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 V.19 No.6 | February 11 - 17, 2010 

Miss Diagnosis

Life and Death on the Night Shift

The following story is a composite and does not depict an actual event. Rather, it was inspired by events that happened a long time ago in a land far, far away. If you think this story is about you, it isn’t. All possible identifying data has been removed and details have been changed. It’s also important to note that the following scenario is a rare exception to the rule of healthy childbirth.

I wore my cutest scrubs (I’m aware of the oxymoron) that night, hoping the pediatrician with the sexy Clark Kent glasses who had been flirting mercilessly with me for the past three months would be on call. I was scheduled to work newborn nursery, an assignment I usually relished. Sadly, my swarthy doc was nowhere in sight. The nursery was eerily quiet until the loudspeaker cackled overhead.

“Code blue, Labor and Delivery. Code blue, L&D.”

Working in a hospital, you grow accustomed to hearing cardiac arrests announced over the loudspeaker, such as “Code blue, ICU.” But jaws drop when there’s a code someplace like Labor and Delivery. I soothed my inner distress by telling myself it must be a false alarm.

A few of the more experienced nurses on my unit rushed toward the L&D unit, but I couldn’t leave the nursery since we had a baby under the warmer. I stood frozen in place. Seconds later, the phone rang through the silence.

A nurse from L&D was calling. Her breath came in gasps.

“I’m sending you the baby,” was all she said.

Within 15 minutes, a nursing assistant pushing a hospital bassinet knocked on the nursery door.

“They’re still coding her mom,” she said miserably as she handed the unlucky baby off to me. I glanced at the clock, cringing as seconds ticked away.

A nurse from L&D was calling. Her breath came in gasps. “I’m sending you the baby,” was all she said.

Despite the ominous circumstances of her birth, the baby in my arms looked like your typical newborna pee-and-poop machine in a deceptively adorable package. I unbundled the kiddo and assessed her from her head down to her perfect 10 little toes. She was in the calm post-birth “zen baby” state, and she didn’t even cry when I poked her heel to draw blood for a routine blood check.

Somewhere in the middle of the baby’s first bath, the nurses who had bolted to L&D to assist with the code returned to my unit with their shoulders slumped and heads hung low. The mother had died.

I pieced together bits of the story here and there. The woman’s heart had stopped suddenly. They had rushed her to the operating room and done everything possible, but to everyone’s shock and horror, nothing worked.

I asked if any family members would be coming for the baby. Apparently the baby’s mother had come to the hospital alone. She had come alone to birth her baby, and she had died.

The returning nurses described the scene in L&D. The obstetrician wept. Everyone else fell silent. The staff was shaken but had to pull it together and get through the night to help deliver the other babies safely. A night that had started out slowly was soon flooded with new patients.

Newborns began arriving at a breakneck pace. They were brought to me for their checkups before going back out to their mothers, but the baby whose mother now lay in the hospital morgue remained in the nursery with me. She slept in the crook of my left arm while I charted. She gobbled down her very first bottle and then cheerfully spit up on my new white shoes. Her bright eyes took in new sights as I brushed her wispy bird hair into a baby mohawk.

As I held her, I tried to feel the significance of the situationone life passed out of this world to safely deliver another into it. I tried to imagine how this baby would feel when she was old enough to learn the story of her origins. But my brain was unable to grasp something so elusive, and so I lost myself in the workflow of a busy nursery.

In a country populated with iPhones and cubicles, it’s difficult to imagine women still die during childbirth. It’s so rare, even people who work around birth every day are stunned when we lose someone. Nationwide, 569 women died in 2006 from complications directly attributable to pregnancy, according to the Centers for Disease Control and Prevention’s 2009 National Vital Statistics Report. This amounts to an average maternal death rate of 13.3 for every 100,000 live births. That's well above the Healthy 2010 goal of less than 3.3 maternal deaths per 100,000 live births.

Our national mortality rate reached a record low rate of 7.1 in 1995 before going back up. The increase over those low rates in the '90s may be attributable to the fact that data collection and reporting methods have changed since then. Yet some people are alarmed that the mortality rate has not continued to drop but rather appears to be either holding steady or climbing.

Some blame our failure to achieve the Healthy 2010 goal on our high rates of C-sections and other obstetrical interventions that carry inherent risks. Others point out that more women are having babies later in life. Most agree that a lack of access to health care results in inadequate prenatal care. Meanwhile, women are entering pregnancy with more risk factors due to the increasing prevalence of obesity, diabetes and hypertension in this country. In reality, many factors probably contribute to our unsatisfactory rate of maternal mortality, making this a complex biosocial battle that must be fought on multiple fronts. But the fight begins with awareness and vigilance.

At the end of my shift, I learned that our social worker had contacted the mother’s family in another city. The family was now en route to the hospital. Relieved, I transferred my patients to the day-shift nurses and slumped toward door, desperate for sleep. As I lugged my heavy heart into the elevator, I found myself looking back over my shoulder at the baby girl in the bassinet. The bittersweet image stays with me.

If you are expecting or trying to start a family, please don’t fly into a panic over sad stories like the one I just told. The vast majority of births result in healthy moms and babies. If you want to help write your own happy ending, the CDC recommends the following measures for a healthy pregnancy:

Food and vitamins: A nutritious diet that includes a supplement of 400 micrograms of folic acid is essential for any woman who is pregnant or may become pregnant. A reputable prenatal vitamin is your best bet. Sadly, Frontier rolls and Dion’s ranch dressing are not good sources of folic acid.

Weight: A very low or very high pre-pregnancy weight can be a strong predictor for problems. Try to aim for a Body Mass Index between 19 and 25-ish before becoming pregnant. Go to nhlbisupport.com/bmi to calculate your BMI.

Blood pressure: Problems with blood pressure can reduce blood flow to the placenta, which is the organ that supplies oxygen and nutrients to the baby. Blood pressure problems can also cause headaches, kidney problems or liver problems for mom. A healthy pre-pregnancy blood pressure is around 120/80.

Smoking and alcohol: C’mon, nobody likes seeing a pregnant lady with a cigarette dangling from her lip and a bottle of booze in her hand. Unklassy.

Diabetes: A healthy diet and regular exercise can help prevent this pregnancy buzzkill.

Prenatal care: CDC data shows that women who receive no prenatal care are nearly eight times more likely to suffer maternal mortality than women with adequate prenatal care.

Go to cdc.gov for more information

Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.

 

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