That was one phrase that stood out at a previous employer: the nurse's goal was to achieve a moment of excellence while giving patient care. As a perfectionist, I wanted this to happen pretty much immediately after the concept was revealed. I'm an over achiever. Well, certainly not in every aspect of my life. Like...uhhhh, exercising :)
It happened when I least expected it. (Which is generally what happens when you aren't trying for something you want). As you know I have a strong history of working with families who experience fetal or neonatal loss. Fetal loss occurs during the pregnancy, neonatal loss occurs when a baby is under the age of 28 days.
I was the go-to person for demises (death of a baby). I didn't really ever have anyone fight me for the assignment. It's not something most want to partake in. For me, thankfully, because of my previously written about exposure to this, it became my niche in nursing and truly a gift from God. I think my psych experience helped tremendously, being a parent, being human, being empathetic, crying with families, etc. drove me to want to care for them. I learned from each family. I am thankful for every opportunity I had. I had a excellent role model of a social worker that taught me many of the "ropes" in dealing with this situation.
So I had a couple come in that learned at a 16 week doctor appt that their baby had died. I'll be honest. They were obviously lower class, including having a lower education level. As nurses you truly want to treat everyone equally. Do we? I believe we certainly try. It can be very difficult at times. They really didn't want to listen to my schpeel about what to expect, what I would do with them, for them etc. They both wanted this just done and over so they could minimally go smoke and ultimately go home as soon as possible.
Mom was adamant she was not going to deliver this child on her own. She wanted no part of that discussion. No ifs, ands or buts about attempting to explain how this all would work. After further discussion of this, they actually wanted me to make arrangements with an abortion clinic in Omaha to speed this process up. This was really frustrating to me.
Depending on the size of the baby, we could perform a D and C. (dilation and curettage) where the cervix is opened and the uterus is just cleaned out. This is generally done early on in pregnancies with miscarriages. However, this child would probably be a little bigger, and by bigger I mean about 6 inches long. Not really something a D and C is designed for. The obstetrician agreed to do a D and E (dilation and extraction) which generally is saved for just abortion clinics. It was something not done at our hospital as it's the closest thing to an abortion, except the child has died. The cervix is opened and the baby is sucked out, no matter how it's able to be removed. They now no longer wanted to go to Omaha, but opted for the D and E. It was local, and the process would of course, be quick like they wanted.
I'm cringing at this thought. Physicians can do a really poor job of explaining procedures while obtaining consent and reviewing risks and benefits of surgeries. It was my time to be the patient advocate and educator and it wasn't going to be easy.
I've always told my patients I'm very up front and honest. I will not sugar coat things. I had to talk myself into this one. I sat down on the bed with her, attempting to redirect her attention from signing the consent and getting this over with. Gulp.I just wanted to spew out the words with my eyes closed not wanting to witness her reaction. Here it comes: I want you to completely understand what is going on here. If you sign the consent for the D and E, your baby is not going to come out whole. It is going to come out in pieces. It's going to get sucked out. If you go to Omaha they will do the same thing. **top 5 hardest things that I've ever said in my life** That's such a horrendous thing to think of, much less say aloud. But I did it. Florence wanted me to.
You could have heard a pin drop. It was, as I thought, something like slapping her across the face. She burst out crying. "Oh my God NO!!! I had no idea. I don't want that at all. I will do whatever it takes to keep my baby whole." We then did a major shift in the plan of care. We were now going to induce and deliver vaginally. Completely the opposite of what the initial plan was.
She ended up delivering vaginally with the baby intact. (They are very friable at this age and if they've been dead for awhile it increasing the friability immensely). They both held their baby. It was only briefly, but they did. And they left soon afterwards.
What if I didn't have the balls to get those words "your baby will not come out whole" out? What if I hadn't educated her? What if I had just gone with the flow of the doctor's rambling and prepped her for surgery? I am so thankful I was able to....again, with the gift and courage from God. It would have been a horrid outcome, unexpected to them if I hadn't.
Who knew I would have my moment of excellence in a situation like this.
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