I seem to have had more than my fair share of L&D drama this past month. I want to commend my long-time friend/colleague/nurse, Clara Bias, for her excellent care of my patient; Mrs. E. She really contributed to rescue a very difficult situation. Clara was calm, collected, and acted with decisiveness. She stayed well after her shift was over at 7pm; several hours after.
Mrs. E. ruptured membranes early Monday morning. She presented in early labor (G1P0) and Clara was her attending nurse. She had a normal labor course, Pitocin, an epidural and began the second stage of labor about 5pm. After pushing for 90 minutes or so, she had a spontaneous vaginal delivery with a second degree episiotomy.
Then the fun began. The placenta was somewhat difficult to remove and I had to remove parts manually. The uterus was completely atonic and did not respond to rapid Pitocin or methergine. She was bleeding profusely. Clara quickly called anesthesia to start another IV line, began rapid fluid infusion, drew a clot for type and crossmatch, put her in Trendelenburg and quickly found some cytotec. By this time our patient was hypotensive, tachycardic, and in shock. Fortunately, after about 2000ml blood loss, the uterus responded. Clara retrieved the blood from the bank, and we infused three units rapidly. There was a large contingent of concerned family circulating and Clara managed them courteously but firmly.
Ms. E. suffered no hits to her kidneys, liver or clotting studies thanks to the prompt nursing care. Catastrophe was avoided. This patient was discharged three days later with her healthy baby.
I have worked with Clara for 35 years. She is exceptional. I am very proud of her actions and quick, decisive decision making that truly averted a disaster.
Way to go Clara!