**Names in the following story have been changed to protect the privacy of patients and coworkers**
I’m proud to say that I recently found myself in my first precipitous birth–that is, it happened so fast that I had to catch the baby myself.
In some ways, doing a “precip”, as it is commonly called, is a rite of passage for night shift L&D nurses. With many doctors in my hospital opting to head home and trust us to call them in time to deliver versus camping out in the call rooms just down the hall, this sets us up for precips, especially when you have a grand multip (a lady who has delivered 7 or more babies) come huffing and puffing into triage screaming, “The baby’s coming now!” If you want to see an entire floor of L&D nurses run, be a fly on the wall when that scenario repeats itself.
My experience wasn’t quite as dramatic, but it was a surprise nonetheless. It was Alana’s second baby–those dastardly, sneaky second babies!–and she had been admitted at 1800 for an elective induction. The previous shift had started her Pitocin just before I arrived, and by the time I took over, she was well on her way into labor.
Things progressed nicely, and soon, Alana was getting her epidural as contractions kicked out every 2-3 minutes. Dr. Donaldson, Alana’s OB, had stopped by after her epidural was placed and broke her water, telling me to give her a call when Alana was complete and it was time to push. Alana had had a long labor with her first baby and on our cervical exams, this baby’s head was still high, so we figured it would probably be a little while until Alana would deliver. As I checked Alana’s cervix through the night, it was clear that she was making steady progress, going from a 2 to a 7 from the time she was admitted to the time of my last check just before midnight.
It was right as the hour hand was edging past the 12 when I asked my charge nurse, Erin, if I could head down for some dinner. “I don’t think my patient is going to last long enough for me to eat a normal meal from the cafeteria,” I had told her. Two AM was when the cafeteria opened its full selection of the overnight meal, and being that it was a little over halfway through a 12-hour shift, most of us night shifters held out for 0200 with surprising tenacity.
Erin nodded. “Sure, we’ll keep an eye on things while you’re gone!” She said.
As planned, I headed to the cafeteria, scarfed down some lunch and headed back to my floor. One of my coworkers had looked in on Alana while I was eating, and Alana was starting to feel lots of pressure with contractions–a good sign that things were moving along well.
I headed straight in to see Alana after lunch and noticed during a contraction that she certainly was having increased pain. Suspecting that she might be making a quick move for delivery, I headed to the supply room for a straight cath kit (used to catheterize moms with epidurals who cannot empty their own bladders due to the anesthesia) and returned to Alana’s side.
A common trick of the smart L&D nurse is to check a patient’s dilation immediately after straight cathing her. She is in the right position for a check (lying down nearly flat on the bed, legs apart and knees out) and if you keep the sterile glove on your dominant hand sterile during the cath procedure, you already have the glove and gel necessary to perform a cervical exam.
That had been my plan as I gelled up the catheter, slipped it into Alana’s urethra, and glanced at the clock. It was just before 0115. Making a note of the time for charting purposes, I glanced down at my cath tray to make sure I had enough gel for a cervical exam and looked back to Alana.
Alana’s perineum was bulging under my fingers, the distinct and growing form of a fetal head peering out between her labia. I was so surprised, I had to look twice. Sure enough, that was a head crowning.
“OK, I’m feeling a lot of pressure all of a sudden.” Alana said, her breathing suddenly labored.
I’ll bet you are! My mind exclaimed. “I’m not too surprised to hear that. It looks like the baby is coming right now.” I said, pulling out the straight cath, throwing away the kit, ripping off my dirty gloves and grabbing a new set of sterile gloves as I pulled the emergency cord out of the wall.
“Right now?” Alana exclaimed.
I was hurriedly pulling on sterile gloves as the baby’s head pushed further and further out of Alana’s vagina. “Yep, right now!” I replied. “It’s OK, Alana. Baby’s almost out on her own. Take nice, deep breaths for me and hang on while I get the cavalry in here.” I said, placing a hand on the baby’s head and supporting Alana’s perineum as I watched the baby wiggle her emerging noggin between contractions, working to help her mom push her out.
The door burst open. “You OK, Sophie?” Shelly, one of my favorite coworkers, asked as she entered the room. As her eyes fell on the bed, they widened into saucers. “What do you need?” She blurted.
“A delivery cart, a tech and a charge nurse!” I said, keeping gentle pressure on the baby’s head as another contraction pushed the baby against Alana’s perineum.
“Oh, man, there’s so much pressure!” Alana grimaced.
“Breathe through it, Alana. You’re almost there!” I coached.
“You got it!” Shelly said, ducking out of the room just as Erin, two other nurses and Jerry, the surgical tech, burst into the room.
“I’ve got a precip!” I called, now holding half of the baby’s face in my hand as Alana’s contractions involuntarily squeezed the head out.
“Oh, well!” Erin said, slapping on sterile gloves and zipping over to Alana’s side. Shelly came running through the door with a delivery cart a few seconds later and I heard a sterile gown rustle just as Alana’s body kicked off another contraction.
“Here comes another one!” Alana shrieked.
Erin reached over Alana’s leg and slipped one hand around the baby’s neck, checking for a cord. “Push, Alana, push that baby out! We’re here now–you can do it!” Erin commanded, her voice full of reassurance and encouragement.
Alana needed no further invitation. I moved my right hand to hold the baby’s head and held up Alana’s perineum with my left hand, guiding the slippery, wiggly little body gently out of her mother as Alana delivered her baby girl with minimal voluntary effort. Even as the rest of the baby delivered, I noticed to my surprise that the newborn already had her eyes open. A scream of indignation arose from the bloody, sticky little bundle in my hands and two dark brown eyes gazed up at me. I don’t think I was able to hide my sigh of relief as I looked over the kicking, pink little baby and realized she had come out perfectly.
“Great job, Alana! You did it!” Erin was congratulating the beaming new mom.
I was watching the baby, whose squinting eyes searched the room with a level of alertness I had never seen in a newborn. Shortly after she was born, those eyes met mine and paused, her forehead creasing as if to say, “You’re not the doctor!”
Another nurse placed a delivery blanket on Alana’s belly.
Yeah, well, you’re not supposed to be here yet, you stinker! I replied mentally, placing the baby on Alana’s abdomen and drying her off with the delivery blanket as those beautiful cries filled the room.
“Nice job, Soph.” Erin said quietly, joining me at the end of the bed. “Was that your first precip?”
“Sure was.” I replied, my heart still racing with the thrill of the moment.
“Way to keep your cool, girl!” She gave me a pat on the back and headed to the warmer for more blankets.
Jerry clamped and cut the cord, stepping into my place to check Alana for tears as Erin and I tended to mom and baby. About fifteen minutes later, Dr. Donaldson arrived and confirmed that Alana had no tears–we were good to clean her up. For about the tenth time, I told the story of how the baby was nearly born during a straight cath attempt. Dr. Donaldson, a (thankfully) very laid-back physician, smiled and congratulated me, heading back home for some sleep.
L&D is by its very nature an unpredictable work environment–you never know what will happen from second to second. And although that can often encompass a number of traumatic and terrifying experiences, I learned that night that not all surprises are bad. Some of them are pink, kicking and crying with big brown eyes.