emotional working in labor and delivery

[admin]

I attended a ceserean tonight where the baby was 10lbs
4oz. This was the biggest baby that I have personally been at for the delivery since I started working in labor and delivery. Beautiful, healthy baby girl. The mom wasn't that big at all, and the only reason they sectioned her was for failure to progress. I went and cried afterwards in the bathroom, very unprofessional.
Got to be said that there are good things about L&D after years of ICU and 'bout every outcome is positive
since the "high risk" deliveries I attend are for a low risk hospital nursery, but tonight it is just EATING ME UP that my baby was 12lbs 6oz and some moron thought that vaginal was the way to go. Sometimes it feels like a healing process when I watch something positive happen, and, god help me, sometimes it feels like a slap in the face. After three years and much more education both personally and professionally I just want to blast the woman who did this to my daughter. I am so mad at her tonight...and I haven't been in a long time. I just want her to know the pain she caused my daughter, and two other children that I personally know about, and god knows how many others I DON'T know about. Lately I have been really stressed at my job, burning out. I used to love it, and I thought that maybe working less ICU/Critical care and more babies/pediatrics might help. Sorry to vent, but I really feel like crying. On top of this, now the hospital is talking about cutting hundreds of jobs for this current budget crunch. My department is dangerously understaffed as is, and now they want to go from 5 people at night to 3. Some stupid attorney suggested that our respiratory therapists should not stay in the ICU continually, check only half of the ventilator parameters that keep our patients alive and breathing, not attend high risk deliveries, and other
cost saving measures. On top of this we intubate all our patients when they need to be, including neonates.
Would any of you like for your baby's nurse to bag your newborn for 10 minutes until someone can arrive to put that tube in their airway and risk permanent brain injury from lack of O2? I feel in constant fear at my job that because I am forced to prioritize and skip patients that someone will be seriously injured or die because we were shortstaffed. Because what happened to my daughter was a series of events from a doctor and midwife with not enough sense, and made much worse because they were so overworked and did not attend me until it was too late, leaving me with a first year resident that did not have enough experience to know how dangerous the situation was. Part of why I am ranting now (sorry) is that I know what it is to have a senseless injury that is permant and painful and completely avoidable happen to someone that is prescious to me and I am very worried that because of staffing something will happen to one of my patients that is avoidable and it will not just be a bad night for them or their loved ones as it would be for the staff, but a permant, life altering event. I just pray that I never hurt someone inadvertantly as my daughter has been hurt.

[admin]

Amy,

So sorry that you have had such a rough night! I am a nurse as well (cardiac OR) and I know all about cutbacks! It's disgusting when you think about who really suffers in the end.
My daughter was injured by an L&D nurse 10 months ago and I don't know if I will ever forgive her. At least you understand the severity and permanence of these injuries. EVERY single L&D nurse in my room said my daughter would be fine in 2wks, they were and are completely clueless when it comes to these injuries, which is soooo unfortunate! The nurse that delivered my daughter referred to my delivery as "easy" when questioned weeks later by my OB. I am not sure what she means by "easy"....an injured baby that stopped breathing upon delivery and had to be bagged with O2, apgars 3&8. Not my idea of "easy". They charted nothing regarding her injury and didn't call anyone to assess my daughter, except a special care nursery nurse, who looked at her shoulder and said "I don't think it's broken"!

I truly hope and pray you are never on the giving end of one of these injuries, but if it should ever happen, I am at least sure you will do EVERYTHING in your power to prevent it. You have knowledge and skills and that equals power to change, never forget that!

May the angels be with you always as you care for every mother and her beautiful baby.

Take care.

Shellie

[Kath]

Amy & Guest
My heart goes out to you it must be so hard. I truly believe that Nursing is a Vocation and most nurses are very loving and caring people you are not in it for the money.
I am the mother of a nurse (cardiac) I tried to talk her out of being a nurse.She said at 7 she was going to be a Nurse and never changed her mind. She will not be going back to intensive care but working at a rehab center because of the low staff on most hospital floors. she has been home with the kids but truly missed Nursing.
Amy I think you handled it well... Crying is good for you it is a great release for your spirit and helps with the pain of what if...
Kath

[Tanya in NY]

Amy,

Let me say that I can completely empathize with you as the mother to a BPI child AND as a L&D nurse, too. I continually talk at work about prevention. Sometimes I wonder if the staff I work with is getting tired of hearing it. I feel like I'm driven at work to prevent this injury from occurring. I don't currently work at the unit where I delivered my injured daughter.

