My Opinion of VBACs

Because just everyone is dying to know....

I hate and despise VBACs (vaginal birth after cesarean). I suspect it all stems from an experience early on in my career. This was back when the swinging pendulum of expert opinion had swung to the side that encouraged women to attempt a VBAC. I was working at a very busy facility where prenatal care was unusual - so unusual, in fact that even if you had prenatal records we never even looked at them. The c-section rate was so far over 50 that we had stopped caring or counting. So, needless to say the majority of women who came in in labor had had a previous c-section. In such cases the Obstetricians allowed them to labor normally if they chose.

One day a woman came in, in labor with her second child. She was young and in love, excited and wanting to deliver vaginally. Upon request she got an epidural and went on to deliver a beautiful baby girl. She was then moved to the recovery room where she began to bleed excessively. The Recovery Room Nurse had called the Obstetrician to come and see the woman immediately. Although he arrived within moments, the patient was already becoming incoherent. I watched, inexperienced from the sidelines. I don't remember all of the details... just a whirl of activity, lots of people, desperation, so much blood... and then they transferred the patient to the ICU. When I came in to work the next day, the first thing I did was ask about the patient. She had died because of a ruptured uterus.

Today when another woman came to our unit with the same situation, I thought of that patient so long ago. I know I'll never forget her. When she comes to mind I remember how happy and excited she was to deliver naturally. I wonder about her young husband and their baby daughter. How does a little girl grow up without a Mother? And all because you want to deliver vaginally. Really??? Is feeling a baby come through your vagina so freaking important? Really, people??? Are you really willing to risk your life and the life of your baby because that is so important?!

I don't know what the rate of rupture is today. It changes somewhat with research. Does it really matter? Whether it's 1% or 10% that means a Mother and/or a baby can die. DIE. It happens. I've seen it. There's no coming back from that.

Break Room Necessities

I've had the absolute enjoyment of almost five days off! That's got to be the one thing I really love about Nursing! Tomorrow I'm heading back to work - ah, the joy! Wouldn't it be great if our places of employment put something like this in the break rooms?!

These massage chairs are available at Takemi Select Wholesale Outlet. This information should really be passed on to all employers.

Uterine Explosion

The funny thing with Labor and Delivery is that there is always something to recount. Whether I actually sit down and write or not. Sometimes I'm so tired when I get home that I plop myself down on the couch, too tired to even eat, and veg. I've been doing that for the last few shifts.

Now that I've been off a couple of days, here's my most exciting moment of the last week: It was one of those days when you're already short-staffed (because it's a guarantee that brown matter will hit the fan on those days!) and the unit was almost full. A hurricane was closing in on us and the weather changes were causing all kinds of Preterm Labor issues. I was running from one room to another, doing the job of several nurses when out of the corner of my eye I caught a glimpse of someone running. This is never good in Labor and Delivery. It's a terrified Husband with his Wife in a wheelchair. Wife is gripping the arms of the chair with both hands, holding her butt out of the chair, her entire body is stiff as a board. Yikes. All classic signs and I don't have time for this right now!

I head them off into the closest empty room while drilling them with questions. They barely speak English. All she could say was "Pain! Pain! Pain!" From Husband I quickly gather that she is about 31 weeks pregnant and having contractions. I help her stand up and an enormous gush of blood spills down her legs. CRAP. I batter the poor Husband with questions to find out she had a previous cesarean section, the pain is constant and worse with contractions. A picture is beginning to form in my head: she's abrupting (the placenta is breaking away from the uterus) or her uterus is rupturing (at her previous c-section scar) probably because of preterm labor. The baby's heartbeat is dropping with each contractions. Despite the bleeding, I decide I have to examine her. She's almost ready to deliver but I can't feel what part of the baby is presenting because of a bulging bag of water. I need help.

I call for help and the troops are rounded up. Within minutes everyone I need is present. The Obstetrician does a quick bedside ultrasound to find out that baby is breech and must be delivered by c-section. We run to the operating room and quickly prepare for surgery. As soon as the Obstetrician cuts into the patient's belly, blood gushes, uncontrolled. She quickly gets baby out and we are able to get a closer look. The patient's uterus has ruptured. Now I've seen many ruptured uteruses in my time. This was the ugliest I have ever seen. It was like a bomb had gone off inside. Hamburger meat. For hours, the Obstetrician worked on the Patient, controlling the bleeding and sewing the unrecognizable muscle back together. She deserves a medal for her skill in saving that uterus. I don't know how she was able to sew it back up.

How did baby survive? By some miracle, the placenta, delivering food and oxygen to the baby was located on the back of the uterus and was never affected by the gaping wound in the front of the uterus! Reports from NICU said Baby was doing wonderfully.

Many, many times I leave work thinking "Thank-God!" In Labor and Delivery, one event or another always seems to work together to lead to miracles, big or small. This was a big one.

Small Man, Large Ego

Ah, don't we see that combination all too frequently!

The other day it was nearing shift change and all of us lowly nurses were sitting at the desk finishing up our charting and counting down the minutes. A small, gray-haired man in street clothes appeared, almost running down the hallway. He did not stop his brisk walk but to jut his face out into mine and demand: "Where's Susie?" Such was his intensity that I am embaressed to say that I was taken aback and temporarily without words.

As he rounded the edge of the desk (Nurse's Territory), he again demanded: "Where's Susie? She delivered a premature baby here this morning. I know her... we grew up together..." The day had been especially slow and we had not had a delivery that day. I interupted him: "No she didn't." By now he's rounded the desk and into the Nurses' Station. NOT ACCEPTABLE! Up to now I was wondering if the other nurses knew who this was... perhaps an over-zealous visitor. We get them from time to time. Interesting how they can never quite remember their good friend's last name. A quick glance around proves that this is not true. The looks on their faces were clear.

"Who are you?!" I ask.

"I am Doctor Napoleon (names changed to be more accurate), urologist (how appropriate!), and Chief of Surgery AT THAT!" he proudly exclaims. I may have giggled. He practically commandiered a computer in order to locate his "friend."

So does that give you license to be a jackass, parade into an area of the hospital you have clearly never been in before without a badge, fail to introduce yourself or explain your presence and then proceed to act like you own the place, violating HIPPA and every rule of etiquette and human decency possible?!

I would like to send a little message to Dr. Napoleon: There is one thing you need to know about Labor and Delivery Nurses. We don't give a flying hootenany about what titles you choose to pin after your name. It's hard to impress us, and claiming to be Dr. ANYTHING will certainly fail to do so. Next time you choose to invade our space, bring your manners and leave your ego.