Complications in Pregnancy and Delivery, a Nurses Perspective
The Privilege to Participate in the Birth of a Child
While working in a place usually filled with wonder and joy there are times things do go very wrong in the Labor and Delivery Unit of the hospital. I had the awesome opportunity to observe the miracle of birth but with that came the pain of things going terribly wrong as we live in a fallen world and not every birth is perfect. It is a joy and privilege to participate in such a special time of a family's life. I will share some of the emergencies I saw along the way.
In the Labor and Delivery Unit and Mother/Baby Unit
I was a labor and delivery nurse for many years and later worked with new moms in the mother/baby unit. During that time I was able to see all kinds of deliveries and new moms and infants. My experiences were usually very happy and gratifying although we did have some emergency and tragic situations.
It is the joyous moments I saw the most and choose to remember but some of the sad ones are difficult to put behind you.
I will never forget the day a young mom was up walking the halls. She was suffering from preeclampsia, a condition causing hypertension and often leading to increased intracranial pressure. Suddenly she collapsed. Not from exhaustion but from a major seizure. This happens when the condition changes from preeclampsia to eclampsia. She died only moments later. How difficult it must have been for that young father to take home his infant and not his wife. It wasn't supposed to happen this way but sometimes it does as nature takes its course.
Another mother was delivering her third infant in our low risk unit when something went terribly wrong. The baby was very large and her labor was slow to progress. A common practice today is to use a pitocin drip. A very safe way to speed up labor but the mom and baby need to be monitored constantly. After several hours she did deliver a beautiful baby girl. Normally the uterus contracts after delivery, once to deliver the placenta and then again to keep the uterus from bleeding where the placenta was attached. Usually the physician will order medication to be added to her IV to help the uterus to clamp down. Gentle massage also helps as does breast feeding, another one of nature's miracles. For an unknown reason this mom would not stop bleeding. You may have heard the term "bleeding out" on medical shows. They are talking about something similar. The blood volume is being depleted so fast that the body can't keep up. At this time IV fluid is increased and blood is given.
In the worst case scenario the doctor will have to go back and do emergency surgery to find the source of the bleeding. The mom is packed with gauze and the mother is taken to surgery. This mom had to be transferred to another hospital with more advanced equipment. Usually an emergency hysterectomy is performed. This particular woman's blood volume dropped to fatal levels and she later sadly died from hemorrhage.
Another cause of a high risk pregnancy that often leads to a C-section is when an infant is presenting in a breech position or feet first. The problem in allowing a mother to deliver a baby in this presentation vaginally is that it is possible the infant's head is too large to pass through the birth canal.
Often when monitoring labor either the nurse or doctor will notice the infant having late decelerations,( baby's heart rate not recovering as quickly as it should), bradycardia, (too slow a heart rate or tachycardia, ( too fast of the baby's heart rate). At this time the mother is often given oxygen and turned on her left side to take pressure off the baby. Sometimes the mom is put in trendelenburg position ( head of the bed is lowered ) to take pressure off a possible prolapsed cord. The moms uterus might be stimulated and the baby's head might be massaged vaginally. Pitocin might be immediately started and mom may be given a bolus of lactated ringers. The mother and baby are then monitored for several minutes and decision will be made whether to do and emergency C-section
A stillbirth maybe one of the hardest things to assist with.Depending on how far the pregnancy has progressed the mother may still have to go through labor and delivery as if her child was alive.. She may even have an episiotomy. Sometimes an infant is alive but too young to survive If the parents do not want the infant with them an RN must stay at his bedside until he breathes his last breath. I did experience this several times and I remember a quiet and almost holiness to the delivery room as I stood by praying and watching the tiny infant struggling to breath.
If the mother is not far along and the baby dies she will probably have a D&C.
Ways to Reduce the Risk of Preterm Labor
Another sign of a problem is preterm labor which can be stopped at home. Some helpful tips to prevent this include but are not inclusive of
- Do no't overdo
- Drink plenty of water to stay hydrated.
- Try to eat a healthy diet and include fiber.
- Ask your doctor about adding things like Benefiber or dulcolax to your diet to prevent
- constipation. Even magnesium can help if allowed by your physician.
- Keep you stress level down
- You can usually keep up your regular exercise routine that you were doing prior to pregnancy
- A nice short walk in your last few weeks is great.
