Monday, May 19, 2008

Harrowing Work Weekend

Lately our birth center has attracted some disastrous circumstances. I'm not sure what it is. Did someone put a sign up outside the hospital that said, "Stop here if you are having an urgent and/or dangerous birth experience!"? It befuddles me... but I'm sure glad that it's OVER with. I worked Friday, Saturday, and Sunday nights... all 12-hour shifts... and I was the nursery nurse on all three nights. This means that it is my job to attend all newborn deliveries and oversee the care of any sick infants.

Friday: The night started off okay. I surveyed the labor board and didn't really like what I saw. One woman was 42w4d gestation. That's a red flag. It means the placenta is on the older side and often begins to show signs of breakdown, which can result in a baby that doesn't fare so well. I never like to see a pregnancy that's gone longer than 42 weeks. In this patient's case, I was told that the OB's office actually sent the police out to her home because she'd missed the last few prenatal visits and wasn't answering phone calls. They were concerned something had happened to her. She was fine and they convinced her to come in to the hospital for an induction. Red flag #2. Induction agents are harsh. Combine them with an old placenta and it can spell disaster.

There was another woman who was 40+ weeks. She was progressing VERY slowly. Her fetal strip looked suspicious to all of us. Her baby's activity on the strip was pretty flat... a sign that the baby isn't tolerating the labor well. And there was a third woman, also in labor and doing just fine.

As the nursery nurse, this is daunting because I'm responsible for these babies the moment they emerge from the womb. When they don't tolerate labor, they often don't tolerate birth. The night clipped along and at one point, I thought I might escape the births. They seemed to be progressing slowly enough that I thought we might just be able to hold them off until the day shift arrived. Hahahaha... that'll teach me to think.

By 3:30am, the doc of the second patient decided we'd waited long enough and ordered a c-section. The woman was prepped and walked into the O.R. She was sitting on the table and the anesthesiologist was getting ready to put in the spinal. In the meantime, we all stood out in the station watching patient #1's fetal strip. All of a sudden, it looked REALLY bad and we all decided we didn't want to wait an hour to do something about it. So the poor patient who was in the operating room and ready to go was told she'd have to wait. She walked back to her room and patient #1 was brought in and an emergent c-section was done. It was emergent enough that they gave her a general for the birth. Thankfully, they handed me a vigorous baby who began crying when I stimulated him. Yay! That baby was born at 4:25am... woman #3 delivered at 5:25am, and woman #2 finally got her c-section at 6:15am! Talk about crazy.

I went home exhausted and collapsed into bed. The guys were all camping. The weather forecast was for hot weather and I didn't doubt it. When I walked out of the hospital at 7:30am, it was already 70 degrees. I closed myself up in my room with the portable a/c and drifted off to sleep. Unfortunately, I still woke up with a headache, though not as bad as it would have been without the a/c. One of the unique challenges about working the night shift is learning how to sleep during hot days. Darkness and quiet requires closing windows and blocking out light. But that also means sweltering heat. The a/c was heaven-sent.

I woke up Saturday afternoon, resolved that that night would be better than the night before. Hahahaha... I had no idea how wrong I was. Once again, the night started off okay. We had a couple of people in labor and they were doing okay. Around 2am, a woman came in complaining of cramping. This was her 5th pregnancy, she was 29 weeks gestation, and carrying twins. We often get women in premature labor. We can typically give them medications to stop the labor and then we can either keep them for observation or send them home on bedrest. This woman was concerned because with her other babies, her labors were only a couple of hours long.

She was checked by the nurse and found to be 2cm dilated. That isn't good when you are only 29 weeks. You should be closed up tight. So she was immediately given medications, an IV fluid bolus, and started on a magnesium drip. We also made immediate arrangements for her to transferred to another hospital... one with level III NICU capability. The transport team had been called and they were en route. A few minutes later, the nurse pokes her head out the door and yells to the OB, "PLEASE come and check her again. She says she feels pushy pressure." Despite all the medications, she had dilated another 2cm and was now 4 cm. At that point, the doc had no choice but to call off the transport. She would not be stable enough to move. It was at that point that I had to get ready for a twin delivery... nearly 3 months early. I knew I'd be dealing with VERY tiny babies who would need a LOT of support at birth.

