Perfect

The phone rang from the birthing center. "Crash section. No heartbeat. Please send the team."

So I did. And I went with them. An extra pair of hands or three comes in handy when you're trying to do everything at once.

By the time the OB handed over the baby, everything was in place. ET tube cut, drugs drawn up, umbilical line ready to go.

She was beautiful. At least I think she may have been a girl. I didn't really look. I was too focused on what I was doing at the time.

No heartbeat.

Dry the baby. Get her off the wet towels.

Bag-mask ventilation.

No heartbeat.

Chest compressions.

No heartbeat.


ET tube in place. Breath sounds equal. Placement checked with CO2 detector.

Epinephrine down the endotracheal tube while the doc placed the UV line (a tube into the large vein in the umbilical cord).

No heartbeat.

One minute APGAR 0
Two minute APGAR 0 -- no heartbeat. No respiratory effort. No muscle tone. No reflex response. Deathly pale.

Epinephrine via the UV catheter -- "Careful. Don't tug on it."

No heartbeat.

Saline for volume expansion. More epinephrine.

No heartbeat.

Coordination of effort could not have been more perfect. We followed the Neonatal Resuscitation Protocol to the letter.

Including the part that suggests that you should consider discontinuing resuscitation efforts if there are still no signs of life after 10 minutes of "continuous and adequate" resuscitation efforts. I don't much like that part, but I agree with it.

She was a beautiful baby. At least I think she was a girl, but she never had a heartbeat. Not while we worked on her.

On days like that, I don't much like my job. I love the people who work with me, though. I value their expertise and their compassion. I particularly appreciate their ability to support one another and to remind each other that no matter how perfect our efforts, the final outcome is sometimes completely beyond our control.

A quiet night

NPC 24 weeks, FDIU. Ominous words appearing on the monitor screen listing the patients in the birthing center.

NPC - no prenatal care at 24 weeks gestation. That's not terribly uncommon in our part of town. Some of our moms show up for their first prenatal visit fully dilated at term.

FDIU - fetal death in utero.

The nurse from the birthing center called for our help. The baby had died some time prior to 24 weeks and she needed a more accurate weight than they could get on their scales. Could she use one of our scales?

Sure, come on over.

340 grams - about 11 ounces.

Do you think the baby has some kind of syndrome?

He looks pretty odd, but he was breech and the cervix had trapped the head for over an hour.

No, I don't think it's a syndrome, but I don't think we should take pictures for the mom to keep either.

We need some kind of memento. Footprints?

Tiny footprints - and perfect palmprints. Both smaller than my fingertip. Think she'll notice that I missed a toe on that left foot?

Probably. Now I wish we'd tried again. It was a quiet night.