This is a continuation of the story of my best friend, pregnant with twins, twin B diagnosed with oligo at 15 weeks. A dye test for ROM was negative, and fetal anatomy was all normal. Serial ultrasounds had tracked both babies' weights right on target, and unresolved oligo for twin B.
She called me on Fri on her way in to the hospital in preterm labor, 24.1 weeks. She had been complaining of increased discharge over the last few days, and I figured we would see her soon in L&D. By the time she got to the hospital at 1700, she was contracting every 3 min. Subcu Terb was given in triage, to which she did not respond. I was on that night, so I got there a little early to sit with her in triage. When the decision was made to admit her, I clocked in and took over her care. Looking back, I'm not sure this was a good idea, but I had promised her way back when she found out she was pregnant that I would take care of her in the hospital when the time came. This was before she found out she had twins, and long before B was diagnosed with oligo, so I gladly made that promise thinking that since most pregnancies are uncomplicated I could take care of my friend no problem and it would be all just a lovely experience to be a part of. I had no idea things would turn out as they eventually did.
We started Mag with a 6gm loading dose, and then 3 gm/hr at 1800. Her cervix had been a fingertip in triage. We turned her up to 4 gm/hr when she did not slow down after 2 hours. The Mag eventually spaced out her contractions to every 5 minutes and she looked like she was getting more comfortable. I sent her husband home to shower and get her things. Suddenly she was complaining of increased pain with her contractions that only palpated moderately and I was having a hard time tracing B. She said she felt like she had to have a bowel movement and my stomach hit the floor. My charge nurse came in the room, I told her what was going on, and she went to call the doc for me. He came a few minutes later, checked her cervix, and said, "She is about to deliver the first one now." My charge nurse ran and got the ultrasound and strangely enough, she was delivering B first. She had somehow slid around A and was coming first, breech. The plan had been for a c/s, but the baby was already too low. We usually deliver twins in the OR, even lady partslly, but she would have delivered in the bed on our way there, so we called the high risk team to the room and just stayed there. The doctor told her that she was about to have her babies, that we would not be doing a c/s as there was not time, and that he had been told by her OB and the perinatologist that the one baby was not expected to live. Magged out as she was, she said she understood and was silent.
I felt absolutely paralyzed. Luckily we were not that busy, so every nurse that had been out at the desk was in my room, just doing. My charge nurse told me to stay at mom's side and hold her hand, that that was exactly where I needed to be. Within three minutes, baby "B" (but now I guess "A" because she delivered first), whom they named Samantha, was born breech with a nuchal cord x2. It was obvious at that time that she was ruptured because there was puss and stuff around her, so now everything made sense; the chorio explained why we could not stop her labor, and now we finally knew for sure why she had oligo. The doc said he was amazed that she had made it to 24 weeks before getting an infection.
When B delivered (Reagan), the team left the warmer where Samantha was and concentrated their efforts on Reagan. I knew then that Sam had not made it, or at least would not. The neonatologist came over in the midst of all this and told mom that the first baby was dying and there was nothing they could do for her. He said they had attempted to intubate her but could not and said something very vague about her getting hit with a lot of contractions and something about her jaw. I really just wonder if they went through the motions because they knew she would have pulmonary hypoplasia from having the oligo for so long . . . I guess it really would not have made that much of a difference. I started to cry at this point, though I already knew before he had even said anything. I asked if she could please hold the baby, and someone finally brought her over. I was furious, and I swear if I could have gotten to her I would have gotten her in mom's arms sooner. I just did not want her to die alone. She took a few little sighs after she was in mom's arms and she was gone. She lived for a total of 7 minutes. I didn't know what to do but to tell mom that I loved her and that I was so sorry. We cried together as we looked at her tiny little body and hands and feet and her sweet little face. Reagan was whisked off to NICU and the whole thing was over in a blur. I had had one of the other nurses call her husband and tell him to come back before she delivered. He arrived after the whole thing was over, and the three of us sat there and all cried together.
I had to remember that I was her nurse and I had to take care of her, so I made myself go into nurse mode, and that helped. My coworkers all helped me with the paperwork and everything; I would cry off and on once her family got there, and every one of them thanked me for being there with her and said how glad they were that I was on that night. Everyone said their hello's and goodbye's to Sam; mom dressed her in her clothes from the memory box, and after all of her family left we went to NICU to see Reagan and my charge nurse and a couple of the other girls made Sam's footprints and got her ready to go downstairs.
By the time 7am came, I was completely fried. The whole night took so much out of me; that would have been hard had I not known the patient - I really don't know how I got through it. I am so lucky to have coworkers that were so supportive and helpful. I feel guilty because so much of my work was done for me; I was not at my full capacity as a nurse and this is why I say maybe I should not have taken care of her. All of that being said, I am glad that I could be there for her and with her through everything, hard as it was.
Mom went home yesterday so that she could be with her family for the holidays. She and her husband said that they had kind of done most of their grieving 6 weeks ago when the oligo was diagnosed. The doctors had all been very up front and honest with them about the prognosis for Sam from that point. She has a two year old at home and lots of people that love her - a great support system. Reagan is in NICU and doing well at this point - or at least today. We know how rocky it is for 24 weekers. I really believe that she is a miracle baby, understanding now the why's and wherefore's of the pregnancy.
Reagan is now 26 weeks and is doing great! She is taking 9cc of food now; still on the vent, still has her umbilical line, so mom can't hold her yet. She got very excited that she got to change her diaper the other day and wash her little face. I spent a lot of time with the mom yesterday; we talked about the delivery for the first time and I tried to explain the why's and what-for's about it to her. She said she never knew when Sam died. I told her the time of death and apologized for not being able to get Sam in her arms sooner. I honestly don't know if she was still alive when mom held her or not - she said that she heard her take a few sighs, but then said she didn't know if they were breaths or if they were just agonal. That really just kills me. I don't know if they had pronounced her before they brought her over or not. I keep thinking about that post about the baby who was born alive and the mother wouldn't hold him/her; I thought it was so wonderful how everyone responded about how they held the babies and did not let them die alone; I thought it was utterly insensitive the way she was left all alone by our NICU team. And I couldn't get to her. Well, getting more upset about it is not going to change it . . .
This is a continuation of the story of my best friend, pregnant with twins, twin B diagnosed with oligo at 15 weeks. A dye test for ROM was negative, and fetal anatomy was all normal. Serial ultrasounds had tracked both babies' weights right on target, and unresolved oligo for twin B.
RaeT,RN
167 Posts
Just an update:
Reagan is now 26 weeks and is doing great! She is taking 9cc of food now; still on the vent, still has her umbilical line, so mom can't hold her yet. She got very excited that she got to change her diaper the other day and wash her little face. I spent a lot of time with the mom yesterday; we talked about the delivery for the first time and I tried to explain the why's and what-for's about it to her. She said she never knew when Sam died. I told her the time of death and apologized for not being able to get Sam in her arms sooner. I honestly don't know if she was still alive when mom held her or not - she said that she heard her take a few sighs, but then said she didn't know if they were breaths or if they were just agonal. That really just kills me. I don't know if they had pronounced her before they brought her over or not. I keep thinking about that post about the baby who was born alive and the mother wouldn't hold him/her; I thought it was so wonderful how everyone responded about how they held the babies and did not let them die alone; I thought it was utterly insensitive the way she was left all alone by our NICU team. And I couldn't get to her. Well, getting more upset about it is not going to change it . . .