Thursday, March 12, 2009

A Mistake

One night we got a call from an ambulance that was pulling in with a “27 week eminent delivery.” Alarmed, we raced into action to prepare for a severely preterm infant. (A full term pregnancy is considered around 40 weeks long.) I called in a neonatal team and prepared a room for delivery.
The ambulance crashed through the elevator doors with a Hispanic woman strapped to their gurney, crying. The paramedic started to ramble off his report of what was happening with the woman in labor. The neonatal team rushed to set up their equipment, preparing for resuscitation. Everything was rushed and frantic.
But then what the paramedic said made us all stop short.
“The due date is actually seven weeks later than we thought. We couldn’t understand because of the language barrier.” This made the baby only 20 weeks along in the pregnancy, about 5 months. It had no chance of survival outside of the womb. There was nothing we could do to help it. It would die if we didn’t stop her. We would have to work fast as she was actively laboring.
The paramedic went on, “We were en route and I was able to visualize membrane so I manually ruptured her bag.”
“You ruptured her bag?” I asked, outraged. He could see my alarm. I and the other nurses in the room looked at each other, not sure what else we should say to this in front of the patient. We could have tried to stop the labor and saved the baby but now that her water was broken, there was little chance. Even if we did stop her labor, without the water bag intact, the baby would most likely have severe physical deformities and major problems with the development of the lungs. Not to mention the high risk of life-threatening infection to the mom and baby. If he didn’t rupture her bag, at least she would have a little chance of getting through this.
We began to work quickly as the neonatal team left the room realizing they weren’t going to be needed. The doctor began to examine the woman while we hooked up the monitor. Her cervix was only 3 cm. Her delivery was not as “eminent” as the paramedic thought. Her membranes must have been “hour-glassing” or squeezing through the cervix—a condition that can be treated.
As time went on, we were unable to stop her labor. The time came for her to deliver and we prepared a delivery table.
“I don’t want to see it!” the woman cried between sobs, “Please just take it out of the room.”
A baby girl was delivered. She gave one tiny gasp and moved her head back and forth as I wrapped her in a warmed blanket and took her into another room. She was just long enough to cover my hand from fingertip to just over my wrist. She was just short of a pound. Her heart still beating, she repeated the movements she did at birth, her chest retracted while she tried to take a breath into her undeveloped lungs. I took her into my arm and held her. She would not die alone.
Her heart beat for 51 minutes.
I’ve been involved with many stillbirths before that day and since. It never gets any easier.

2 comments:

  1. Just started reading your blog...I hope someone tore the EMT/paramedic a new one for rupturing a severely preterm membranes!

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  2. Even if she wasn't preterm...even if she was full term, there is NO reason whatsoever why he should have intentionally ruptured her membranes (especially en route!). What in the world was he thinking?

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