Whenever I am in a delivery, I speak with the patient and the midwife beforehand about prevention by saying we will be using various pushing positions and you need to listen to the midwife and/or me for cues and not just the family. We all know that families truly do mean the best for the mother-to-be, but they get very emotional and loud I might add, in the heat of the moment. We also know there is a lot of misinformation that they may be saying to the mother-to-be, so I make it very clear that they need to listen to the midwife and/or me for delivery so we can help her guide this baby into her arms without difficulty. I think preparing someone beforehand is very important.

At each vaginal delivery I attend, I have a lump in my throat and am on pins and needles worrying about SD. I have actually had moments of fear that freeze me for a few moments, like a flashback. What if SD occurs? What will my actions be? Have I earned the trust of my patient enough for her to listen to me right away when I say to change position rather than her saying "I can't" because she is in so much pain? And so many other thoughts pass through my mind. I have been known to cry after a tough delivery before. It used to be because I was so happy that the outcome was good, but now it's because I'm so happy the outcome was NOT bad! Usually the patient thinks it's because I'm so happy for them and their new baby and got caught up in the moment, although that has happened as well. This all has gotten better with time, more knowledge, and the willingness to learn how to prevent this injury from happening from the staff I work with.

Trust in your abilities to guide this baby to a safe delivery. If something is saying in your gut that there's something wrong, talk with the provider. I know it's so easy to say and at some institutions you wouldn't be readily accepted in doing this. I just hope that you have that option as I do at my job.

I understand about cutting staff. It's such a crisis all over the USA! Are you NALS certified? If not, who is? Is there someone who is always immediately available who is NALS certified? At my job, we (the nurses, obs, midwives, and peds) are all NALS certified, so we are trained in intubation. At my old L&D job we were not trained in the intubation though as nurses, but there was a neonatologist on at all times and there was a CRNA who slept on the unit to work just for us with intubation (whether for mec, after prolonged PPV, or for ET tube meds). At my current job, there is no CRNA for us let alone a neonatologist. We have a SCN that is basically for TTN, hypoglycemia, and stabilization for transfer to Albany Medical Center. We all review the NALS protocols and do drills frequently though.

How good is the respiratory team for high risk deliveries? Are they really that beneficial in such a circumstance. In my experience, they are more nervous that I in this instance because they have LESS of an opportunity to work with neonates. Maybe it would be beneficial for your nursing staff to learn intubation, along with the peds docs? I don't know. I'm just trying to make suggestions for you so you can feel more comfortable at your job.

Could you request a pediatrician at every delivery or a CRNA/anesthesia there? I'm sure your unit would LOVE this suggestion (ha, ha).

I think venting is a healthy way of healing. I think you are very brave to continue to work in a L&D unit after your previous delivery experience. I think that you could, and probably are, an asset to your L&D unit in prevention and education. I know that many families who post on here say that the L&D nurse should know better than to say "this will get better and go away," but I in all honesty had NEVER heard of this injury until AFTER my own daughter was born with ROBPI! I had never heard about it in nursing school or while working for the 3 years prior to my daughter's delivery on a L&D unit. No lie. I was told that her arm would get better in a few days to weeks by the midwife, the staff I worked with, and the neonatologist who saw my daughter. Boy, were they wrong. Now, I tell the staff I work with (a different hospital) to NEVER say that to a family. There has only been one injury since I started working 2 years ago at this particular unit (it occurred while I was not working). I now talk regularly with that mother about her child's progress. Let me tell you though, not a single nurse or doctor told that mother that it will definitely go away. Instead, they provided her with accurate information, a PT referral for ROM exercises, my phone number, and information from the UBPN site.

Please don't feel as though your frustration and worrisome feelings are bad in any way. They are all justified indeed. I hope that you do continue to work L&D and don't continue to feel burned out. You are such an asset to your unit and the future mothers and babies that deliver on your unit.

Feel free to email me if you'd like.

I apologize to all for running on and on in this thread.


