December 5, 2006, 6:55 pm

Birthin’ Babies

prissy

Ah…one of my favorite movies is “Gone With the Wind”.

Prissy and I have something in common!

Neither of us know nothin’ ’bout birthin’ babies.

But Scarlett and I have something in common, too.

We were both faced with the prospect of having to “birth” a baby.

And just like good ol’ Doctor Mead in Atlanta, the ER doctor was needed elsewhere for more pressing matters.

******************************

The call came from the intensive care unit, right next door to the emergency department.

A patient had self-extubated and was decompensating rapidly. Would the ER doctor rush over and re-intubate this patient?

He was through the double doors before I even hung up the phone.

*****

I was the night charge nurse at the time.

The night was surprisingly slow for that little “mini-county” of an ER. It was just a smidge before two am and only one or two patients were over on the “clinical” side.

This particular ER required that all pregnant women, even if they were at term with ruptured membranes, sit down at triage and get their vitals taken along with a bunch of other busy work that could have and should have been done up in labor and delivery.

Emergency: the dumping ground for everyone else’s scut work.

*****

So here comes a very pregnant young lady. She wasn’t a child but resided somewhere in the nebulous area between the state saying you are an adult and actually being one. Her mother pushed her through the ambulance entrance in a wheelchair.

“Hi!” I said. “Is it time?”

“I do believe it is” answered the soon-to-be grandmother. “She’s been havin’ pains for about six hours and her water broke ’bout half an hour or more ago. Now she says she has to go to the bathroom.”

First baby. A week from scheduled due date.

Ding!Ding!Ding! The little bell in my head went off.

(Actually what went off in my head was “Oh s***!” )

But I just smiled and said “Okay, let’s have you lay down on the bed here and see what’s happening!”

The patient herself was quiet, withdrawn and seemed not quite “all there”. As the wheelchair was pulled parallel to the gurney, the patient stood up and began to walk away!

“Whoa! Hon, where are you going?” Seemed like a natural question at the time.

“I’m goin’ to the bathroom.” Ask a silly question…

“Oh no you’re not! You need to lay down right now.”

She just looked at me wierd. Didn’t budge.

I repeated the need for her to lay down, like, yesterday.

No response. Just stared at me. No crying, no clutching her abdomen. No hysterics. Just a straight stare.

So we, uh, assisted the patient into a supine position and I told her I needed to take a “peek” at what was happening “down there”.

(Son of a B****!!!!!!!!!!)

She was crowning.

(Okay. Stay calm. You have had your class in Neonatal Resuscitation. You know what to do.)

I quietly surveyed my staff. Has anyone delivered a baby before?

Nope. So that made me the senior nurse on duty.

(Delegate!)

Anne, run next door and tell Dr. Emergency that we have an impending delivery. Margie, call nursery; have them run a warmer down STAT. Joe – can you hand me a pair of sterile gloves and get the precipitous delivery pack from the top shelf and get out the bulb syringe.

(Oh s***, oh s***….newborns are nose breathers, suction mouth first…..or is it the other way around?????)

“You are doing just great!” Outwardly I was as calm as you could imagine. You would have thought I did this every single day of my life. “I see the top of the baby’s head!” Big smile.

(My pulse was 186. At least. Probably V-tach for all I knew.)

I put on the gloves just as Anne came flying back to tell me the doctor couldn’t come, the intubation was difficult.

(Holy s***!)

“Just go with what your body tells you to do,” I instructed the patient. “If the urge comes to push, you just go right along with it”. None of this telling the patient not to push. The baby’s crown was right there.

So there I am with my hands about three inches away from the woman’s peri area and a bulb syringe at my right hand.

And nothing happens.

Ummm….shouldn’t she be pushing? Oh, wait…there’s one and here comes the…no, not that time.

And all around the gurney, in a half-circle about five feet behind me is every single staff member on duty that night, plus the two nursery nurses who aren’t even coming up to help, they are just standing behind the ER staff with their warmer!

(Good god, ladies, you’ve done this before, why the hell don’t you come over and help…do I look like I know what I’m doing?)

I guess I did.

More encouragement for the patient. Found out the baby was a girl. No name yet. “She has a ton of hair!” I noted.

Here comes the head! Okay honey….good girl…go ahead and pu…..

Right as that baby’s head popped out a huge mass moved my considerable bulk out of the way and a big blue hand caught that baby’s head and the rest of her, too.

The doctor had rushed through the curtain at the last minute and literally pushed me out of the way to catch the baby.

Rude?

You might think that.

Loss of a teaching moment? I mean, he could have talked me through the delivery.

You might think that, too.

But I could have kissed him.

Right there in front of God, country, patient and co-workers. He’ll never know how close he came to the biggest smooch ever smooched in history.

*****

The new mom? She did great.

After it was all over, the enormity of what just happened seemed to dawn on her and she was no longer “out of it”. She held the baby briefly and then the nursery nurses did their thing, taking the baby back to the nursery.

