“Oh, you’re a labor and delivery nurse? What a fun and happy job! I wish I could snuggle babies all day long!”
It took exactly 10 weeks and three days into my nursing career to realize what an offensive statement that is.
In March 2020, I graduated from nursing school with the sole intent of becoming a labor and delivery nurse. I never wavered. Because I was in the accelerated program, our clinical opportunities were reduced, so I only observed one single vaginal delivery during the entirety of my nursing program… and I had to trade another student for that opportunity! Nevertheless, I knew what field I wanted to pursue and ended up getting hired at the same hospital I delivered my own biological children at.
I remember one of the interview questions they asked was, “How are you in high-stress situations?” They followed that grenade of a question with, “Because labor and delivery is not just good outcomes all the time.” For some reason, I recall answering immediately with an overly confident, “Oh, I know. Bad things happen… and I thrive in stressful situations.” I don’t even know what the ‘bad things’ were I was referring to; however, I never would have imagined one of the things I would experience would be a rare, poorly-understood, unpredictable birth complication that took the life of my patient and left her newborn baby without a living mother.
In nursing school, almost all of the professors recommend that new grads start their nursing careers in a medical-surgical unit. They tell us we will learn important organizational and time-management skills that will make us well-rounded and equipped for any specialty. Since I’m as stubborn as they come, I kindly ignored that suggestion and went straight for one of the most demanding and highly sued nursing specialties.
Labor and delivery is its own monster – it’s a combination of specialties mixed into one unit. We circulate in the operating room, resuscitate infants and/or mothers, and perform emergency and critical care… we wear many hats. Not only that, but we literally can’t see one of our patients. Our unit is so specialized that not a single other unit is able to send nurses to help us if we are short-staffed. Even our badges are a different color! But we just snuggle babies all day, right?
Anyway, I started my six-month (yes, half a year) orientation on the labor and delivery unit in April 2020. Back then, orientation consisted of two to three months of vaginal deliveries with your preceptor followed by a month of being ‘backed-up’ by your preceptor, then, one month of cesarean section deliveries with your preceptor followed by a month of being ‘backed-up.’ After that, you go to nights and you’re on your own.
About 10 weeks into my orientation I started being backed up and took more of a lead with my preceptor and my patient assignments. On July 2nd, 2020, my preceptor and I got report from the night shift on our patient, and then she let me continue on with this patient’s induction. Sometimes our patients come in at 8:00 pm or midnight the night before the doctor anticipates delivery to start the induction process. This particular patient received a couple of doses of a cervical ripening medication the night before to prepare her cervix for the Pitocin part of the induction. It’s common for physicians to use a cervical ripening medication prior to starting Pitocin if they feel the patient’s cervix isn’t yet favorable for a successful induction. I’m not going to get into the details of why she was being induced, but I will say this was her first child – a baby boy – and her husband and she were thrilled to be parents.
Since her Pitocin wasn’t due to start infusing until 9:00 am, I spent time at the bedside discussing the plan of care, answering questions, and getting to know my patient, her husband, and her mother. In my opinion, the best part of nursing is building relationships with your patients and their families. You are let in for an extremely vulnerable part of their life. It’s such a privilege learning their stories and being a small part of this particular part of their story. I do not take it for granted, not then and definitely not now.
I remember being in her room for quite some time. I remember her pink, fuzzy slippers, her purple and white chevron blanket, and her gorgeous, glowing smile. At 8:49 am, her obstetrician arrived to discuss the plan, answer questions, and break her water. That’s the last time I remember her smiling. Her OB left the room immediately after breaking her water and it was finally time to start her Pitocin.
Since her baby was still pretty high in the pelvis, we positioned my patient upright in bed and butterflied her legs. This position is called high fowlers with tailor sitting and is ideal when we need the pelvis to open in order for the baby to engage. Shortly after I got her positioned, my patient started feeling lower back pain and pressure. When asked, she rated this pain ‘mid to low’ on the pain scale, although, her body language said otherwise. You could tell she was such a strong woman by the way she tried to push through whatever pain she was feeling at the time.
Because my patient mentioned she was feeling pressure, I made the decision to recheck her cervix. Sometimes, when a patient reports intense pain and pressure, it can mean their cervix is changing rapidly. I leaned her back, performed a sterile vaginal exam, and determined she was two centimeters dilated, which was subjectively one centimeter off from what her physician reported just minutes earlier. As I lift the head of her bed up, I notice her fists clenched and her facial grimacing. This ‘all of a sudden’ type of pain didn’t seem to add up to me. It didn’t seem normal. With that, I decided to call my preceptor for help. I mean, that’s what she’s there for, right? To back me up?
After explaining the situation over the phone, we felt it was appropriate to offer IV medication to my patient to help with her pain. At this point, my patient was unable to articulate exactly what she wanted. She was hurting. She wanted it to stop. My patient was finally able to verbalize that she wanted an epidural, so I followed our unit’s protocol and notified our charge nurse of her request. The certified registered nurse anesthetist happened to already be on the unit due to other procedures needing her expertise, so she was able to come rather quickly… within 10 minutes, to be exact. Just before the CRNA came into the room, I noticed the baby’s heart rate starting to decrease – 150 beats per minute… 120 beats per minute… 65 beats per minute… nothing. I was no longer picking up fetal heart tones.
Friends, family, and fellow AFE survivors/supporters, this next part of the story is hard to describe because what I experienced was something I cannot explain. At that moment, when I could no longer hear or see the baby’s heartbeat, as my patient was grimacing with pain and fear, I had this overwhelming feeling that something wasn’t right. Something was about to happen. I remember crouching down, eye-level with my patient’s abdomen, trying so very hard to find her baby boy’s heartbeat while simultaneously calling my preceptor for help. Right after that, I call our charge nurse for help. I didn’t even say the room number I was in. The only words that came out of my mouth were “I need assistance, now.”
