As a labor and delivery nurse, you are part of such an intimate part of someone’s life. In both good and bad ways. The birth of a baby can be the best day in someone’s life. Or the worst I fell in love with labor, not only the process and physiology, but the care you give your parties can be so incredibly meaningful. I have always said that our job is 80% sunshine and rainbows, and 20%…… not so much. And you have be get through that 20% for your patient. They tell you all the scary stories of things that can happen to your patient in labor, all the things that can go wrong.
As a nurse of just shy of four years, I had my share of bad deliveries or losses, but nothing would prepare me for December 16th, 2022. I was told that I would get a triage patient who was being sent over from the office for blood pressure monitoring. She was 38 weeks and some change, and already had at least one elevated blood pressure in the office, so at least monitoring and possibly admission and induction. I met her at the desk to take her to triage. Her blood pressures for me had been fine, so we were just waiting for her doctor to make the call either way.
Once she reviewed her chart, we planned to admit her. As I am moving her over to her room, we are talking about her family, and she says that her father is an obstetrician, and her mother is a labor and delivery nurse. Now this was near the end of my shift, we just got her induction started before I was supposed to leave. I gave report to my coworker how I had just finished training. I told her that I was on call all day tomorrow and would like this patient back if I was going to be called in. I told my patient and her husband goodbye and that they were in excellent hands and went home. I woke up to a call from my charge nurse from night shift saying that they were going to need me, and I would be getting 27 back from the day before. I came in and got report on the good progress that has been made overnight. Her cook catheter had come out and we were just going up on Pitocin at this point. The patient and I had talked about her getting an epidural before they broke her water- as her mother had recommended, and I agreed. I went in to say good morning. We caught up about the night’s events and the plan for the morning. She mentioned that she was getting more uncomfortable and asked about the epidural process. I told her that there was a scheduled case that morning, but I would have everything ready for her so that the anesthesiologist could come right over after the case was done.
Her doctor was making rounds and told me that she wanted to break her water. I told her the patient would probably refuse until she had the epidural. But I told her she could ask anyway. We went in together and discussed it with the patient, and she said that she still wanted to wait. Her doctor told me to page her when she was comfortable. The epidural was delayed shortly due to an emergency in the scheduled care, but once the anesthesiologist was done, they came to my patient’s room and did the epidural without issue. After she was comfortable, she told me her mom was here in the waiting room, and her husband left to grab her. I paged her doctor to let her know that she was ready to have her water broken. Her husband had returned with her mom by this time. She introduced herself and said that she was here to be the mom today and not the labor nurse and promised not to get in my way.
Her doctor came down and broke her water without issue and she was five centimeters dilated. I set her up with a peanut ball, tucked her in, and told her to rest and I would return later. I got a call from her less than an hour later and she told me she was having a severe headache. I could tell she was in pain. We talked about it, and I did a set of vitals for an assessment. Her blood pressure was fine, but her pulse showed that it was 130 bpm. I looked at it confused and thought it had just miscalculated the pulse. I put the pulse oximetry monitor on her just to verify. Sure, enough it was reading in the 130’s. I told her that I was going to leave it on her a little bit and go chat with the resident. I found the resident in her usual spot.
I gave her a quick update on my patient and showed her the monitor with the baby’s heart rate monitoring beautifully and the pulse oximeter tracing her pulse in the 130’s. She suggested I call anesthesia and see if this could be from the epidural. I called the anesthesiologist and explained what was going on, and he explained what it could be, I asked if he could come and explain it to my patient. By the time he came up, she was visibly and, in more pain, saying that she was having pain that was pulsing in her temples and radiating down her neck. He explained to her what he thought it was and then left. I made her a cold washcloth and gave it to her to put on her head. She said that it was helping, I told her I would make her an ice pack for her head.
I walked down the hall and made her an ice pack. I glanced at one of the monitors to check my heart tones were still on. I noticed that my heart tones were off and that her contraction monitor had a pattern as if she were puking. I walked back to her room and when I came in, I saw that she was throwing up. Her mom and I gave each other a knowing look like we thought she may be progressing in her labor. After she was done, I put the heart tones back on and heard the low, slow sound of heart tones in the 60’s. I called the resident saying: “I have tones down in 27, can you come my way.” I turned my Pitocin off, and the resident walked in with another one of my coworkers which she had grabbed on the way. We started a fluid bolus and got things set up to check her. She was 9.5 centimeters! Huge change! Tones were still down, so we went to change her position. I will never forget how resistant she was to changing her position. She just kept telling me that she didn’t want to but couldn’t tell me why. I told her that the baby did not like this position, so we had to move. I needed more help, so I pushed the emergency light for more assistance.
With more hands-on deck, we went to hands and knees. Tones still down. Her doctor was paged to the bedside, Suddenly, her legs gave out from under her. I called her name to see if she was okay. No response. I looked down and she was looking at me, not responding, and foaming at the mouth. I yelled for someone to call a rapid response. The doctor calls for us to flip her over. She is 10 centimeters and places a vacuum on which pops up twice. I called her name and saw that she was not looking at me anymore and was unresponsive. I yelled for them to call a medical emergency. The doctor yells for us to run to the operating room. I ran ahead of my coworkers and the bed yelling that we were coding her. We left the room at 1338. Entered the operating room at 1340.
The baby was born at 1345. I was grabbing supplies and turned to see compressions had started. That’s when I lost it. I dropped to the floor and cried. My charge nurse came over to me and gave me the best pep talk. “If you need to take a minute, you can, but you are the only one who knows anything about this patient, I need you and so does your patient.” I don’t know how I picked myself up off that floor, but I did. I had to for my patient. Two rounds of CPR had worked. I remember looking at my patient and will never forget how pale and gray she was, and how cold she was. We stayed in the operating room for two more hours to stabilize her before moving her to the ICU. The one jammed-packed OR was suddenly quiet and mostly empty. Once she was transferred to the ICU, my coworker took over so I could chart. The only thing I remember after that was how numb and empty I felt.
The whole experience is like talking about war. All the trauma, pain, and sadness. And going to war, surviving, and living on the other side. Miraculously she and her baby survived. She has no deficits from the event except memory loss. Three months later she and her son came to visit. Once we saw each other, we both broke down and cried and just held each other. That moment right there made it all worth it. We are still in contact and see each other regularly.