There are four types of death in OB.
As a nurse, one of the easiest deaths for us to deal with are spontaneous abortions. This is the loss of a pregnancy before the baby is 20 weeks in gestation. This is still sad, and still traumatic for the family, but of all the deaths that occur in OB, this is the easiest one for me to deal with. You would be surprised though, to see what a 17 week gestation baby looks like…it looks like a baby! Just a miniature version of one, one that you can fit in the palm of your hand. The eyes are still fused together, but you can still count every finger and every toe.
When a mother comes to the hospital and we can’t find a heartbeat, we call this an IUFD, or an intrauterine fetal demise. Sometimes we know the moment the patient begins to speak that we wont find a heartbeat. She’ll have a certain look, like she already knows something is wrong. She just doesn’t feel right. She seems anxious, and she’ll begin to say things like ‘I haven’t felt her move since this morning, and usually she moves all the time…’ We’ll move the monitor all around her belly, but our attempts are futile, and even though we are somehow supposed to wait for the physician to break the news, she will already know what she already knew: her baby is dead. Then we will labor someone who will bear a baby who will never take a single breath. These require medical intervention so that we can deliver the baby. These are especially hard, because the baby is born and looks as if it’s sleeping.
Most mothers respond in the exact same way when they find out that the baby inside of them is dead. They sob, sometimes hysterically and sometimes silently. Family will come, and they will all cry and ask why. They will recall a time in the mother’s pregnancy where she was sick or didn’t feel well, and they will ask if this information is important. The mother will then go into a state of shock, she will look like she’s in a trance. Maybe it’s from lack of sleep, maybe it’s from crying, maybe it’s from the sadness that consumes her. She will sporadically cry throughout her labor, but she will not break down again until her baby is born. Then, with the delivery of her sleeping baby that will never let out a single cry, she will cry again because she will know it is true: her baby has died before it was even born.
A fetal death is the third kind of death in OB and this is heartbreaking. I’m fortunate that I haven’t seen many of these. This is where the baby is born alive and dies after it’s born. The absolute worst ones are the ones when no one knows anything is wrong with the baby, or when the death is from the actual labor and delivery process. This is devastating for everyone…the patient, the family, the nurse, and the physician.
There is one fetal death that I will never forget. I labored a sweet patient all day. It was her first baby, the first grandchild for her parents. All day, I joked with her and her family. My shift ended before she delivered, and my last words to her were “I’ll pray that you have a quick and easy delivery.” When I returned to work the next day, I asked how my patient had done and the night shift nurse said “it was horrible, the baby died.” I felt like I had been punched in the stomach. We had no clue that anything was wrong with the baby, and all day long I had carefully monitored her fetal strip, which had been perfect. I didn’t know what to do. What do you say to a family who will leave the hospital without their baby?
And last, there’s maternal death, or death of the mother. There is no other word to describe this except as shocking. No one ever expects a typically healthy and typically young mother to come to the hospital to have their baby and never leave. There is nothing more shocking than a baby going home without its mother. Mothers die for many reasons. Sometimes it’s from a postpartum hemorrhage, which is where the mother bleeds too much after she delivers. Sometimes the mothers have an underlying condition, like liver problems or heart problems. Whatever the reason, this is shocking for everyone involved. No one ever expects a mother to die.
In my somewhat short career as a labor and delivery nurse, I have seen all too many of all of these.