By Lori Boggan
I have worked with babies as a neonatal nurse for nearly 12 years. In that time I have seen countless well babies, premature babies, babies with heart defects or bowel defects, and babies born with Down syndrome or syndromes incompatible with life. I have seen babies die. It happens and is the sad, unfortunate part of the job. It's sad for the parents and family that longed for this little person and lost. It's sad for the medical team that worked so hard to give the baby a fighting chance and lost. So how does one overcome a particularly poignant loss?
The hardest moment I endured in my career, that still haunts me from time to time, happened two years ago. I was in the middle of a three-month internship at a NICU in Gothenburg, Sweden. It was part of a required "clinical" to prove to the Swedish Board of Health that I was a competent nurse worthy of my Swedish Nursing License.
I had worked as a NICU nurse at home in the U.S. so it was familiar territory with the huge exception of having to speak another language. I was shadowing one of the brightest nurses in the unit. We had an assignment as well as the delivery phone. We were near the end of an evening shift when we heard a sound on the other side of the locked door to the NICU. It was the sound of a woman in labor screaming out. Only a few minutes later, the delivery phone rang. They needed us for a repeat cesarean; the indication was failure to progress with a slight indication of fetal distress. Any nurse who has worked as the NRP nurse knows that this was just a routine cesarean.
We went in the OR, checked the radiant warmer, suction, bag and mask, and probably started talking about something completely unrelated to the task at hand. After all, it was maternal indications, the baby was fine. So we thought.
We saw the baby come out, hit the APGAR timer, and the rest is a one-hour blur. The baby was pale, limp, and completely unresponsive. We dried and stimulated the baby according to newborn resuscitation guidelines. Nothing. We started ventilating the baby, hooked her up to a pulse oximetry probe, and checked a heart rate. Her heart rate was low, and she wasn't responding to ventilation. This was about the time I had a brief out-of-body experience of disbelief. I took over ventilation so my preceptor could call the attending. Can you imagine calling a doctor in an emergency and having to speak another language? All the while, the baby's father stood directly behind us in quiet observation. The baby was intubated, ventilated, given round after round of epinephrine, given blood, given every bit of life-saving effort but sadly was pronounced dead after every possible effort was made.
I can still see her little face. Her eyes were wide open. She had a full head of hair. She was a beautiful, healthy, full-term baby that didn't make it. This was the hardest to come to terms with. Premature babies are not ready, not mature, we know sometimes they fight to live and it still it isn't enough. A full-term baby, though, without any defects or complications? They are supposed to live.
I think all present that evening were shocked. We had a debriefing in the days that followed and it was discovered that the baby had severe meconium aspiration that occurred in utero. I must say in retrospect I have never worked with such a calm, collected, organized and respectful group of people during a code. Each had a job and calmly but quickly performed it.
So what advice can I offer to others that have suffered, or may in the future suffer, the same trauma?
I still feel my heart skip a beat sometimes when carrying the delivery phone and it starts ringing, but it has gotten better with time. I take deep breaths as I make my way to the operating room or labor and delivery unit.
I talked about it to anyone that would listen. My coworkers were sympathetic, many even offering to follow me to deliveries until I felt more confidant again. I think it is human to need to know we are not alone and are supported.
BE KIND TO YOURSELF
It's easy for anyone in a code situation to second guess if they did the right thing. Doctors do it. Nurses do it. At some point we have to know that we did everything we could and it would not have made any difference.
The reason I say this is that it is better to be prepared for the worst and hope for the best than the latter.
I remember my preceptor crying immediately after, me attempting to console her as I left, shocked. It didn't hit me until long after, over dinner with my family. I cried in my dinner. Nurses witness more trauma and stress in a day's work than others in a lifetime. We are not superhuman, not robots.
The thing is that following a traumatic event, we have to pick up and assume the role of caregiver to another patient-sometimes all in the same day. Allow space for reflection at some point. It is necessary. We are only human after all.
Originally posted on AWHONN Connections.
Foreman, S. (2014), Developing a Process to Support Perinatal Nurses After a Critical Event. Nursing for Women's Health, 18: 61-65. doi: 10.1111/1751-486X.12094
Puia, D. M., Lewis, L. and Beck, C. T. (2013), Experiences of Obstetric Nurses Who Are Present for a Perinatal Loss. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42: 321-331. doi: 10.1111/1552-6909.12040