When I was first finished with my training on L&D, I had my eyes opened to a very deep and serious reality of life…and labor nursing. I arrived on my shift to review my assignment and found that I would be caring for a woman who was 22 weeks along (a little more than half way.) She had learned that day that her baby had very serious brain, kidney and heart defects that weren’t “compatible with life.” The woman and her husband, having had extensive counseling by her perinatologist and physician, decided to come to our unit to induce labor to end the pregnancy. The charge nurse told me, “This baby won’t even survive labor.”
“OK,” I thought. Being relatively inexperienced at the time, I considered the anomalies so severe that this would not upset my beliefs. The baby’s life is lost. It’s hopeless to expect anything more than death; whether that occurs now at preterm induction of labor before viability, or to bear to carry this baby to term along with this grave anticipation for weeks longer and have it happen then. The latter would be too much for a person, wouldn’t it?
So, I cared for this dear woman that night. I began infusing Pitocin. I’d never cared for a woman who’s baby would be dead. I struggled so hard to know how to act. Do I smile at her when I introduce myself? Do I offer my condolences right away…or wait until it happens? Do I go on with business as normal to spare her pain? I found myself feeling very awkward. She and her husband were very numb. Their affects were as flat as ice. Who could blame them? There were no tears. Not yet.
Labor carried on quite quickly actually. In fact, very suddenly the woman was exclaiming that the baby was coming. We hadn’t monitored the baby’s heartbeat (a moot point, isn’t it?) After all, the baby would not survive labor. I called the doctor for delivery right away. But the contractions overtook the woman and I found the baby suddenly in my hands…gasping…and moving its arms and legs. I was in utter shock that the baby was alive. The father cried out, “Oh God! She’s alive!” and let out a cry that only comes from someone who is watching their child die. It’s beyond agonizing. The mother, paralyzed, was silent.
I feebly carried it to the warmer to wrap it and watched it gasp and struggle in my hands, helpless to control my own emotions. The baby’s heart beat for 20 minutes before it died. We, with all our technology…and arrogance…did not dictate or preconceive, or control, the time of death. We never will.
This couple wasn’t warned properly of what they might expect. Unfortunately, me being so inexperienced at the time didn’t help them. Of course any baby that is induced alive may be born alive, more often than not.
But what I took from this experience and held ever since is that we shouldn’t be deciding when a baby dies. That’s not our decision to make.
My nursing friend has a friend with a beautiful story. She, like the woman above was faced with certain death of her baby with life-threatening anomalies discovered at 20 weeks gestation. She was counseled to end her pregnancy and try again. But she decided not to. Her perinatologist actually told her that she needed no further prenatal care if that’s what her decision would be…that there was no need for him. She dealt with a lot of opposition about her decision to carry her pregnancy. But she just couldn’t end her baby’s life herself. She carried the baby for 20 more weeks.
Although this time was painful, knowing what would happen, she found herself bonding with her baby in utero. She played little games with her by pushing and feeling the child push and kick back in her womb. She and her husband took every opportunity to make the most of that time. When she finally went into labor, she described feeling like she knew that little girl so well, and loved her. When the baby was born, she and her husband held her for two hours until she died quietly in her arms. She says, “I feel like I sent my little angel to heaven.” She says that she will always treasure that time she had with her daughter, and she never regretted a second of that decision.
I, after caring for my patient, had to deal with my own guilt. I, after all, gave the medicine to induce labor. Does that mean that I killed that baby? No, I don’t think so. That will be between me and God. But what about my duty as a nurse? Just because a couple is doing something that I don’t agree with doesn’t mean that they don’t need care. In fact, they need it more than ever! I can’t abandon them!
This is why I have voiced my own position to my employer about these cases. My personal solution to this is to care for these dear patients that deal with such a hard time, but I won’t manage the Pitocin (or other induction agent.)
What are your thoughts? Stories?