In a past “At the Nurses Station” article, On a mission to improve maternal safety, it noted the importance of quick, clinical decision-making to improve patient outcomes.
There are many articles by the experts in our industry regarding the devastating statistics surrounding morbidity and mortality in obstetrics in the United States.
The article shared that 700 women die in childbirth every year, ranging from preeclampsia, heart failure, and hemorrhage. Obstetrical emergencies, like severe bleeding and amniotic fluid embolism, cause most deaths at delivery. Besides those that lose their lives, there are 50,000 more per year that nearly lose their lives. That means for every 1 woman that dies, 70 more women come close.
This month in “At the Nurses Station,” I will share the story of one of those near misses.
Rachel is a vibrant, beautiful woman. She grew up in a large, Catholic family in the Midwest. Rachel was a great student, graduated from a prestigious college and, like most vibrant young ladies, she soon fell in love and became engaged. She married the love of her life, Will, in 2010.
Rachel loved Will for many reasons, but toward the top of the list was the confidence that he would be a good father to their children looked forward to starting their family right away.
Rachel’s first delivery resulted in a c-section due to macrosomia, so with her second, she and Will discussed having a VBAC and planned an induction on her due date.
In preparation for the birth, her parents and one of her sisters traveled to their home to help with their son. It was the night before her induction, and Rachel was very anxious. Unable to pinpoint the reason for her emotions, she wondered if it was because her first labor did not go as planned (a long 30-hour labor that resulted in a c-section) although, Rachel did not consider that a traumatic birth in any way. Rachel sat at the table with her sister and shared her overwhelming feeling of dread.
Her sister, a nurse, gently reminded her that she had been through this before, and all would be fine. But the words of reassurance did little to quell Rachel’s feelings of anxiety.
Even though she was induced, she wanted to labor as naturally as possible. As the day continued, Rachel was not progressing. Her OB wanted her to start to prepare mentally for a c-section. The staff began to prepare Rachel for a repeat c-section, and at 8 PM they brought a healthy, beautiful baby girl into the world. Rachel does not recall anything strikingly different about the delivery except that she thought a time or two that it was taking a long time to close. But she quickly dismissed her concerns. She had Will at her side and was fully soaking in every detail of her daughter.
They were moved to the recovery room for that golden hour. Looking back, Rachel recalls that the recovery nurse was not very aggressive at checking her fundus, but then again, she was distracted by the grandparents from both sides coming in and meeting their new granddaughter. Recovery was completed, and the nurse did not seem to indicate that anything was out of the normal.
The nurse that greeted them in the post-partum room stated that she was a visiting nurse from another campus and asked Rachel and Will to bear with her as she acclimated to this unfamiliar unit. As they settled in, Will fell fast asleep, but Rachel’s excitement and what seemed like an adrenalin surge simply kept her hyped up and wide awake. It was getting close to midnight, and Rachel felt wet and realized that she had experienced a gush of blood. Awakening Will, she also put on her call light. The nurse promptly came in and checked Rachel’s pads, and the startled look on her nurse’s face instantly put Rachel ill at ease. Her nurse needed help, yet she struggled with the call system, she did not know the name of her coworkers and was clearly unsure what to do next. She was able to get a more seasoned nurse in the room, and additional help followed as the seriousness of her bleeding continued. As the nurse continued to massage her uterus, Rachel could feel herself losing more and more blood. Her fear intensified as her husband was shoved into a corner, and no one was communicating with her. Rachel’s mind reeled as she wondered what was happening. Blood was called for; everything was starting to become a blur. By the time the blood arrived, she was getting weaker, and she continued to bleed despite the continued, painful uterine massage. A rapid infuser was obtained to administer the blood transfusion quickly. The room was full of staff, and yet no one knew how to set up the infuser. The rapid response team was called, but they could not figure it out either. To add to Rachel’s horror, she heard one of the team members suggest that they Google instructions on how to set up the infuser. Rachel could see the terror in her husband’s eyes, and all she could think of was that she was becoming too unstable to transfer, and she was surrounded by people that did not know what they were doing, and “Am I going to die?” As she looked at her husband, would she ever have an opportunity to tell him she loved him, would she see her baby again? She could feel herself fading away and wondered if these were her last moments on this earth.
The machine issue finally resolved, and blood was now being administered, the bleeding was under control, and she started to feel better. Rachel asked about her vital signs, was anyone watching the machines? She was told that she was a healthy young woman and that her vitals were fine and would stay fine… until they weren’t.