Tanya in NY

[admin]

The thing is I am not a nurse, I am a respiratory therapist. I moved South from NJ and in NJ and up north therapists did not intubate or work l&d. I have worked NICU for several years, but never went to deliveries before this job. The hospital I work for now is roughly 350+beds and is a tertiarry care facility that accepts critical patients from hundreds of miles away. We are expected to be the critical care team here and have lots of responsibilities, we do the majority of the intubations, the arterial line insertions, and I still work about half the time in a 20 bed ICU. Our special care nursery nurses are of course NALS providers, and quite competent. We work in teams of two, an RN and a RT, and we attend all deliveries deamed high risk...mec,decels,premature,mag,
stadol, and all c-sections. The SCN nurses are also overworked with a full lode, they take turns attending deliveries with us. If something hits the fan so to speak, we may or may not have had time for the neonatologist to arrive from the level III hospital a couple of miles from here. Our anethesia guy is running the case on the table, and they have less experience intubating neonates than the rn's or rt's.
Lots of hospitals do not use therapists at deliveries but ours chooses to and does not have the staffing for a second SCN nurse instead, nor are the regular l&d nurses confident or trained to do what we do. They are talking about cutting us to 3 rt's at night...to cover a 350 bed hospital. Last night we had 13 vents, one intubation, a baby on CPAP, and three deliveries. I was supposed care for that baby, attend those deliveries, go to a code, and had 17 other patients on the floor to give neb tx's to. Multiple patients did not get seen. I am burning out at this job. Tonight I went to a c-section that was 300lb mom, breach baby, true knot in the cord with only two vessels.The kid was 9lbs 6 oz, they had a really hard time getting him out, then he had to be bagged for several minutes until we could get the heart rate up. Then we realized he wasn't moving his left arm at all. It wasn't until about 10 minutes after birth that the kid started to move that arm about normally. I was tearful until he started to move it, and when the RN and I were going over notes, apgars and etc. I told her to make a special note about the left arm. I have this huge pit in my stomache, I am worried about loosing my job as I am a new hire, I am worried about not seeing my patients, I am worried about my daughter's arm, I am worried about our maxed out credit cards and unpaid medical bills from her treatments and surgeries. I am pissed because I worked at the hospital where she was injured and somehow I thought being one of them, working in a hospital, would somehow protect us from something bad happening because they were my peers, my friends and coworkers. My supervisor asked me if I was sure I wanted to continue taking l&d since I am so traumatized watching shoulder distocia's and such that I sometimes cry afterwards. Of course that was one of the things I was hired on specifically for and there aren't but a few of us that can take that assignment anyway, and my only hope is that they can't afford to let me go because most of our RT's can't do, or are too afraid to do deliveries.Anyway, sorry to rant, and I usually only post sporadically, but lately I just feel so stressed out and depressed. My poor husband wishes I had taken a different line of work, he's tired of hearing me complain, so I come here to complain, instead.

[admin]

I'm sorry Amy, I had just assumed you were a nurse by the wording of your post! I also thought that by delivering at the hospital I worked at would be better than going elsewhere, afterall, I was a part of the hospital team, I figured our care (mine and my unborn child) would be exceptional and beyond the care that other's may receive. WOW, was I soooooo wrong!

I completely understand your need to vent, cry, scream or lose your mind every now and again. I have been and am still there currently. I have been seeking counseling myself to try to deal with all of my emotions but sometimes I feel no matter what I do to try to heal myself, time is the only thing that can do that for me. One of the hardest things about these injuries is the lack of control we have over them and in our jobs, we are so used to controlling the situation and when we can't heal our own child it is nothing less than devastating, especially when the injury never should have occured in the first place.

I truly hope both of our daughter's as well as all of the other children injured have amazing recoveries and long, HEALTHY, HAPPY lives!!

Take care Amy

Shellie

[Lilmaem]

I don't want to seem negative, but unfortunately after my delivery, I have lost alot of fait & respect for nurses and other medical staff. If the nurses would have listened to me, my son wouldn't have a LOBPI. Ater 19 hours labor and 3 hours pushing with no progress, I knew the baby wouldn't come out. I pleaded with them and they wouldn't listen to me. I had to urinate numerous times, and they got mad at me because I needed the bed pan. They told me I didn't know what I was feeling, that with an epidural I couldn't tell If I had to pee or not. I proved them wrong over & over again. Still, nobody would listen to what I was telling them. I told them, I had a bad feeling, I couldn't push him out, he was too big, do a c-section, or at least get an ultrasound to size him. They told me he's not that big, I'm not pushing right...etc. etc.....If there is anything nurses can do - listen to your patients because they know themselves and what they can and can't do.