Complicated Pregnancy and Delivery, a Nurses Perspective

I was a labor and delivery nurse for many years and after that worked with new moms in the mother/baby unit. During that time I was able to see all kinds of deliveries and new moms and infants. My experiences were usually very happy and gratifying although we did have some emergency and tragic situations.

I will never forget the day a young mom was up walking the halls. She was suffering from eclampsia, a condition causing hypertension and often leading to increased inter cranial pressure. All of a sudden she collapsed. Not from exhaustion but from a major seizure. She died only moments later. How difficult it must have been for that young father to take home his infant and not his wife. It wasn't supposed to happen this way but sometimes is does as nature takes its course.

Another mother was delivering her third infant in our low risk unit when something went terribly wrong. The baby was very large and her labor was slow to progress. A common practice today is to use a pitocin drip. A very safe way to speed up labor but the mom and baby need to be monitored constantly. After several hours she did deliver a beautiful baby girl. Usually the uterus contracts after delivery, once to deliver the placenta and then again to keep the uterus from bleeding where the placenta was attached. Usually the physician will order medication to be added to her IV to help the uterus to clamp down. Gentle massage also helps as does breast feeding, another one of natures miracles. For an unknown reason this mom would not stop bleeding. You may have heard the term "bleeding out" on medical shows. They are talking about something similar. The blood volume is being depleted so fast that the body can't keep up. At this time IV fluid is increased and blood is given.

In worst case scenario the doctor will have to go back and do emergency surgery to find the source of the unstoppable bleeding. The mom is packed with gauze and the mother is taken to surgery. This mom had to be transferred to another hospital with better equipment. Usually an emergency hysterectomy is performed. This particular woman's blood volume dropped to fatal levels and she died from hemorrhage.

Another cause of a high risk pregnancy that often leads to a C-section is a baby in coming breech or feet first. The problems is the doctor can not tell whether the head will fit through the birth canal.

Often when monitoring labor either the nurse or doctor will notice the infant having late decelerations, bradycardia,too slow or tachycardia,too fast of the baby's heart rate. At this time the mother is often given oxygen and turned on her side to take pressure off the baby. Sometimes the mom is put in trendelenburg position ( head of the bed is lowered ) to take pressure off the a possible prolapsed cord. The moms uterus might be stimulated and the baby's head might be massaged vaginally. Any pitocin would be immediately started and mom might be given a bolus of lactated ringers. The mother and baby are then monitored for several minutes and decision will be made whether to do and emergency C-section

A stillborn baby is a very sad experience to observe. The mom still has to go through labor and delivery as if the baby were still alive. This depends on how far along the pregnancy has progressed. She may even have an episiotomy. Sometimes an infant is born too young to live. If the parents do not want the infant with them an RN must stay at his bed side until he breaths his last breath. I did experience this several times and I remember a quiet and solemness to the delivery room as I stood by the tiny infant struggling to breath.

Another sign of a problem is preterm labor which can be stopped at home. Don"t overdue. Drink plenty of water or enough to stay hydrated. Try to eat a healthy diet and include fiber. Ask your doctor about adding things like Benefiber to your diet to prevent constipation. Keep you stress level down. A nice short walk in your last few weeks is great. Don't get overheated. Be sure to be taking your prenatal vitamin with extra folic acid for the baby's health. Don't eat too late at night .If you are having trouble sleeping try a slow down routine. Turn off all your tv's, computer and maybe a warm bath or shower. Eat a light high protein snack like cheese and crackers with milk or a small bowl of cereal. Read for a few minutes before bed.

Signs of preterm labor can include bloody show a clear bloody stained discharge usually seen a week to two before delivery. Cramping more than ' Braxton Hicks' often seen at end of 3rd trimester and usually normal unless they do not stop with rest or last for extended periods and you can't talk during them,These contractions usually start around the 6th week of pregnancy although are not felt that early. They prepare the uterus for labor. Signs of urinary tract infection. Bright red bloody discharge or of fluid and finally persistent back ache that does not go away with rest. I experienced the latter and my baby was born 18 hours later.

Women need to go into a pregnancy knowing they are caring for two lives. It is important to start early prenatal visits and keep up with your appointments

• Taking 400 micrograms of folic acid is very helpful for the infant

• You need to be up to date on your immunizations

• Maintain a good diet and try not to skip meals

• Drink plenty of fluids and try to drink only one cup of coffee a day. Coffee can speed up the baby's heart rate.

Drinking alcohol can be very dangerous for your baby as is smoking. Alcohol can lead to Fetal Alcohol Syndrome with birth defects. especially brain and changes in the shape of cranial bones.

• Ask your doctor about any medications you might be on

• Get plenty of rest and some exercise as your body allows

• A daily nap can be helpful

Don't change your cat litter box. Don't be obsessive and get rid of your cat but be cautious with feces to prevent toxoplasmosis

This is a very exciting time. Take lots of pictures, maybe journal and enjoy!!!!

There are many forms of high risk pregnancy along with many cause:

• Gestational Diabetes This is often caught early when mom is growing faster than expected or a urine test reveals sugar . Hypertension is another sign and she might be feeling extra thirsty. having frequent urination, nausea, fatigue, blurred vision and even weight loss even though she is eating enough. Good prenatal care. diet and sometimes medication may need to be given. The baby is often very large and a c-section may be necessary.
• Fact to help with gestational diabetes
• mothers with little or no prenatal care
• multiple births
• very young mothers
• older mothers
• HIV or AIDS We now have preventive drugs to stop the baby from getting HIV from the mother
• mothers with sexually transmitted disease
• High blood pressure is often from preeclampsia sometimes seen in young mothers or with twins. Protein will be found in her urine. This can lead to death of the mother, baby or both. Eclampsia is more dangerous and presents with seizures and coma. Preeclampsia is more treatable and with corrective diet and bed rest the pregnancy can progress normally. It is a possible sign that the placenta is beginning to separate from the uterus. If not liver enzymes can rise to dangerous levels and cause damage to the mother's kidney, liver and brain. If the condition can't be slowed delivery will be induced or a c-section will be performed.
• over weight or under weight moms
• Pre-term labor. This is often classified as labor prior to 37 weeks and the infant can often live out side the woman's body with a very controlled environment. In my early days as and RN the doctor used IV alcohol to stop labor. One afternoon a young mother of twins, with a bit too much alcohol lost her lunch all over me.
• Today we know better and have some great medications to stop labor.such as mag sulfate or calcium channel blockers. The baby id often given corticosteroids to make sure his lungs are developed and prevent respiratory distress syndrome. Mom is often put on limited or strict bed rest.
• Pre-existing medical conditions or a history of previous difficult pregnancies