As morning approached, Rachel suddenly felt another gush of blood and quickly called for her nurse. She was deteriorating quickly and was rushed back to labor and delivery.
The painful massaging caused Rachel to cry out and beg them to call her primary doctor to assist. Through the night, her primary doctor never came to the hospital, and Rachel, who was once close to her doctor, felt so abandoned by her now. She had been bleeding for over 6 hours.
When her doctor finally arrived, she shared with Rachel and Will that during the surgery, she and her partner were concerned, as the placenta seemed to have stuck to the uterine wall, but that they had gotten all under control. She further explained that it might be an accreta, and if it is, then a hysterectomy would have to be done. Will told Rachel, “I don’t care about anything else. I just need you”. As she was taken back to the operating room, she said goodbye to Will and to her mother, wondering if it might be the last time.
Rachel survived her hysterectomy, and the woman who wanted to cherish and soak in every moment was robbed of this as she was in so much pain and was so weak that she could not even reach up and touch her newborn.
In the days that followed, the staff was contrite and seemed to tiptoe around them. The director asked her if she would like to talk about her birth experience. At that time, while she did not say so out loud, Rachel refused help, feeling that the staff had done quite enough. She needed to process what had happened, and her top priority was caring for this new life they had created.
Afterward, the doctor was very candid with Rachel. The doctor told her that she was not aware of the gravity of the situation. If she had known, she assured her that she would have come right away. At this point, Rachel was not comforted by the sentiments, and after recovering physically, she was discharged home. Unfortunately, this near-miss story does not end here. This is only the beginning.
At Rachel’s six-week checkup, she had a full panic attack just being there, revisiting not just the hospital but also all the emotions associated. Being aware that post-partum depression is so prevalent, Rachel wondered why there was no therapist to talk to about her traumatic birth experience. Surely someone should realize that she was not okay.
At home, Rachel vacillated between gratefulness and despair. Grateful that they had two beautiful children and she was alive to raise them, but overwhelming despair about the lost opportunity to give birth again and raise another baby. Instead of feeling joyful through milestone moments, Rachel found herself saddened with thoughts of “this will be the last one-month picture”, or “the last time I will use the newborn clothes”.
As time went on, Rachel was continuing to have flashbacks. Conversations with her sisters would result in sadness and tears. Seeing other pregnant women would trigger emotions that would cause nightmares and insomnia. She would talk with Will about what happened to them, but he did not always understand how Rachel felt or what she was going through. Both Will and her sisters realized that Rachel needed some additional support to work through her emotions.
Rachel’s own PTSD from her birth took away the ability to enjoy the births of her niece and nephews that followed. She wanted to figure out a way to live and enjoy life, and it took over a year for Rachel to move in that direction. She finally sought counseling, and as she became stronger, she realized she needed to have a feedback session with the hospital.
Even as a layperson, Rachel could identify several areas where the hospital staff did not do things correctly. She wondered if her doctor had come in sooner, maybe she would not have needed all her blood replaced. What if she had a more experienced nurse on post-partum, maybe the trauma could have been minimized. Why didn’t they know how to use a lifesaving piece of equipment? Why wasn’t her chart flagged as high risk so that she would only be assigned the most experienced nurses? Rachel and Will wanted the hospital to learn from their mistakes and hear their feedback. As difficult as it was to step foot back into the hospital, that feedback session took place. Since then, processes have been established at the hospital, which Rachel is thankful for but wishes it had not been at her expense.
Her daughter’s birth was a pivotal moment in her life. It changed her outlook on how she processes everything. Two more years have passed, and, through counseling, she is learning coping mechanisms to deal with PTSD, recognizing her triggers, and how to suppress them. Rachel is still a work in progress. She is forever changed. She longs for the woman she was before this trauma but must learn to live with who she is now. She is better, and most days, she does have a grateful heart.
This is one story, one woman and her family. Do you remember the statistic at the beginning of the article? Fifty thousand women a year are near misses. We must do better; we can do better.
Will and Rachel want to use their experience to help others. If you or someone you know would like to reach out to them, please contact me at firstname.lastname@example.org, and I will be happy to put you in touch with them.
About the author:
Caren Busen, RN, worked at Blessing Hospital in Quincy, IL, for 35 years as a labor and delivery nurse. She has held several roles at Clinical Computer Systems (OBIX), Educator, Manager of Education, Director of Clinical Sales Support, and currently, is the Director of International Clinical Support.