30 Something Baby Doc

It was a very busy nite on call this Friday. One of those "all hell breaking loose" kind of nites, the kind that I laugh at when I see them glamorized on TV medical dramas.

We had done several C-sections back to back and had just rushed a patient pregnant with twins to the OR who was about to delivery rapidly. Both babies delivered vaginally without any problems. Just as the second twin delivered, the emergency room call the resident to notify us that they were rushing a patient up to our unit who was about to deliver. The charge nurse was very irritated and angry that the ER hadn't notify her initially. I could tell the stressful night was eating away at her. We intercepted the patient at the elevator and moved her into the triage area. The patient only spoke french and was unaware that she was pregnant at all. The resident quickly scanned the patient with the ultrasound and discovered the patient to be 36 weeks (8 months pregnant) and in a breech (butt first) presentation. Thru a translator, the patient indicated that she had previously had 9 vaginal deliveries. On vaginal examination her cervix was already dilated significantly. Given her history of several vaginal deliveries, I knew should was at risk of delivering quickly and infants delivered is the breech position have a higher risk of death and long term disabilities. I immediately instructed the residents to take the patient directly to the OR in order to setup for a C-section. We started heading towards he OR and the charge nurse quickly caught up with us. She was highly frustrated and I could hear it in her voice. She exclaimed that all he OR's were dirty form the previous C-sections. She became more upset stating we just can't move patients back to the OR without notifying her. I tried to explain to her my reasoning for rushing the patient back, ask her for her suggestions and I tried to offer other alternatives in order to expedite the patients surgery. But mostly I felt bad about my decision not to notify the charge nurse of our intentions. I honestly just didn't think about calling because I know we would contact all key individuals once we reached the OR.

We took the patient to OR holding while we waited for the OR to be cleaned. The patient eventually underwent a C-section without complications. Mom and baby did fine:-) I guess I just have to think more prior to making decisions.