Just some writing and rantings and views about my job as an L&D nurse..
Friday, August 1, 2008
Saying Hello and Saying Goodbye..
...this will be a difficult subject to blog on; but one that needs to be shared.
Childbirth is something we go into fully expecting to finish with a fresh pink lusty crying baby. But sometimes that's not the case. In fact, Until I worked in the L&D dept. I never realized how many baby didn't get to have that chance.Everyone feels being an L&D nurse is attractive because most of the time the "patients" aren't really patients. Because they're not sick, they're in their prime of life. There is loads of suffering tho. Women in labor, even with epidurals which are so popular today Still have alot of discomfort. There is always some mucous, feces, urine, blood and usually vomit. As a nurse there is only so much you can do to alleviate the pain. It's difficult sometimes to remain composed while helping a mom deal with these discomforts of delivery.
So we like to think its always happy in L&D. But death is always lurking on the unit. Its a common occurrence. More than I realized! As you monitor the mom's strip closely evaluating the FHT's (fetal heart tones) you always have to keep in mind the real possibility that this new little baby might not get to see the light; and may quickly decelerate and god forbid, die on you.
Sometimes the Mom goes to her doctors visit and he has to tell her that there are no heart tones; that they baby's died. And they just don't know why. This can happen at any stage of pregnancy unfortunately.
My patient the other night had been told her baby was gone. She was scheduled to come into the hospital the next day and have her labor induced. As I approached this young couple I could see the pain they were carrying. Tears were dried on both their faces and the veil of death hung over them. It felt strange to walk them down the hall past mothers with healthy infants sat just feet away in their safe rooms. It just felt so wrong.
As I explained what I was going to do; I tried to be most respectful of their pain. I first told them how sorry I was for their pain. For their loss... Its a hard thing to put into words. But we know that its best dealt with face on. Their baby died. Not their fetus, nor did they lose a "pregnancy". They lost their child, no matter what the gestational age. That's how I feel and that's how I deal with it. Its a real child and needs their place in the family recognized. This mom was 23 weeks along. It seems to be a common time of fetal death. There must be a very important transformation that happens around that time; and sometimes it just doesn't happen.
I hooked her up to a monitor to see her contractions after having her change into the gown. They I started her IV and her pitocin. I then told her when her contractions became difficult to manage to let me know and I'd call the anesthesiologist for her epidural. This mom did Not need to get any award for her stoicism during labor.
The labor took almost 10 hrs to produce a birth. A stillborn baby girl was delivered and placed in my hands. I wrapped her gently in a blanket and took her to the warming table to tidy her up. It is policy to encourage parents of dead infants to see, touch and hold their babies after delivery. At first, most parents are horrified and decline quickly. But usually after a bit, they tentatively ask to at least see the baby, after we explain how this helps with the grieving process. Research has shown that parents are better able to resolve their loss better if they see their baby and know what they look like. This also gives them the opportunity to say goodbye.
As I carefully cleaned and wrapped this little baby, my heart was breaking. With tears in my eyes I went to the bedside and told the parents they could see and hold her when they were ready. They knew how to get in touch with me, and I left the room to allow them to have their time together. Then I went into the bathroom and just cried until I felt empty.
The parents did want to see and hold their baby after about 30 mins. I gently picked her up and placed her in her mothers arms. The mother broke down and just sobbed. That's when my tears started up again. I bent down and hugged the mom and just said "I'm so sorry..so sorry". The parents held that baby for 5 hrs before they were ready to give her up. They had the grandparents come visit and everyone had their chance to say goodbye. It was heart wrenching but I felt a sense of peace that they were dealing with their horror face on. They were so strong... So this is the dark side of my job. Lucky for me, they rotate the IUFD's amongst the staff so its fair and distributed evenly. I should not have another demise for weeks, hopefully months. Its very hard and very heartbreaking.
We as nurses do everything we can to facilitate healing of this suffering. We take photo's and wrap the little one in precious clothes handmade by women somewhere who make extra small gowns and bonnets just for these babies. You can see the love sewn into these garments. We give the parents a memory box filled with things to remember their child by. The measuring tape, the clothes the baby was dressed in, photo's and a small teddy. This teddy appears in the photo next to the baby. As harsh and terrible as this all sounds, it really does validate this child's life as best we can.
If the parents don't want the box at the time of discharge, its put into storage for a time when they probably will want it.
My heart was heavy that day as I walked off the floor. But I knew I had done all I could to tenderly and carefully care for this family. I was glad to come into my next shift and have someone just getting ready to push. To see that 8lb 9oz baby enter the world screaming made me dizzy with joy!
..I go back to work tonight. I never know what is waiting for me..but I Love my job. This is why I became a nurse.
RN working nights L&D in a large teaching hospital learning how to help newborns join the human race. My job is a blessing and I want to be really good at it.
Everything written in the main body of the blog is my own opinion. My opinion may be based on incorrect information and I may be competely and utterly clueless and wrong. If you disagree with any of my posts or opinions, please feel free to leave a comment. Intelligent discourse is always welcome. I also abide by HIPA laws. This blog is Not about you or your family. Thanks.
You can contact me at firstname.lastname@example.org