As an obstetrical nurse, I am surrounded by beauty every single day I come to work. What people who don't work in obstetrics don't know is that labor and delivery can also be incredibly sad. As maternal child nurses, we're not just holding babies and taking pictures of new parents. Some days, we leave work so emotionally shattered, we feel crippled by the weight. I cannot count how many bad or unfortunate things I have seen in my short career as a nurse. But without hesitation, the absolute worst thing I have ever experienced is the unexpected death of a baby.
When I admit someone for labor, I can't help but get so excited. Even if I'm tired, even if we're short-staffed, even if the mother is screaming in a lot of pain, I love it. Part of the magic of labor and delivery is that the same process unfolds at each delivery. Sometimes something unexpected comes up, but nurses are trained to deal with these things. We know how to handle a shoulder dystocia. We know how to handle a seizure. But when a baby is delivered and dies right before our eyes without any notice or warning, it can shock us to our core and leave us questioning if labor and delivery is where we really should be.
I once admitted a young mother in labor. She was pregnant with her first baby, and she kept telling me how excited she was to finally meet her baby girl. Both sets of grandparents were with the young couple. They were all eagerly awaiting the birth of their very first grandchild. The mother was the most perfect patient any nurse could have asked for. A petal-pink lace dress delicately hung on a baby hanger inside the patient's room. Throughout the entire day, we laughed and took bets on when her baby would be delivered. I offered my best guess -- the baby would be born right at shift change. They wrote my name on a piece of paper next to 7:08, and I jokingly told them I had an unfair advantage as her labor nurse.
When she finally felt the urge to push, she delivered the most beautiful, perfect baby with a sweet button nose and the longest lashes I had ever seen. But we could immediately see what was wrong. And I still remember it all, as if in slow motion. With the absence of a baby cry and the frantic moves of every nurse in the room, I still remember that mother hysterically asking what was happening. I still remember her husband crying with his head in his hands. Nurses and physicians flooded into the room, crowding around the baby in the warmer. I remember watching the chest compressions, watching the intubation, watching the placement of the umbilical lines. But the absolute best physicians and the greatest nurses I have ever worked with, all working quickly and steadily together, were unable to save that baby. I still remember that mother trying to climb out of her bed, clawing at the rails, her legs still numb from her epidural. And when the room, full of physicians and nurses and a code team went silent, she fell back into her bed paralyzed in disbelief and in shock. The time of death was called at 7:08.
Thinking about that day, tears still blind my vision and it's still a little hard to breathe. Thinking about that day, I still choke on all the sadness. That day, in that delivery, I felt suffocated by every event in the room. I didn't know what to do or what to say. I didn't know how I was supposed to help her. Long after everyone had left, I didn't want to leave her alone in a room empty of a warmer or a crib. The room felt so bare. When I finally left her hours after my shift, it all hit me. My heart pounded out of my ears and the realization of what had just happened made me sink in so much sadness. I walked into the break room, full of nurses with red faces and tear-stained cheeks, and we hugged each other and I sobbed into their shoulders. And then I got my things and went home, because I had to work the next day and because that's what we do as nurses.
I couldn't talk about what had happened that day at work with my family. That night, tears flowed down my face and into my bath water. I texted my patient's nurse to check on her before I went to bed. And when I finally fell asleep, I dreamt of that perfect baby, her incredibly sweet parents and the little lace dress hanging on the closet door in her room.
When I went back to work the next day, my heart started racing as I approached L&D. I ducked into the nurse's lounge as quickly as I could. I was so afraid that I would see her family. I didn't know what I would say to them, what I could possibly say to people who came to the hospital thinking they were going to leave with a healthy baby. I couldn't tell them that I had no sign, that there was no warning and that I too was blindsided, just as they were. I was so frightened that they would hate me for not being able to just know. I sat in the break room, waiting for my shift to start with my head down. I bit my lip so hard to keep from crying I noticed the metallic taste of blood in my mouth. I only raised my head when I felt someone's hand on my shoulder. I looked up to see the charge nurse standing over me. With a soft voice and sympathetic eyes, she asked me if I would be willing to take care of the patient. She told me that the family had requested that I take care of them again. And beneath her comforting hand and her reassuring fingers, I crumbled right there in my chair. I took care of that patient for the next three days until she went home, coming in even on my days off.
As I sit here typing this, I have to blink away tears. Thinking about everything that could go wrong in labor and delivery, thinking about everything that does go wrong in labor and delivery, I have to close my eyes and wish with everything I have for only one thing.
This holiday season, my one wish is that every nurse knows their worth and that every patient knows theirs. If you are a nurse or if you are a patient, do not ever be afraid to voice your concerns. Do not ever be afraid to ask questions. Sometimes, no amount of planning can alter a bad outcome. Sometimes nothing we do can prepare us for what we'll be presented with. But we all have to work together to prevent the negative outcomes we can. And it's not just about bad outcomes, it's about the best outcomes. We can no longer solely focus on improving communication between the physician and the nurse. We have to engage our patients, because they know more than we think they do and they know more than they're telling us.
If you have ever been the patient in a situation where you were devastated by the unexpected, if you've ever been the family that didn't take your baby home, please know -- please really know -- that there's still a nurse out there thinking of you. I hope that one day we will all meet again and that we'll all have something to celebrate. But until then, know that your nurse remembers you and the life of your baby, however short their little life may have been. Somewhere out there, there is a nurse with a heavy heart in their chest and eyes blinded by tears. Your story is not forgotten. We remember.
Until my next delivery <3
Because no mother and no baby should die from childbirth, visit Every Woman, Every Baby to find out how you can help.