Ugh! Delivered Baby On My Own The Other Day...

[jenrninmi, MSN, RN]

Total accident of course. Needless to say the attending was very angry about this.

This was a g2p1 lady. She had a 15-month-old at home. Of course even with an epidural, she had a ton of pressure with her contractions. The resident did a sve she was 10/100/0. Resident said it would be best to labor down so that patient wouldn't be pushing for hours. Patient was confused, miserable and very frustrated of course, practically in tears. I stayed with her for the next hour, helped her through her contractions and checked her again. Still at 0 station. So, I called the resident, can I do a test push with her, she is very miserable. Resident says, "sure, go ahead and start pushing with her, but let her know she can stop and rest if she needs to". So, I document this and start pushing with the patient. Doing a sve at the same time so I could feel if she was moving the baby. Not moving the baby with her pushes yet, so coached her on this. I can feel just minimal movement, and let patient know this when she asked. She asks how long I think it's going to be and I said I think it's going to be a while yet as baby is really not moving. Well, I think this is all the patient needs to hear because with her next contraction, she pushes that baby right on down. The labia begin to spread and I say, "well, awesome! ok, hold on, let's call the doctor to come in." (We use Voceras where I work and I was able to call the resident while I was sitting on the patient's bed). Resident is on her way, she calls the attending as well who is also in house, sleeping (this is 3 in the morning) With the next contraction, patient is not even pushing, the uterus is doing everything. Well, baby is now crowning and is continuing to make it's way out. I call out the room to get some help...Baby was out 30 seconds before resident is in room. Then 30 seconds later attending is in room.

I can't help but feel horrible this happened. The attending is livid with me. "I want to know why I stayed all night waiting to deliver my patient, but still missed the delivery??!!" I went over exactly what happened. I think the resident should have let the patient give some trial pushes when she did her sve and felt the patient was complete and at 0 station. Especially when the patient was so miserable.

I know this may not be the only time this happens, but not sure what else I could have done in this situation?

How did your first deliveries turn out? Any bad situations? Did you get repramanded? I talked to my clinical coordinator and she says, "hey, it happens. It's not the last time it's going to happen."

[Jolie, BSN]

I would look her in the eye and state, "Because OB is unpredictable sometimes. But, as an experienced physician, you already knew that. Let's be thankful that mom and baby are healthy."

Give up the guilt trip. You're too busy and too stressed to allow this to divert your attention.

Good job, BTW :)

[Canadian_Nurse]

I'd say your attending needs to get a grip...multips tend to deliver quickly! I like the previous reply. If the doc wants to ensure they're there for a multip delivery, then they can get their butts to the room when she is fully dilated, epi or not. I've delivered a few multips in my time (and even a few primips who have surprised everyone), that is the unpredictibility of obstetrics! The attending needs to suck it up and get over it.

Congrats on your first delivery! Sounds like you did a great job.

[Jo Dirt]

My baby boy did not move down until he was ready to come out. The L&D nurses were questioning the doctor's judgement when he broke my water and did not seem worried several hours later when the baby was still high up.

Turns out everything went just as the doctor had planned. Doobie came out with no trouble.

BUT, I know L&D can change in an instant. It sounds like you had no control over how things went, but did a good job at dealing with them.

[romantic, BSN, RN]

"I would look her in the eye and state, "Because OB is unpredictable sometimes. But, as an experienced physician, you already knew that. Let's be thankful that mom and baby are healthy."

Thank you very much for the tip!

I am a new grad and L&D is my dream. During my preceptorship I was told that the situation when a nurse can deliver a baby happens sometimes. Therefore I was very interested to hear the details and what one should say to defend oneself :). Thank you both!

Give up the guilt trip. You're too busy and too stressed to allow this to divert your attention."

[ktwlpn, LPN]

. The attending is livid with me. "I want to know why I stayed all night waiting to deliver my patient, but still missed the delivery??!!" "

Oh- Because you really cannot walk on water or part the Red Sea....

[RNmama05]

If the attending wants the privilege of charging for the delivery the attending darned well should have been there at the patient's bedside. There is no reason at all for you to feel bad. Quick deliveries happen, and anyone with a day of OB experience knows that.

I think the issue here is how to handle the attending's behavior. I'm still working on that kind of thing where I work.

[Elvish, BSN, DNP, RN, NP]

Don't see as how you did anything wrong, hon. :)

Babies are going to come when they are going to come. Don't wanna miss the delivery? Then stay in the room all night, buddy.

You did just fine. Baby and mom are both healthy.

[allthingsbright]

Dude--these docs jost dont get it sometimes--do they???

Your post made me laugh--I am at a teaching hospital and we have had many babies come out in the bed on us. Labor just CANNOT be predicted!!! And we can never tell beforehand how effective of a pusher mom can be. The above poster was right--if docs want to make sure they are there, they shouldnt leave the bedside. You did great--scary for you, I bet, but you are a wonderful nurse. No reason to feel bad, IMHO!!!!!!!!!!!

[nurseshepherd]

I've had HCP's miss the delivery and they were wide awake and sitting at the nurses station (maybe 30 feet from the room) talking on the phone or playing on the computer. When you have a bad outcome it is good to question what could have been done differently, but that was not the case and like some of the previous posters said, you did fine. Congrats on your first of many.....

[Vito Andolini]

Well, I have never worked in this area but I think you did exactly what you were supposed to do, as do those of your colleagues who posted above. It angers me that the doctor would be angry at you. Will he not get paid for the delivery since he wasn't there or what?

Used to be that nurses were actually required to use a towel to hold the baby inside, actually prevent it from coming forth, until His Highness, M.D. could arrive and do the delivery. I'm glad I never worked OB, as I would not have done that. It reminds me of how I've read that sometimes the Nazis tied laboring women's legs together. Imagine the agony of mother and baby from such barbaric action.

If you even think about feeling guilty any more, I'm gonna getchoo, Girl.

[LizzyL&DRN]

I giggled too when i read your post. This is going to happen so many more times. I don't work at a teaching hospital but I delivered one last night with the doctor right next to me struggling to put his gloves on. He didn't get his gloves on til the whole baby was out. The fault in this situation lies with the resident that left the room and the attending should know that. Multips usually don't have to labor down. Especially if they are in that much pain. If the resident would have pushed a couple times with her right at first she would have delivered right then. Don't let that doctor get to you. That's why your clinical manager wasn't too worried about it. You did a GREAT job!