Everyone is excited to see me, but I'm sad deep down. I don't get any patients because we are slow so I have more time to feel sorry for myself. I am listed on the board as first admit which typically gives you a feeling of impending doom all shift because whatever walks in the door you know is yours. Well, lo and behold a woman walks up to the desk stating she's in labor. First she was only 2-3 cm dilated. An hour later after spaced out contractions she's a good 3cm. This is her second baby and the plan is to let her walk for a couple hours before we check her again and decide if she is going to stay. A couple hours goes by and the woman is rechecked. She is now 4-5 cm. I take over from here and start the admission process.
In the last 30 minutes from the time she was in triage to the time she is in my care her pain has increased greatly. She wanted pain medication but the epidural wouldn't happen for another 30 minutes at least. The Dr. that is consenting her for delivery decides to check her again while I draw up IV pain meds. She is now what he calls 6 cm. I give her the medication and that helps for maybe 1 min. Just kidding. She feels a little better while I get through the rest of my god awful admission questions and assessment. I move as fast as I can to get through with questioning her, talking in between each contraction. Her husband stands patiently by her side holding her hand, reassuring her and answering any questions he can.
I leave to go find anesthesia to get this epidural rolling. While all this was happening, our floor ended up getting pretty busy and everyone seems to be in different places. The anesthesia provider comes up, but happens to over hear another nurse tell me about his fresh post partum patient that has increased bleeding and he wants to call the doc who is off the floor at this point. To me, the fact that he's left the room and is sitting in a chair stating this, I know its not an emergency. The charge nurse is in triage, so I go in to his patient's room with him to assess her bleeding. The bleeding at this point isn't concerning and I recommend he drains her bladder. I walk out and tell anesthesia that his patient is fine and she can put my lady's epidural in. I can hear my patient from the hallway so I go in to make sure she is okay. She is, but she firmly and loudly states she needs the epidural now. I go out and tell anesthesia that my patient is REALLY ready for her. She says "respectfully, I'm not going to go in there if there is another patient on the floor that's bleeding and we need to go back to the OR." Insert my nursing eye roll here. Okay, I understand this, yes if the patient were in fact bleeding enough to be concerned but I just told her she wasn't! And its labor and delivery...everyone is bleeding.
So I go back into my patients room and give her support and reassurance. When she starts asking me where the epidural is I go back out to the desk to see what anesthesia is doing. She's not doing anything, but still refuses to go in my patient's room. I go back into the room. I come back out of the room and confront anesthesia again. This time I say, well can you at least consent her so she knows you're here and starting the process. So she does. While I'm about to get the patient set up, she states she kind of feels like she has to push. Okay, recap, its been 45 minutes since she was admitted and 6 cm. Her bag of water is intact, but her pain has changed significantly in the last hour and this is her second baby. All these things are going through my head. I check her cervix and she is 9 cm, completely effaced and the baby is at a 0 station. I inform the anesthesia provider and she states that she will place the epidural if the patient can sit still. The patient demands the epidural. Anesthesia steps out of the room to get her cart and happens to inform the Doc (that is now on the floor confirming that the other patient wasn't bleeding) that my patient is 9 cm but she's going to try the epidural. The Doc then leaves the floor to go to clinic but states he'll be back. Insert another nursing eye roll here.
We get all set up for the epidural. While anesthesia is attempting to place it, my patient is literally clinging to me. I'm talking, bear hug, nails in my back, squeezing me. I'm not quite sure what her husband was doing standing next to me. I didn't mind though, honestly I've never had a patient grab a hold of me that tightly and felt so useful, but helpless at the same time. When I started to feel the nails, I hit the call bell. It was all I could reach while my other hand was trying to keep the baby on the monitor. A very new and wide eyed corpsman walks in and I ask him to bring my delivery table into the room and to find out which corpsman was doing the delivery with me. A few moments later I notice my patient started to shift her weight off her bottom. I hit the call bell again, a nurse walks in and I ask him to grab all of my delivery medications and to let the Doc know that I don't think its going to be long till this baby comes. I give him the eyes to know I was very serious. He leaves the room. All of a sudden, my patient is trying to stand up. She is sitting on a bed that is completely raised off the floor and an epidural needle is trying to be placed in her back. This is not the time to move. I make the executive decision this baby is coming epidural or not.
The patient states she has to push and forgets about the epidural or lack there of. Anesthesia basically runs out of the room. I lay the patient back and sure enough I can see her bag of water bulging. I hit the call bell again and the nurse comes back in. I said "the baby is crowning, get me Ms. Murta! and a doctor or I am going to have to deliver the baby myself!" At this point, I did not think I was actually going to have to deliver the baby. And Ms. Murta is the charge nurse, a long time L&D mentor of mine, and my friend. She was there when I delivered Dagny. So, I break down the bed and stand in-between the woman's legs. Almost frozen. All I can think in my head is "don't EVER leave the perineum!" Something my preceptor yelled at me when I first started nursing. Several corpsmen, God bless them, are running around the room getting it ready for a delivery. Finally, Ms. Murta storms in. "Ms. Murta, the baby is crowning!" "Okay...get your gloves on!" She takes my place while I struggle to put my sterile cloves on, shaking to the core. I come back over and retake my place, all the while reality is setting in. I'm about to deliver this baby. The mother has really regained control at this point, or I just didn't seem to notice anything anymore. I put my hands on her and watch and feel as the baby's head is coming on its own with out any pushing. Miss Murta put her hand on mine to show how to give more support to the mom's perineum. All of the sudden the head is in my hand. I remember saying hold one, don't push, while I took my other hand and completely felt around the baby's neck to make sure there wasn't an umbilical cord wrapped around it. There wasn't, and the mom was involuntarily pushing again. Just like that the entire slippery body was in my hands! My hands instinctively went from its head to its body as I pulled it up and out of her. I immediately placed the baby on the mama's belly. I could feel the tears coming and remember looking at Ms. Murta who was right at my side, with the biggest smile I could ever smile on my face. It was the best feeling ever. I was shaking and smiling. I felt the cord stop pulsating in my fingers and then clamped it twice. I gave the dad scissors and he cut the cord. I put the baby up on moms chest. At this point the Doctor comes running in. He is the sweetest man and is as happy for me as I am. He takes over for me and I stumble through the rest of what needs to be done still shaking to the core.
Labor and delivery nurses deliver babies all of the time. It doesn't happen at our hospital very often because we are a teaching hospital and always have residents and providers in house. I won't ever forget that experience and the feeling I felt as my hands brought a baby into the world.
"When the peaceful happy moments roll.
When Jesus shows his smiling face,
There is sunshine in my soul."