Immediately after I hung up, the CRNA was walking in the room, which meant my patient’s husband and mother had to leave. Normally, one person is allowed in the room while a patient is getting an epidural, but COVID changed this protocol. Her mother and husband got to the door, turned around, and smiled at my patient. The encouragement and love they were able to exude to her in this desperate and scary moment was absolutely inspiring. This particular moment is what I remember the most. They didn’t know it, but this was the last time they would see or speak to my patient/their loved one while she was alive. It was as if time slowed down for just this occasion, to allow her loved ones to say goodbye. Her husband told her he loved her and he’d be right back, and her mother said, “Everything is going to be okay.” They both left the room and, unfairly, time sped back up.
As soon as they were gone, I tried to get my patient to sit up and get into position for the epidural. She looked at me with urgency and fear in her eyes, told me she needed to go to the restroom, and then kind of slumped down into the bed diagonally. The baby’s heart tones appeared on the monitor for just a moment and then disappeared again. At the exact same time, two of my fellow nurse coworkers charged into the room, powerfully, followed immediately by the charge nurse. While the first two nurses were talking to my patient and trying to get her to respond to them, the charge nurse and I were attempting to find the baby’s heartbeat, so that we could see it and hear it on the monitor… neither team gaining any ground.
For some reason, I look towards the front of the room and see my preceptor running in to help. I felt a sense of relief when I saw her. She had been and still is someone I admire immensely. When I turned back around towards my patient, she was posturing (a rigid bodily movement due to brain injury) and her lips were turning a blueish tint. Before I could even blink, oxygen had been applied and the CRNA called out, “Code blue!” One of the nurses immediately started compressions, and the CRNA obtained an advanced airway, meaning she was able to intubate my patient to provide the best possible opportunity for gas exchange to occur.
All of a sudden, I find myself, the three-month-old baby nurse, standing towards the front of the room thinking to myself, “Is this really happening?” It felt like I was having an out-of-body experience – as if I wasn’t in my own skin. There were no sounds to be heard, no fear to be had. There was only hope filling my heart as I watched these amazing healers trying to save the life of my patient and her unborn son. The code team arrived just two minutes after code blue was called and two OB physicians were there just two minutes after that. In less than 60 seconds, at 9:25 in the morning, a postmortem cesarean section was performed right there in my patient’s delivery room. The last thing I remember is her son being taken to the warmer to be resuscitated. After that, everything was black and faded.
All I really remember afterward is crying hysterically in an empty delivery room for a couple of hours and people coming in and out repeatedly telling me, “It’s not your fault. You did nothing wrong.” Fellow nurses, scrub technicians, the chaplain, my manager, my supervisor, the director of women’s services… they were all saying the same thing. Of course, at that moment, I didn’t hear them. I was in shock, total and complete shock. I specifically remember my other preceptor fanning me with a menu that was in the room. She won’t ever know it, and it doesn’t seem like much, but I love her so much for doing that for me. She stayed in the room with me for the majority of the time, while my main preceptor, the one who experienced all of this with me, was trying to save a life.
My manager walked into the room a couple of hours later to tell me they were going to call time of death and wanted to see if I’d like to be there. Suddenly, I gained the courage of a lion and the strength of a warrior and walked down to room nine to say goodbye to my patient. When I walked in, everybody was standing in a half circle around her. Not a single word was spoken. I weaved in and out of people in the room until I got to the head of the bed where the nurse who started the compressions was wiping the blood off her face with a wet washrag. My patient looked different. She wasn’t glowing anymore, she wasn’t pregnant… she was gone. I said a quick prayer, grabbed another wet washrag, and started cleaning blood off the cabinets and walls. Don’t ask me why I felt the need to do that. I guess I wanted to feel helpful. I left the room and headed back to the empty delivery room where all my feelings waited for me and wept.
Why did this happen? What could I have done differently? Why me and why my patient? These questions consumed me for several months following her passing. In October of that year, I went spiraling down quickly, mentally and emotionally, and ended up taking leave from work. During that time, I attended many therapy sessions, was put on several new medications to control or lessen my anxiety and depression, and prayed. Eventually, I got to a point where I finally believed what everybody was telling me that day in that empty delivery room… I didn’t do anything wrong. It wasn’t my fault. But something was missing, something was holding me back. Something felt unfinished. Towards the end of my leave, I experienced a revelation of some sort. After going over the event countless times in my head, and with my therapist, I realized what it was that I was missing – my patient’s family. I never followed up with or got in touch with her family after the horrible, horrible day.
After the time of death was pronounced and after weeping in that lonely and empty delivery room for however much time, I immediately went home. I never spoke with my patient’s family afterward. Later that night, I sat down at my computer and just started typing. I won’t go into specifics as to what that letter entailed, but I will say that I poured my heart out and let them know that their daughter and his wife’s life mattered to me. A few weeks later, both the husband and the mother reached back out to me to thank me for my letters to them. Her mother actually invited me to her house where we went through the entire event together, piece by piece. We laughed, we cried, we reflected… and at the end, we felt a sense of togetherness. We were now bonded for life. Since then, I’ve been in touch with my patient’s mother and husband through AFE Awareness Day activities, on the anniversary of her death/her son’s birth, and many times in between.
Although July 2nd, 2020 will always be considered one of the worst days of my life, I also see light in what happened and feel I was her nurse for a reason. I am a better nurse because of what happened. I am a better person. She changed my life, and I hope to change many more in the years to come.