Wednesday, June 13, 2007

Beware of flying babies, a cautionary tale...

Have you ever seen a movie where a woman is having a baby and the baby comes flying out of a woman like a cannon ball or something and the doctor is standing right at the end of the bed and catches the baby like a football? This very thing happened a few weeks ago with a patient of mine. Here's the story.

It was a busy night in the delivery rooms and I already had one laboring patient, but she wasn't doing a whole lot so I was assigned an active laboring patient. She was a gravida 2 para 0 and she was 6/90/-2 on her exam. She was 31 weeks pregnant, which is viable (at our facility anything over 23 weeks is viable which I think is crazy but that is another post). The doctors told her that they believed that they could possibly stop her labor because recently we kept a lady at 5 centimeters with a bulging bag for almost two months in a reverse trendelenberg. Not common, but possible. The plan for this patient was to give her Indocin (a medication to stop labor). If that stopped labor good, but if not we were planning to have a baby. So I gave her the Indocin and the Nubain (pain medication that works at the neuromuscular junction to intercept pain impulses) and then the waiting game began.

Her family surrounded her bed and they held hands and prayed. They were pleading with God to stop the labor. It was very nice, and I was hoping that would work because I am not very good at code pink deliveries. After about two hours the pain started again. I had her checked and she was 9 centimeters dilated. She wanted an epidural, but the doctor suggested that she just go at it natural because she was afraid that it would have a negative outcome, but at the same time she told the patient it was her decision. Why didn't she just say no? The patient was begging me to get her an epidural and I knew that Anesthesia wouldn't allow it because she was to far gone. About a half an hour after that we start pushing.

I have a general rule about pushing, I never take the bed apart without a MD being at the foot of the bed. And this time it was for a good reason. As a matter of fact we didn't even take the bed apart, we just lowered the foot of the bed to make it like a chair. So I had the patient begin to push. I called my neonatal resuscitation team and my charge nurse. I also had all the necessary OB doctors at the bedside. My idea was that we do slow controlled pushes so that the baby would glide out gently into the doctors arms and be given to code pink. And we did do a few pushes my way, but the charge nurse had a different idea. She wanted that baby out and she wanted it out NOW! So she told the patient to curl up like she was doing a crunch and push down into her bottom with all her might. She did and after about two pushes the bay came flying out, and if the doctor hadn't been standing at the foot of the bed, that baby would have had airtime. I was mortified. I was speechless for about 10 seconds. Being pleased with the outcome, the charge nurse went over to the warmer to assist code pink and it was business as usual.

DiVa, know when to break the bed and when not. Babies are fast when no one is there to catch them!

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