I phoned the neonatal nurse practitioner (NNP) and said, "Sorry to wake you up. I need stat assistance for a 29-week twin delivery." The NNP on call was very nice, asked me to set up all necessary equipment and that she was on her way. She arrived a half hour later and we continued to set up. We set up two warmers in the nursery and two warmers in the operating room. We had ambu bags with preemie masks on them, intubation equipment, and line kits ready. The patient was taken to the O.R. for the delivery. We usually deliver twins in the O.R. because often the first baby will come out head first, but the second baby is breech. If that is the case, they often have to do a c-section to get the second baby out. In the middle of getting all this ready, another woman walked in, pregnant with her 3 baby and contracting every 5 minutes! The poor mother was in terrible pain and finally, out came baby #1... a little girl who came out crying. Crying is a very good sign. She was all of 860 grams... 1lb 14oz. She was darling. She tried so hard, bless her heart. But at 4 minutes of age, we opted to intubate her because she was just working too hard to breathe.

We waited and waited and waited for baby #2. She was breech. The OB asked the NNP if she thought it would be okay to deliver breech. I thought it was cool that he'd ask her first. Between the two of them, they decided a c-section was best in order to ensure the best possible outcome for the second baby. The mother was put under general anesthesia and they delivered baby #2 quickly. She was 1160 grams... 2lb 90z. She was floppy and not making any efforts whatsoever to breathe or move, so she was intubated right away. Once we had both girls in the nursery, the place was BUZZING with people. The transport team had arrived for the babies (each baby had at their service a transport RN, EMT, and RT... so six total). They took over care and I helped out where needed and acted as gopher. I got to assist with umbilical line placement and other things. It was an amazing learning experience.

The parents of these babies were so sweet and amazingly grateful for all the help and care. They spoke very little English, but enough to constantly tell us over and over through it all, "Thank you so much for your help." They were scared and they were warned that their little girls might not live or might have complications. We got the girls safely transferred to Tacoma General hospital. I called last night to get an update on them was thrilled to hear that hey had both been extubated and were now on CPAP! YAY!

I left work about 2 hours late yesterday morning. The girls left at 6:30am and then I had the daunting task of charting on both of them as well as doing the hospital charges. It took awhile. Once again, I came home and collapsed, exhausted both physically and mentally. When I woke up, Mike and the boys were gone. They came and saw me at the beginning of my work shift. I was so happy to see them and it really made my night!

I was stuck in the nursery ALL night last night. I had a sick baby. Unfortunately, his mother uses illegal drugs. He was born at home after a quick labor and wasn't looking so good. I had him on a warmer with IV fluids going, a monitor on, a saturation probe on, and a radiant warmer probe on. He was snowed from all the drugs the mother took. It really broke my heart. I watched him SLOWLY wean off the drug overdose over my 12 hour shift. He was finally looking better by the time my shift was over. My replacement was a bit late and no sooner did she come in, she was called away to a delivery. So I had to stay with the baby in the nursery. She came back quickly and said she'd found someone else to attend the delivery. And as I am getting ready to walk out, they called a code on that mother! UGH! Thankfully, things were okay and I was able to leave finally.

I just wanted to add in here... how much I felt the Holy Ghost with me over the weekend. Whenever I attend ANY delivery, regardless of the circumstances, i always say a prayer and ask for assistance from the Holy Spirit... and I have never been denied that. It was a special gift I am so grateful to have. The events of the weekend could have been FAR worse. We could have had very bad outcomes for some of these babies. But they were all just fine! I am so thankful!

What a WEEKEND! I'm TIRED! More importantly, I'm happy to have the next four nights off and happy to be able to have a three-day weekend coming up for Memorial Day!

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