New Mom asked New Grandma to go up with the baby.

For the next hour-and-a-half, our ER tech held the patient’s hand and talked to her and told her what to expect post-partum. And the tech was the perfect person to do the patient teaching – she was the mother of six herself, having had the first at the same age as our patient!

It meant a lot to the patient to have that support. So much so that there is a little girl, probably in the second grade by now, running around with the same name as the ER tech!

Me?

I should have gotten the Academy Award for Best Actress (In a Stressful Situation).

Then Scarlett and I would have had two things in common.

12 Comments

  • Steven F. Palter, MD
    Steven F. Palter, MD

    December 5, 2006 at 7:05 pm

    I remember that happy feeling of deliveries well! It helped that I was actually trained to do them. You got it all right – it’s really quite simple push with the head then breathe for the shoulders and placenta – clamp and cut the cord – dry baby and suction mouth and nose (hey we never really smack the bottom any more). That is unless it all goes wrong and all hell breaks loose! Good job.

    You did forget the part after the delivery where you try to convince the mom to name the baby Kim…


  • jen
    jen

    December 5, 2006 at 8:50 pm

    awesome! sounds like you did wonderful! delivered a baby boy last weekend in my ED. supposidly a 28 weeker, but looked and apgars were full term!!! All I kept thinking, is man, the ER is a very dirty place to deliver a baby.


  • laura
    laura

    December 5, 2006 at 11:51 pm

    i must say most nursery nurses know nuthin’ ’bout birthin’ babies too. we usually just catch them when the ob or th panicky l & d hands them off to us.
    most.
    i once delivered a baby and like you i was very reluctant and close to stroking out. lucky for baby, mom and me, it was an easy delivery and all i did was catch a 8 pound boy with 9 and 9 apgars.
    i say you did awesome girlie!
    congrats to you and the happy family.


  • Steven F Palter, MD
    Steven F Palter, MD

    December 6, 2006 at 7:01 am

    Also remember when handing baby to new dad make sure he is sitting or else you will be getting the smelling salts when goes down


  • Candy
    Candy

    December 6, 2006 at 8:28 am

    Closest I ever got (besides participating on the other end for my own kids) was as a labor coach. The second time, the OB in our little town was “otherwise occupied” at the critical moment, and I was ready to step in, but his partner happened to be in house and did the job himself. Who’d take a bathroom break during a delivery?


  • Universalhealth
    Universalhealth

    December 6, 2006 at 10:01 am

    Whn ya gotta go, ya gotta go. And that goes for babies, too!

    What great work, Kim!

    (I was in the same boat until I ran an animal sanctuary – learned about birthin’ kids of the caprine variety, as well as helpin’ chicks out of their stuck shells, foals who needed a hoof up and the occasional pup or kitten who’s mama got tied up in traffic.)


  • apgaRN
    apgaRN

    December 6, 2006 at 1:31 pm

    Ha ha haaa! Kim, I’m laughing my A off… you are too funny. Fortunately, the babes I end up delivering at work are the ones who are coming so fast, they usually don’t need much help from me. 🙂

    N


  • Alyson
    Alyson

    December 6, 2006 at 4:34 pm

    That sounds so awesome and exciting. Although I think I would have been disappointed that the Doc showed up. I almost delivered a mom who was having a precipitous labor but she decided to try to make it to the hospital and had the baby in the car on the way. I was following in my car.

    ~Alyson


  • Teresa
    Teresa

    December 6, 2006 at 6:53 pm

    Once rode in the ambulance on a call to pick up “woman in labor”. New mom and grandmother were standing on the back porch waiting for us with baby wrapped in a quilt. Mom age 15 had awakened grandmother, asleep after working third shift, to tell her she had just delivered a baby all by herself. Grandma had no clue that mom was even pregnant!

    Baby was a little cold, but otherwise perfect, weighed about 4 #. We took all three to the hospital where OB nurses took over and all was well.


  • MandyHAmm
    MandyHAmm

    December 6, 2006 at 11:13 pm

    While it is an exhilerating, awesome moment, it is indeed…well, nothing I want to do…assist in a “surprise” delivery, that is. I can say, “Don’t push!” in Spanish verrrry well…


  • TC
    TC

    December 7, 2006 at 7:59 am

    Excellent job! I know that feeling of, “I may look like I know what I’m doing, but…” Once, in triage, I had a woman come in, about to deliver her 5th, her water had broke and contractions were 1-2 minutes apart. Another “oh, S*&%!” moment. I knew I’d never get her upstairs intime, so I had another nurse bring her to a bed while I called for the warmer. Next thing I know, I hear “waaaaah!waaaaah!” from behind the curtain. That’s about as close as I’ve come to catching a baby.


  • Andrea: The Family Fork
    Andrea: The Family Fork

    December 7, 2006 at 12:20 pm

    Unbelievable! I nominate you for actress of the year. Whatever with the teachable moment.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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