labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, December 3, 2007

Mama Said Knock You Out

It looked like a scene from a horror flick. Seriously. It was awful. I've never seen a bloodier birth in my life. No one saw it coming either. I was caring for a young woman who was being induced for postdates (40 weeks 2 days.... I won't go there tonight). It was her second child, and her first was also induced. The first induction was 8 hours, which is fairly quick for a primip. This being her second child and second induction, I was anticipating a quick labor and birth. But I had pitocin going for hours and hours.

Six hours into the induction she became uncomfortable and asked for an epidural. She was 5 centimeters and so I began prepping her for anesthesia. During the few minutes I was out of the room to fetch the epidural pump and medication (because, god forbid the anesthesiologist fetch their own supplies from the room they have to walk by to get to the patient rooms) she became a wild woman. I walked back into the room to her crying hysterically, screaming for me to make it all stop; it was a huge change from what she was like minutes before, so I had a sneaking suspicion that she was likely fully dilated. I called for the MD, who verified my suspicion. Just then her water broke, and she grunted like no woman has ever grunted before.

I called out for some help, and in the meantime the fetal heart rate went to 60 and never went back up. We called for NICU in case this baby needed resuscitation. The woman sat in the bed holding her knees while she pushed (she assumed this position on her own). We were also anticipating a large baby, as her first was 9 and 1/2 lbs. As the baby's head was crowning, it was showing us the classic turtle sign that precedes shoulder dystocia.

And sure enough, that is what happened. After the usual measures to help relieve the baby's shoulders, the baby shot out like a cannon and behind him came the spray.

Now...remember this all happened so quick that I never had the chance to put on my protective gear. Normally I wear an impervious gown and mask, but all I managed this time was some gloves. So when the bloody spray came down upon us, I got soaked.

For whatever reason, I managed to turn my back as I saw the spray coming from her vagina so only the right side of my face and body got coated with blood. A big splotch hit my forehead and was quickly trickling down to my eye so I ran into the bathroom to wash off. Once things settled after the birth, I went to change my scrubs and noticed that the blood had soaked through to my bra and was caked in spots on my back.

I was thankful that none of the blood went into my eyes, nose, or mouth because I would totally be skeeved out. When I walked out of the bathroom I caught sight of the room for the first time. Blood was down the front of the doctor, behind her on the wall, over the chairs by the window, in the patient chart across the room, the neonatologist's hair was speckled red, and worst of all was the woman herself. If a birth had not happened in that room, you would think a murder occurred.

I asked the doctor what she thought that massive spray of blood was from, but she wasn't quite sure. Perhaps an abruption was occurring (hence the fetal heart rate of 60) and the blood was trapped behind the baby. That's my best guess.

As I was cleaning up this woman after the birth, she started joking with me about all the blood. She said that she was "clean"; no blood borne diseases and she wasn't a prostitute or IV drug user, she said. I said that is what they all say....but good thing nothing landed on my mucous membranes.

I felt bad for the housekeeper.


PE Mommy said...

YIKES. I remember blood being all over the floor in the delivery room when I had my second. My dh even said omg look at all the blood. In the next several days, I bled ALOT. So much so that I realized I had a uterine infection 5 days pp and was bleeding big clots. Called the drs office and was told to go to the ER. Went to the ER and had a nurse that was a smartass. He quickly changed his tune when I brought my urine sample to him and literally appeared that I peed blood. Was taken back immediately. Had an exam to rule out pp hemmorage. I was bleeding. They pulled enormous clots from my cervix. One I felt and tried to look but the nurse said oh don't look. Her eyes got huge when that one came out. I think it was fist sized. They called my obgyn and he instructed them to start me on iv antibiotics and fluids and they gave me a painkiller too. I also went on massive oral antibiotics. 2 days later another one was added in for ecoli.

There was a reason for all the bleeding later on. I had a D&C 8 days pp for retained parts (amniotic bag had stuck to the back of the uterine wall) and a severe uterine infection.

Anonymous said...

Holy crap Labor Nurse, Holy freakin' crap!!!!

Was the umbilical cord too short? (hence the abruption)
How much did this troublesome babe weigh?

Jesus, if you didn't have grey hair before I'm guessing you do now...

Labor Nurse said...

Funny you mention the gray hair, anon, because I have recently noticed quite a bit of grays atop my head. As I get older, I am realizing how much I take after my father...he was almost all gray by his late 30's (I'm 31).

The baby weighed just under 10lbs. During the labor, I was suspecting an occiput posterior (sunny side up) baby based on Leopolds and there was a fairly high fetal station until she was fully dilated. My suspicion (not based on anything actually confirmed) is that baby quickly went from an OP to OA position, was able to move down further in the pelvis, and subsequent full dilation occurred. There were fairly large variable decelerations when she was contracting once she hit full dilation and the baby did have a tight nuchal cord. The cord itself appeared normal in length; I suspected the abruption in hindsight when considering the fetal bradycardia several minutes before actual delivery (even before the shoulder dystocia) and the enormous amount of blood that came out. It was like the baby was the champagne cork and once let loose out came all the champagne. Except, well... it wasn't champagne. Also, the placenta came out immediately following the baby without any "active management" techniques by the physician. Not sure if this would have happened naturally or if it was from the placenta already detaching before the birth.

I don't think we'll know for certain (unless the physician decided to send the placenta to pathology, which could tell us if an abruption might have occurred). Fortunately mom and baby ended up just fine.

AGK said...

Oh my goodness - I can't even imagine!

doula_char said...


This has got me thinking, because as a doula, I don't in general get gowned.

Thank goodness I stay mostly up by mom, and don't have to get down by the messy end of things!

I'm sure you'll see your doc soon, and that all of your vaccinations are current!

geena at codeblog said...

Holy heck. I've seen blood spewing forth from someone's mouth hard enough to hit the wall, but I was sort of expecting it (Pt said "Uh oh, I'm going to be si...") and was able to get out of the way in time.

I guess vaginas don't usually give such warnings.