I work in a hospital with a reputation for female issues, we get lots of pregnant ladies all the time. I’d say 1/3 of our ER cases are pregnant bleeders and maybe 1/5 are pregnant pukers followed by another 1/3 of “abdominal pain”. We don’t -under normal circumstances- handle babies or deliveries. Since I started in the ER as a tech back in November we’ve had maybe 3 ER (or ambulance) babies that I’ve been present for. Always an accident because if we can AT ALL help it, we get the woman up to labor and delivery before it gets to that point. With a whole lot of “no no, deep breaths, no pushing in the hallway! In through the nose, out through the mouth” There was the one lady that came in by ambulance in labor and the ambulance hit a bump pulling into our parking lot and whoops out comes the baby in the ambulance bay. Then there was another one who wheeled in on the stretcher making that specific grunting noise that forces you to take a laboring woman seriously and we lifted the sheet covering her and quickly put the stretcher in a room before the baby could pop out in the ER hallway.
Last night made number 4 and 5. I was in a room triageing my patient (a pregnant puker) and I came out and noticed the other two nurses and LPN were wearing gloves in the hallway -not normal- and there was that peculiar vibe of anticipation. The charge nurse got a call saying we were getting a woman who gave birth at home, no prenatal care, she swore she didn’t know she was pregnant til last week and they were guessing the baby was about 30 weeks, they’d be here in about 10 minutes and were coming by separate ambulances, the baby was pink and breathing on it’s own. I missed the stats but I think they said she was a G5 So we begin making preparations, clearing the patient currently occupying our “trauma” room waiting for admission into another room. Plugging in the infant warmer, getting the baby stuff out, getting warm blankets. And calling the NICU team to come stand by. T-7 minutes.
NICU team arrives (like 12 people- all running) and three of them upon hearing the ambulance isn’t here yet glare at us throw their hands up and turn around. (that’s the spirit ladies…)
The charge nurse’s phone rings with an update. – that almost never happens either
The ambulance carrying the mother reports there is now a baby #2 (what they thought was the placenta delivery was actually baby B. Then they tell us they had to cut the sac open and the baby is not breathing and they’re starting resuscitation, they’ll be here in 2 min. This presents a bit of a logistical issue as we have everything set up for 1 baby. We have but one warmer in the ER. We now call a code blue and cut the locks off the neonatal crash cart. There’s now about 15 people assembled in the trauma room waiting.
Ambulance #1 shows up lights flashing siren on (which SO never happens in our ER) One of the NICU nurses has a gown on and goes out to meet the baby with warmers, scoops baby #1 up (the pink baby) and we pile warm blankets on top of the baby and she takes off scurrying for the NICU with about half the team in tow. We wait. Ambulance #2 arrives lights and siren on, we again go out to greet the ambulance with warm blankets. This baby is taken to our trauma room where they begin to do serious resuscitation as opposed to neonate CPR. Epi, epi epi. I guess it’s a good thing the steady night nurses I was working with just took their neonatal resuscitation refresher course last week!
Then they wheel the mother in, and the EMTs take her into the trauma room, and someone suggests “mmm maybe mom should go in a separate room” as they’re attempting to intubate the baby.
As much as I desperately wanted to go in and watch the action in the trauma room on the baby since it’s something you don’t see every day, that’s where all the other nurses went so I went into the room were we put the mother. I was at a bit of a loss as to what to do. The EMTs were in the hallway giving report to one of the nurses and the doctor came in for literally a minute with the mother then left (if I hadn’t gone in she would have been alone) With a lack of any direction I decided, “hey why not start an IV and draw labs, I assume they’ll need one or both of those?” Then one of the older nurses finally came in and started cleaning the mother up and helping me try to keep the mother in the bed. She was still having contractions, sitting in a pile of blood and was begging us to let her go sit on the toilet to pee.
I took a moment to just take the mother in, I’d guess she was in here late 30s but she looked a disaster with rotten teeth and balding, she was a little heavy but I was really trying to see how someone 30 weeks pregnant with twins might miss the fact that she’s pregnant.
We got her cleaned up and the dad came in the room looking just totally shell shocked and detached. I was trying to imagine them finding out the week before that she was pregnant, having a handful of kids at home and then having surprise twins.
They got things straightened out a bit, we had the IV running labs were drawn and we started a pad count and were waiting for them to get her a room in labor and delivery. Then the NICU doc arrived, asked if they had names before he started talking. They said no. Said baby A, a boy, had good color, normal vital signs, that they were going to keep him in the NICU but he expected he would be fine. Baby B, a girl, required a lot of effort and medication to get her heart beating at a rate it should be, they had to intubate her to get her breathing, and that if he had to make a guess, he would guess the baby isn’t going to make it. It was hard to even read what was going on in the family’s head. The dad looked a little pained when he heard the baby wasn’t going to make it, but he just overall looked shell shocked and detached.
At that time they got her a room in labor in delivery so I wheeled her up with the older nurse that had been cleaning her up.
We take her into the room in labor and delivery where we were met by this excessively rude nurse. We were helping the mother move from the ER bed to the L&D bed and the nurse was standing in the corner, not even looking at the patient. I gave her the like 2 sentence report that pretty much summed up my entire knowledge of the situation: “She had twins in the ambulance en route to the hospital, the babies are in the NICU” The nurse says “Where’s the LD report” I said “Excuse me?” then she starts wagging a piece of paper at me, I handed her a summary of the events on the “code blue” report form and said “That’s all I have”, she has a 20 gauge IV in her right wrist and..” the nurse interrupts me “What time was baby B born”… I said “is it on the sheet? That’s all I have” and I go back to trying to give report about the mother and ask the nurse if there’s an IV pole in the room and she walks out. Doesn’t say anything, just walks out.
The nurse I was with starts to get WAY pissed off at this point. The nurse returns about 2 minutes later with an IV pole, at which point the nurse I’m with and the L&D nurse start trading attitude and the nurse I’m with says “Well we had no way of knowing where you went since you just walked out and didn’t say ‘oh I’ll get an IV pole'” Then our aide arrives with a bag full of placenta and can’t get the L&D nurse to tell her where she wants her to leave the placenta.
I mean honestly, if someone dropped a patient like that in my room who’s obviously been through a lot and there’s not clear details, the first thing I want to do is look at MY PATIENT. The babies are in the NICU, the NICU is taking care of the babies, concentrate on YOUR PATIENT lady, instead of being rude in front of the patient. This family just had surprise twins in an ambulance, were just told their newborn daughter is likely not going to make it and you’re more concerned about filling out your chart on the baby. This goes back to how the most important thing is patient assessment, the paperwork can always be handled later.