Surprise in Labor and Delivery – Part 2

March, 1982 – 12:50 a.m.

I glanced at the white board after we transferred the surprise twins to Neonatal ICU for observation (see Part I of previous post). Bonnie, the health tech, had put a new admission in my other room named Wanda. Bonnie handed me her blood pressure and temperature on a piece of paper, and warned me, “Pam, she is extremely overweight, so I think she will have a difficult delivery.” I walked in the room and introduced myself to Wanda who was accompanied by her equally large husband, Martin. She told me she was 23 years old and this was her second pregnancy. She had a miscarriage at 14 weeks last year. Her last weight in the office was 305 pounds. She said her contractions began about 5 hours ago and were now 5 minutes apart, so her doctor told her to come to the hospital to be checked. I had brought the doppler stethoscope with me which was a very sensitive electronic stethoscope that is more sensitive than the manual fetoscope.

Manual Fetoscope to listen to baby's heartbeat. Curved part is placed on nurse's head for conduction.

Manual Fetoscope to listen to baby’s heartbeat. Curved part is placed on nurse’s head for sound conduction.

Electronic doppler to listen to baby's heartbeat

Electronic doppler to listen to baby’s heartbeat

I placed ultrasound gel on the end of the doppler and began trying to listen to the baby’s heartbeat on her very obese abdomen for an entire 5 minutes. I couldn’t hear anything through the layers of fat. Wanda grimaced and said she was having a contraction as she looked at her focal point and started Lamaze breathing. I placed my hand on her abdomen to feel the contraction, but felt nothing. After she said the contraction ended, I did an internal exam and felt her tightly closed cervix with the baby’s head up high in the canal. I did not have an elastic band long enough to go around her abdomen for the external monitor, so  I asked her and her husband to get up and walk around the halls for 60 minutes and then I would recheck her. This was our standard procedure if we were unsure if the woman was in labor.

After an hour, I rechecked her and there was no change. I called the resident MD and gave him my assessment. “Give her one seconal now and another to take at home if she is not asleep in one hour.” I went back in her room and told her that since her cervix had not changed in an hour, she was having false labor pains (Braxton Hicks) of her ligaments stretching and gave her the seconal. She was NOT happy to be going home and told me so.

I finished that busy night, and as I was walking out the door at 7:30 a.m., Barb, one of the day shift nurses came up to me. “Pam, they just brought Wanda back up from the emergency room. The ER doctor delivered her baby in the parking lot! She is furious with you for sending her home and said she is going to sue you.” My heart sank and my eyes filled with tears as I walked out the door. Sometimes, nursing is a very tough job….

When I arrived home, I opened my Bible to Psalm 46 and asked God to comfort me.

God is our refuge and strength, a very present help in trouble. Therefore will not we fear, though the earth be removed, and though the mountains be carried into the midst of the sea…Be still and know that I am God; I will be exalted among the nations, I will be exalted in the earth. The Lord of hosts is with us; the God of Jacob is our refuge.

I prayed that Wanda and her baby would be healthy.

October, 1982 – 7:30 a.m.

After we gave day shift report, my head nurse came to me. “Pam, the hospital attorney wants to speak with you in the legal department at 8 a.m. about a law suit from one of your patients.” I took a deep breath and asked God to give me a quiet heart. I entered the office and a tall thin gray haired man greeted me and introduced himself as Attorney Steel.

“I asked you to come review a chart with me because a woman named Wanda S is sueing the hospital for emotional trauma, inaccurate assessment, and negligent care of her when she was in the labor and delivery unit. You were the only one who examined her,  and then she came back later that morning and delivered the baby in the parking lot. Please look at your charting and tell me about what you remember about Wanda.”

I opened her thin paper chart and read my brief notes. I read the verbal order I wrote from the resident to give her 2 seconal and discharge her home. Thankfully, he had cosigned it. It seemed strange to be reading my handwriting six months later. Attorney Steel said, “Did you forget to write any other assessment or do you remember anything else about what happened with Wanda that night?” “No, she was only there an hour. She was very difficult to assess because she was so obese. My charting is complete.” He thanked me for coming and I went home.

I never heard the outcome of the law suit. But it was a good reminder to me to chart completely and accurately immediately as things occur, especially in a place like labor and delivery where things change dramatically in mere seconds.

Reflection – 2015

One of the huge problems in medical care in the USA is the cost which is driven up by exorbitant malpractice suits against medical professionals. When I took a nursing tour of China in 1986, I was amazed that each patient only had a single piece of paper on a clipboard hanging on the end of their bed! I looked with longing at that little clipboard, wondering what it would be like to only have to write a few characters on each patient each shift. The head nurse explained that since it is a communist nation, the people were not permitted to sue any doctor or nurse for malpractice. Each patient has their personal health notebook that they bring to the clinic or hospital and then take back home. Therefore, there are no departments for medical records or malpractice attorneys.

Minimal charting in China in 1986

Minimal charting in China in 1986

Much of the charting we do is to prove we are practicing nursing according to the standard of care and to cover ourselves if we are ever sued. My college nursing instructor drilled into us, “If it’s not charted, it’s not done.”

The following is an exerpt from “Make Your Nursing Care Malpractice Proof” – January 2012, Vol 7, No. 1 by Deanna L. Reising PhD, RN

Six categories of nursing malpractice claims have been identified:
•failure to follow standards of care
•failure to use equipment in a responsible manner
•failure to assess and monitor
•failure to communicate
•failure to document
•failure to act as a patient advocate or follow the chain of command.

As I thought about the situation with Wanda, thankfully I did not commit any of those “failures.” Babies simply have a mind of their own, and they don’t read a book about how or when to be born! Expect the unexpected in obstetrics.

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