jessicafaith992-blog1

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2 different heartbeats, 2 lives, 1 funeral.

That’s the story in a nutshell. Every patient assignment is different, every baby inside the womb is different. Every single case where a 19.6 week twin gestation mother comes in for bleeding, is different. Although the outcomes are sometimes the same. No one likes that report for any mother, unless the bleeding is from cervical change. No one understands that patient’s situation more than the patient. I get the assignment in addition to another twin gestation pregnancy at 32 weeks for possible delivery, of otherwise known live babies. So yes, 2 patients with twins on Labor and Delivery (not including the babies in the bellies).  I’m their RN, I’m responsible for their lives, and for keeping four babies on the fetal heart rate monitors at all times. Except, I found out, the 19 weekers were not being monitored per patient request and MD deferral. So what do I know? I know how to smile, I know how to put on a poker face. I know that gut wrenching feeling I get when this situation occurs and it just so happens the delivery becomes imminent. 

The last time I had this similar situation and patient assignment, it was a single gestation where there was no prenatal care (PNC), and it was a guestimated 19-21 weeker. By policy, 24 weeks gestation or less, the infant is previable. AKA, even with life support, etc there is a low threshold for survival, if survival is even for 1 week or 6 months, there are almost guaranteed defects that are incompatible with life. It’s either a demise, or it’s life support and maternal-infant attachment that would become a separation due to death. I am completely unbiased about the whole abortion argument in the US, because for one I can’t be biased. My job requires me to remain professional. Moreover, after seeing a few of these cases where God decided that an baby in utero should not live to see the light of day, my heart becomes numb because I don’t know how to feel. Now, the last case I was talking about the mother wanted resuscitation. NICU was refusing to come to the room at delivery, but we insisted they did due to the fact that it was just a good decision to do so. This infant delivered en caul, alive, small, transparent skin. NICU did not only do the basic resuscitation, but they intubated. so life supportive measures were performed. Even when the doctors explained to the mother who was seeing her infant “breath” mechanically, she had that 2 minute window of hope for an everlasting life for this baby. Although even with life support, there was <1% chance of survival. When life support was withdrawn I was left with an infant that still had a heart beat, that was dying in my arms. You can see the intracranial hemorrhage as it occurs. Even at this point, brain damage has already taken place. As much as my training prepared me for, there is absolutely nothing to help the human mind when the instincts tell you to do CPR because the mother is crying seeing her infant gasp for air. One of the hardest days of my life as an RN. 

The 19.6 week twin gestation mother was exactly 19.6 weeks because it was IVF pregnancy. So 1 day from 20 weeks. She was told earlier by the doctors that if she delivered, her babies would not make it. Point blank. The mother understood. She didn’t expect resuscitation, or anything like that. She told me she didn’t want to see them at this stage.

 She tells me she is having a lot of pain, her water breaks. Not good. She gets an epidural, and then 15 minutes later she is saying she has to push. I immediately call the doctor and instruct her not to push. She gets checked and she is 10cm. With my gloved hands, a tiny baby falls into them. Head is a burgundy color from trauma, but it has a slight reflex. Barely anything. Completely flaccid. It passes within 5 minutes. I stay calm on the outside but on the inside I’m like “Oh my God, there is another baby to be delivered, and I’m holding this one in my hands.” as the mother covers her face. Her husband loses the ability to stop crying. Second twin delivers eleven minutes later, with a heart beat. It gasps for air and passes 9 minutes later. Let me tell you, this entire 20 minutes from the time of the first baby delivering, to the death of the second infant seems like an eternity. I’m helping the mom, I’m cleaning her up, I position her babies on a blanket in a heart shape and present her twin daughters to her. She actually decided to hold them. This is her second miscarriage. She won’t ever hold any of her own children ever again. It’s a few moments of silence in the room, and my heart is pounding in my chest. These situations never get easier. I end my shift telling her that despite the situation, I still give her congratulations for ever having the chance to have two heartbeats in utero. I wish her the best, and encourage her to follow up with her appointments, to not be afraid to grieve in a healthy way and to seek support after she goes home. The patient and her husband both hug and thank me. It’s the least I can do. I can help with the physical pain, but I will never be able to take away emotional pain. I take a deep breath, give report. You remember I said I not only had 1 patient, I had 2 patients?! I go to give report on my other patient with a set of 32 week twins still beating away in the moms belly. I walk into the room and this mom is crying. She’s crying because “I’m tired of being pregnant I just want to have these babies”. I’m glad I have a strong tongue because I surely did have to bite it really hard. I said “let me tell you the best thing you can do… Let the nurses and doctors take care of you. Your babies will come when their ready, the main thing you should focus on is that monitor over there… You hear those heartbeats? Those are music to my ears, please focus on the fact that you have two healthy babies inside of you, and that soon enough you will see their faces” the mom sniffled and said “I guess you’re right”. Many people never realize how lucky they are until something goes wrong. I wish this patient the best and then I clock out, walk to my car, and 20 steps from my car, I lose my composure. I burst into tears. I get home to a husband that always asks me how my day was. I shrug. Make a line for the shower, hop in and as soon as the hot water comes on I wail. I cry like a little baby. Squat to my knees in the shower and cry. I cover my mouth so I’m not heard. I get out of the shower, and then join my husband for dinner and a tv show. The next day I have off of work. I never, ever try to dwell on these kinds of situations, but they are haunting. Every time I go to put a EFM on a belly I think “what if there’s not a heartbeat?” Every time an overexcited mother says “I’m tired of being pregnant…” My brain goes to those women that wish they could be pregnant or wish they could have babies that were alive inside the womb. Lessons learned and taught: be thankful