This patient was on the unit for induction of labor. All was proceeding as planned until the unthinkable happened.
The patient was in the bathroom to void and while on the toilet, experienced a true obstetrical emergency. While voiding, the patient "felt something come out." She called for her nurse, Laura, who upon checking the patient while still in the bathroom, realized that a cord prolapse had occurred. The patient's membranes had spontaneously ruptured and the cord had come down through the vagina with the fluid and a portion of the cord was visible. A cord prolapse will occlude the blood flow from the placenta to the fetus necessitating immediate delivery by C-section.
The patient's nurse, Laura Clarke called for help. Amanda Gates assisted Laura in returning the patient to her bed and Amanda immediately gloved and placed gentle, upward traction on the presenting part of the fetus to relieve the pressure on the umbilical cord. This allows circulation to continue to the baby. It is a difficult task as Amanda had to remain kneeling between the legs of the patient maintaining the position of her hand on the presenting part until the baby was delivered. Laura, meanwhile, called to have the C-section room opened by a staff member and notified the OB provider who was in her office seeing patients. The nursery provider was called to the section room, anesthesia was called to the patient's side and the patient was moved to the CS suite in preparation for a stat C-section. In the CS suite, Laura quickly and calmly assigned key tasks to the staff members present so all knew what their role would be.
When the OB provider entered the CS suite on the run and accompanied by her partner, the room was ready, and the patient was prepped for the procedure. The baby was delivered at approximately eight minutes from the time the OB provider was notified of the cord prolapse. The baby required a few minutes of support before being transported to our nursery. Mother and baby did very well and had an uneventful course post-op and were discharged at the normal time.
Laura Clarke and Amanda Gates exhibited a complete calm and a high level of proficiency to the patient and her husband. The way they handled the emergency allowed the parents to feel that all would be well because they were receiving highly skilled care. Laura and Amanda led the team in a quiet and professionally organized fashion and all involved performed their jobs perfectly, resulting in a great outcome for all involved.
The patient and her husband were effusive in their praise of the care delivered by Laura and Amanda. The parents expressed a strong desire to have the performance of the team acknowledged but more so, the care delivered by Laura and Amanda. They recognized that the skill and care of these two nurses made their happy ending possible.