- Don't get overheated.
- Be sure to be taking your prenatal vitamin with extra folic acid for the baby's health.
- Don't eat too late at night.If you are having trouble sleeping. This can cause indigestion with the infant pushing on your organs.
- Try to slow down your routine if you are feeling overwhelmed
- If you are having trouble sleeping try turning off all your electrical devices like iphone and television and maybe take a warm bath or shower.
- Eat a light high protein snack like cheese and crackers with milk or a small bowl of cereal before bed.Dark Chocolate Almond milk has the benefit of added calcium if the caffeine from the chocolate does not bother you.
- Read for a few minutes to help you get sleepy.
Signs of preterm labor
Signs of preterm labor can include
- bloody show a clear bloody stained discharge usually seen a week to two before delivery.
- Cramping more than (Braxton Hicks' (normal pre labor contractions that prepare the cervix for delivery)are often seen at end of 3rd trimester and usually normal unless they do not stop with rest or last for extended periods and you can't talk during them,These contractions usually start around the 6th week of pregnancy although are not felt that early. They prepare the uterus and cervix for labor.
- Rupture of your membranes or your water beaks
- Low back pain that does not let up
- The baby slows down movement considerably
- Braxton hicks contractions will often stop if you change your activity. Walk if your were laying down. Lay down and rest if you were up and active. If they become harder and closer together call your doctor or midwife.
Stages of Pregnacy
Development of a Normal InfantClick thumbnail to view full-size
Chance for low birth weight Infant
Women need to go into a pregnancy knowing they are caring for two lives. It is important to start early prenatal visits and keep up with your appointments
- Taking 400 micrograms of folic acid is very helpful for the infant
- You need to be up to date on your immunizations
- Maintain a good diet and try not to skip meals
- Drink plenty of fluids and try to drink only one cup of coffee a day. Coffee can speed up the baby's heart rate.
Drinking alcohol can be very dangerous for your baby as is smoking. Alcohol can lead to Fetal Alcohol Syndrome with birth defects. especially brain and changes in the shape of cranial bones.
- Ask your doctor about any medications you might be on
- Get plenty of rest and some exercise as your body allows
- A daily nap can be helpful
Don't change your cat litter box. Don't be obsessive and get rid of your cat but be cautious with feces to prevent toxoplasmosis
This is a very exciting time. Take lots of pictures, maybe journal and enjoy!!!!
Age in Relation to having Down's Syndrome Infant
Different Kinds of High Risk Pregnancy
There are many forms of high risk pregnancy along with many causes:
- Gestational Diabetes This is often caught early when mom is growing faster than expected or a urine test reveals sugar . Hypertension is another sign and she might be feeling extra thirsty. having frequent urination, nausea, fatigue, blurred vision and even weight loss even though she is eating enough. Good prenatal care. diet and sometimes medication may need to be given. The baby is often very large and a c-section may be necessary.
- mothers with little or no prenatal care
- multiple births
- very young mothers
- older mothers
- HIV or AIDS We now have preventive drugs to stop the baby from getting HIV from the mother
- mothers with sexually transmitted disease
- High blood pressure is often from preeclampsia sometimes seen in young mothers or with mothers carrying twins. Protein will be found in her urine. This can lead to death of the mother, baby or both. Eclampsia is more dangerous and presents with seizures and coma. Preeclampsia is treatable and with corrective diet and bed rest the pregnancy can progress normally. It is a possible sign that the placenta is beginning to separate from the uterus. If not liver enzymes can rise to dangerous levels and cause damage to the mother's kidney, liver and brain. If the condition can't be slowed delivery will be induced or a c-section will be performed.
- Over weight or underweight moms
- Pre-term labor. This is often classified as labor prior to 37 weeks and the infant can often live out side the woman's body with a very controlled environment. In my early days as and RN the doctor used IV alcohol to stop labor. One afternoon a young mother of twins, with a bit too much alcohol lost her lunch all over me.
- Today we know better and have some great medications to stop labor.such as magnesium sulfate or calcium channel blockers. The baby is often given steroids to make sure his lungs are developed and prevent respiratory distress syndrome. Mom is often put on limited or strict bed rest.
- Pre-existing medical conditions or a history of previous difficult pregnancies
Some helpful website
National Institute of Child Health & Human Development
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