Reflections from a High Risk OB Nurse

(Last Updated On: January 9, 2018)


When I was leaving the hospital and saying “Good night” to RNs from another floor someone said “How was your night?” “Oh, I have had better.” She nods and says “I know.” What she knows is that L&D can get very busy. What she doesn’t know is that when L&D is bad it is really BAD! When we have had a BAD shift it means that the unthinkable might have happened; the loss of a mom or the loss of a baby or the loss of both.

When working in obstetrics (OB) you became aware of other nurses who think OB nurses are just lucky and only have healthy patients. What they don’t know is that we have many patients who are not healthy at all! It’s unthinkable to the general public and even to other RN’s that women still die during child birth, especially in a busy, high risk OB unit. Comments are all over the table: “Don’t they know what they are doing?” “There should be no excuses; we are not in a third world country”.

There is a reason why obstetrics is the most litigious area of medicine. Births are expected to be perfect and this leaves absolutely no room for anything but a 100% perfect outcomes. If the baby ends up with any long term issue the lawyers often try their best to blame it on labor and delivery. Awards are often sky high because they are supposed to cover expenses related to medical costs and lifelong care. Jurors are almost always going to favor the families because babies are supposed to be perfect and women aren’t supposed to die during child birth. Isn’t that the truth?

Emotionally we agree with the general public, and that’s why when we lose a mom and/or a baby we grieve in ways that are hard for someone who is not in OB to understand. We beat ourselves up repeatedly going over all the “what ifs.”

Intellectually we know that even for as much as we engage in improving ourselves and our practice, we can never eliminate the moments when the unthinkable happens. In fact, I speculate that the more perinatologists and fertility specialists are able to help high risk women become and stay pregnant, the more we are going to see “the unthinkable.” Maybe the reasons why some women can’t get or stay pregnant is nature’s way saying that it is just too risky for these women who have numerous medical problems to carry a baby to term.

I often wonder what kind of discussions take place between the fertility doctors or perinatologists and their patients. Do they talk about how their numerous medical issues will affect pregnancy? Do they discuss the possible risk to moms including but not limited to an increased risk of premature delivery? Do they talk about what kinds of issues premies are likely to face? I hope they do.

I hope that in this increasingly profit driven industry, high risk families who see these specialists are able to enter pregnancy with their eyes open to the various risk factors for moms and babies alike. As much as I am happy for all patients who can benefit from improvements in fertility medicine and perinatology and are able to have children. But I am equally worried that too many patients and their families go down this road without having been given all the facts upon which to base their decisions.

When “the unthinkable” happens in our department, one always walks around in a fog for a while unable to shake the profound sadness for the family who will be unable to celebrate new life and instead face the hard reality of having to make funeral arrangements. Going from “the unthinkable” to a normal, happy and healthy birth routine doesn’t feel quite the same for a while; it just brings up too many mixed emotions.

Then slowly, over time, you are able to get back to feeling happy and lucky for being part of a family’s most profound moment: the birth of a child.

Seeing that father who has just lost everything precious in his life fades slowly over time but yet it will forever be a part of your fabric of life….and time moves a bit slower for you after that.

This post was sent to me by an L&D nurse who asked to remain anonymous


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