Tuesday, July 15, 2008


My job as a Nurse is to care for the patients who come to my unit.I am charge of a busy labor and delivery suite,part of our ,we care for a lot of types of Expecting moms' those who want to have babies and those who do not,sick moms,healthy moms and everyone in between.On our unit this week was a 21.3 week gestation gravida 2-0 who was high risk because of her age and an "incompetant"cervix from her previous loss.She was advised to have a "circlage"which is a stitching of the cervix to hopefully prevent it from dilating and hence loosing the pregnancy.This woman did not comply with the advice of her MD,she arrived on our unit at 3 cm dilated with a "bulging bag of water",will she loose the prenancy?,most likely yes,should she try to save the unborn fetus untill viability is favorable? She could try,we have methods and drugs that could possibly get her to the 22 week age of gestation where our NICU will give the baby a fighting "chance",does that mean the baby will be OK? No a myriad of problems can and will arise leaving you with a child that will never be "normal" and may not live despite the heroic measures we have available.The prognosis for this woman did not look good.She chose to actively induce the "evacuation" of uterine contents,due to non viability of the "prenancy".This produced another problem on our unit!!! Nurses at our hospital do not have to participate in the "administration" of a "terminating" pregnancy.but was this a "termination"??? Or the quickening to the inevitable for the sake of the "mothers" welfare?? After a lot of discussion and a DR, who was not happy with our nurses,as charge of the unit I became the only one who would be in the room as the md inserted the"CYTOTEC" that would help to finish dilating the cervix enough to let the fetus pass through.Did I consider this my "Stamp of Approval"? NO!! certainly not,it is painful for all of us to see this happen,The woman proved to have dilated to 5 cm with the "bag" very much protruding through the cervix without the drug,however the MD and she chose to go ahead,so she would contract and the "birth" would happen quicker.
This is exactly what happened,and the baby was delivered,with a weak cry a heartbeat that although would not support his little body,he kicked his legs and moved his arms,and the wonderful nurses that did not "JUDGE" this woman ,but simply were there to care for the pt.' took this tiny life and wrapped and held him and as APRIL the nurse who did this all said " they sang him to HEAVEN.
There was much debate about the right or wrong of this on our unit,I cannot say this would have been my choice,or the choice of many of the Nurses who would not help care for this pt. obviously,would it have happened anyway?? Yes,from my 24 yrs experience and too many same situations to count,it would have the same end.
Should the CYTOTEC have been used?? Should the mother have hastened the inevitable?? The choice was not mine to make or judge that day,but to care for the pt. who made the choice,many there did not agree,the best thing to do would have been to get that CIRCLAGE placed immediately when the DR. advised,then to follow closely with your care untill you can deliver with the best outcome and knowing you have done all you could to keep that precious life going.Why did she not do that???!!! None of us will know that answer,those of us who cared for the "baby" and he was in every way a "baby",and watched as he struggled for 90 minutes,to leave this world he had entered,we are the ones who wrap,take pictures"in case the mom ever comes back to want" and then go home and cry and dream of these babies,it never gets any easier no matter how many you see,we will continue to do what we pledged to do,without judgement,and pray for those who make their own decisions,right or wrong.