The Perspective of a Labor Nurse

By: Jennifer Kouri RN, CPLC

“You are a labor & delivery nurse? You are SO lucky! That has to be the happiest unit in the hospital!” Working as a labor nurse for 20 years I have heard these phrases many times from people when they ask what I do for a living.

Yes, it truly is the happiest unit in the hospital……. until it isn’t.

 For as long as I can remember, I have wanted to be a labor nurse. I even worked as a secretary on a labor unit while in nursing school, anything to get experience. I was accepted into a new grad program working on a high-risk L&D unit. About 3 weeks into my training my preceptor said, “Today we have a mom that is being induced at 18 weeks because her baby died.” I’m sure the look on my face was priceless. I said “Oh, I don’t think I can do this.” My preceptor looked at me in complete disgust and said “This is NOT about YOU! This is about that mom in there that has to deliver a dead baby today.” I felt like I had been slapped across the face. Little did I know at the time, but that nurse did me the biggest favor by saying that to me. She truly helped shape me into the nurse I am today.

In nursing school, I believe there was maybe one paragraph that addressed stillbirth and miscarriage. For my labor & delivery clinicals I was able to be part of two beautiful deliveries. I had NO idea that babies died during pregnancy or even during delivery. I did not know that these moms still had to deliver their babies. I had NO idea how to support a family that was grieving the loss of their unborn baby. I was like the rest of the general public that believed that these things only happened “way back when.”  Little did I know that this happened approximately 24,000 times a year. How is this possible? 24,000 babies die before delivery EVERY YEAR in the Unites States? 1 in 4 pregnancies end in miscarriage? These statistics are horrifying.

I remember my “first time” being in the room when a stillbirth was diagnosed.  It feels like it happened yesterday. I was working triage that day when I was told I had a patient coming in due to decreased fetal movement. I walked in the room when they arrived, and the parents did not seem overly anxious or concerned. I made small talk while putting the monitors on her belly. As I moved the heart rate monitor from side to side, hearing nothing in return, I began to get the feeling in my gut that this would officially be my “first time”. The first time I was unable to find a baby’s heartbeat and would eventually have to hold her hand while she was told those dreaded words

“I’m sorry, your baby has died. There is no heartbeat.”

She could tell that it was taking longer than usual to find the baby’s heartbeat. I opened the door and asked the charge nurse to find Dr. R and have him bring the ultrasound machine in. That was code for “I can’t find heart tones!!” Mom began to ask questions “why did you ask for the doctor?” “why can’t I hear the heartbeat yet?” I did my best to stay calm & upbeat, but she could see right through me. I said, “I am having trouble finding her heartbeat, so I am going to have Dr. R use the ultrasound machine.” I continued to ask her questions, trying to finish my assessment because I knew there would be no chance to ask these questions after the doctor was in the room. Dad was with us in the room, and he was completely unaware that there was something wrong. He was laughing and making small talk. At this point mom became very quiet and only gave one-word answers as she stared at the wall. When Dr. R arrived, he was visibly uncomfortable due to the situation.

My heart breaks for these physicians that come into a room knowing that they will likely deliver life altering news to a family.

As he scanned her belly, he was very quiet. I could already see that their beautiful baby girl had no heartbeat. I remember avoiding eye contact with both parents. Afraid that they could already see the tears in my eyes that I was desperately trying to control.

Dr. R sat down on his stool and turned to the parents and said those dreaded words “I’m sorry. Your baby girl has died.” I looked at the mom and will never forget the blank look in her eyes as she started at the wall. She had braids in her hair, no makeup on. Very quietly she whispered “I knew it. I knew it.” The dad said “What? What the hell are you talking about? My baby is not dead. Well, get her out. FIX HER! SAVE HER!” At this point he was standing up and yelling. He threw his chair and ran out of the room while screaming. I was so torn; do I go after the dad or stay with mom? I pulled up a chair and held mom’s hand. She was eerily quiet and still. She turned and looked at me and said, “I knew it.”

When I reached in to give her a hug, she clung to me sobbing.

I had NO idea what to say, so I just hugged her and cried right along with her.  We sat this way for about twenty minutes when she looked at me and said, “What am I going to do?” By this time another nurse had found dad and brought him back in the room. We sat there for over an hour talking and crying. Every few minutes dad would ask “Why did this happen?” Again, I had no words, no explanation, no answers.

Eventually I talked mom and dad into going home for a bit and coming back in the morning for induction. After walking them out to their car and watching their reaction when they spotted the brand-new infant car seat strapped in and ready to go, I hugged them both again and told them I would see them the next day. Mom grabbed my arm and said, “Please tell me you will be here tomorrow.” In that moment I briefly wanted to say something like “Sorry, I’m off tomorrow” because I knew how hard this was going to be. But I could hear my preceptor’s voice in my ear “This is NOT about YOU.” I promised her that I would be there. I lied in bed all night scared, sad, dreading this delivery.

The most beautiful baby girl was born silently into this world the next day.

Instead of hearing the sounds of a screaming, healthy baby, there were only the sobs from a mom that watched all of her dreams die along with her first baby. I will never forget that moment.

I cared for this family for three full 12 hour shifts in a row. I didn’t sleep much, I cried A LOT, and I was physically and emotionally exhausted.

That sweet baby girl took a piece of my heart with her that day.  I will never forget baby T. There is definitely a bond formed when you care for a family in these situations.

I held their baby.

I dressed and bathed their baby.

I said their baby’s name.

I am still in touch with this family today, six years later. I was invited to her 1st birthday party where we released butterflies in her memory. I was the first person that she called when she found out she was pregnant again. I was invited to her Rainbow baby shower that her friends and family put on. I had the honor of being there when baby T’s little brother was born. I was invited to his baptism. I have received Christmas cards and school/family pictures every year. If I had not been there in triage that day, I would not have had the honor and privilege of being part of this family’s story.

“You are so lucky to be a labor & delivery nurse!” Yes, yes I am. I am so grateful that I have the opportunity to be there when a baby is born healthy and screaming, but I consider myself blessed & honored to be there when a baby is born silently into this world. To know that I am one of very few people that actually get to meet or hold these babies, means everything to me and I wouldn’t trade that for anything.

---

About Jennifer Kouri RN, CPLC

Jennifer is a Maternal & Child Health Care Manager for UCare and serves as a Health Educator for Star Legacy Foundation.  A Labor and Delivery nurse for 20+ years, Jennifer has a passion for caring for families during perinatal loss and has been recognized many times for her dedication to bereaved families.