Friday, August 19, 2011

Muy Rapido!

It's that time again friends! I think most of the nurses that I work with are aware of my little series and it leads to lots of interesting conversations around the nurse's station. It's been fun hearing about their own experiences with disrespectful patients, poop, and... their fastest deliveries. Babies born in wheelchairs and toilets and sweatpants- oh my!

Disclaimer: I haven't been doing this labor & delivery thing forever. I don't know everything. Things are going to get gross FAST. Don't say I didn't warn you. All names/patient identifiers have been removed. All stories written are my own experience unless otherwise noted. The end.

Fastest Delivery Story:
I had recently started my orientation in Labor and Delivery at BASMC- before it was AWH. I'd already been working in postpartum for 6 months and had gotten a great deal of unlicensed experience while I was in nursing school, so this whole labor thing wasn't entirely unfamiliar. I think I'd been orienting for a few weeks already and was growing more and more comfortable with life in labor.

We get a call from a lady who is on her way to the hospital. She tells us she's having a contraction about every 25-30 minutes. Now, there are a few things that will guarantee a quick admit and discharge, and I was already pretty certain that this woman's lack of labor would earn her walking papers in 20 minutes. She waltzed onto the labor unit with a friend and I escorted her to her room and asked her to change her gown. She looked like she was no more in labor than I was. Or am. Whatever.

But here's where it gets interesting. She walks back from the bathroom, freshly gowned, and climbs into the bed. I'm in the process of getting all the monitors powered up and belts behind her when she gasps and says: "Oh- I think my water just broke." I pull back the covers just to see if I can see anything (Is now a good time to mention that this lady was of the rather large variety?), only to find a growing pool of thick green meconium-stained fluid under her bottom. I excused myself from the room at this point to find my preceptor, so that I could tell her that this patient was indeed staying to deliver because she had just spontaneously ruptured and not only that, but the fluid was yucky (meconium = fancy name for baby poop) and we would definitely need extra nursery personnel at delivery.

So we both head back into the room in order to expedite her admission process and find her now huffing and puffing and moaning and writhing around in the bed. Mind you, at this point, she hasn't even been put on the monitor. Has had no vital signs checked. Has no IV, arm band, or chart. Anyway, so I go to check this woman's cervix and she is 7 centimeters dilated.

At this point, chaos ensues. My preceptor and I are calling for the nursery, and a delivery table. The patient starts dry heaving, which is a sure sign of transition, and within seconds, the baby is crowning. Now we're screaming for help- the NICU team, extra nurses, instruments and a midwife. The patient is also screaming. And pushing. And pooping. Everywhere.

I remember this day like it was yesterday.

This woman was a definite 20% Code Brown-er.

So, the baby's head pops out. We are yelling at the patient to stop pushing the entire time while still trying to get a hold of at least a pair of scissors and a cord clamp. My preceptor immediately notices that the umbilical cord is wrapped tightly around the neck of this baby and it cannot be reduced by slipping it around the baby's head. The safest way to deliver at this point is to clamp and cut the cord, unwind it from the neck and then deliver the body. However the patient is still hysterical and pushing, despite our very vocal urgings to quit. The body squirts out covered in meconium and mom dookie, blue and limp. Finally, my preceptor clamped, cut and unwound the cord and handed the baby off for resuscitation. The baby shook off the crazy/fast trip pretty quickly and was pink and screaming in no time. Welcome to the world.

I think the time from door to delivery was about 8 minutes. Now, it's not unheard of to have patients come in who have been laboring at home and are 9-10 centimeters on arrival, but this woman was by FAR the fastest, start to finish. Later, we come to find out, that this patient has a history of rapid labors, including an unexpected delivery on her couch and another in the back of a taxi cab! I'd hate to see that fare!

...stay tuned for more!

1 comment:

Kristina said...

Since I had one of those super fast labors I can say without a doubt that sometimes pushing is just kinda uncontrollable. For me it felt like my body was just pushing the baby out and I had no idea how to stop it! Because, believe me, I wanted to slow that baby down!

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