and breakdown. It also cannot hold in fluid or heat. The insensible fluid loss cannot be accomadated because of the immaturity of the kidneys. If you try to replace the volume lost it cannot be processed and these little guys just swell up like a water ballon and again their skin splits and breaks open.

It is awful when one of these tiny, tiny FETUSES are brought into the unit because all you can do is inflict torture on them for a very short period of time until the inevitable occurs.

It is much more realistic, and humane to just let their mommies hold them until they pass.

I know you had a tough experience, but I hope this helps you to understand a little bit of what happened.