Just Another Cesarean Delivery in OB

It didn’t take me long to fall in love with labor and delivery. As a new graduate nurse, I was enamored with my co-workers, who seemed to know exactly what was going to happen to every patient and how every provider was going to act.  Most deliveries went exactly as expected, surprisingly producing a pink and screaming baby, regardless of any circumstance that may have complicated their labor or delivery. Usually, we were presented with a perfect baby who everyone could ohhh and awww over.  It’s the deliveries that don’t go expected that surge the adrenaline through our veins, stealing every ounce of our energy in its wake.

In OB, there are few emergencies that unquestionably warrant a cesarean delivery.  A prolapsed cord is one of these emergencies. Compression of the umbilical cord causes the baby’s heart rate to decelerate quickly. Fresh off of orientation, I experienced my first prolapsed cord. I was standing next to the bedside when the patient said she thought her water had broken. The words were barely out of her mouth when I heard her baby’s heart rate suddenly drop.  I pulled back her blanket, relieved not to see her baby’s umbilical cord hanging out of her vagina.  But her water was definitely broken and her baby’s heart rate was definitely down.  I quickly put on a glove and carefully checked her.  And then—there it was. I could feel her baby’s umbilical cord inside, pulsating against the back of my hand. Even in nursing school we were taught what to do if our patient ever had a prolapsed cord. But no one ever told us how frightening it would be, feeling a baby’s sluggish heartbeat through its umbilical cord.  I knew at that moment that I wouldn’t be able to take my hand out of the patient until she was taken to the OR and her baby was delivered.  I put a little pressure against the baby’s head, trying to relieve some of the cord compression. I looked at the patient, certain she could see how alarmed I was. I tried to sound calm and told her that a bunch of nurses were about to come into the room and rush her to the OR.  She looked like I felt, scared and uncertain. And as she titled her head up to the ceiling to put on a brave face, nurses rushed through the door, simultaneously yanking on cords and pulling IV fluids. I hopped on the patient’s bed, my hand still in her vagina, and looked up at the patient to see tears falling silently down her cheeks.  I could feel all the force of her body as it tried to push out her baby, and all the time feeling her baby’s heartbeat steadily decline against the back of my hand.

Before I knew it, we were in the OR and the patient was asleep.  I was covered with a drape, my body literally falling off the OR table.  My hand trembled inside of my patient, trying to relieve pressure off the cord.  I never prayed so hard in my entire life.  Under the drape, I could feel how hurried everyone’s actions were.  Under the drape, blood and amniotic fluid soaked through my scrubs.  Under the drape, I soundlessly started crying…I knew there would be no cry when the doctor pulled the baby out of that woman’s abdomen, because there was no more heartbeat against the back of my hand.

When the baby was born, I scooted out from underneath the OR drape. I stoop up, dizzy from every emotion running through my body.  I didn’t know what to do.  I was still new, fresh off of orientation, constantly looking to my coworkers for guidance. I looked at her physician, suturing the mother back up, and saw her crying behind her mask. She didn’t make a sound, but the tears welled in her eyes, forcing decent down her face.  Her eyes steadily focused on the work in front of her.  I looked at the nursery nurses, coding a baby who had never made a sound.  They worked determined, their hands steady and their actions focused.  I looked at the anesthesiologist, her hand on the patient’s shoulder, comforting her even as she lay sleeping.  And I looked at my patient, sedated and so peaceful, completely unaware of what was happening.

I remember standing in the middle of that room, the sterile glove still on my hand, my scrubs wet from blood, clinging to my body. Everyone worked in a whirlwind around me.  And it was that moment that I pledged myself to nursing.  Images of every single thing everyone was doing flashed through my mind, the beauty and sadness of it all made my heart hurt and my whole body weak.  Tears, and a comforting hand, and nurses and a neonatologist all performing a perfectly executed code, and the patient sleeping and serene, and her family outside the OR door, and everyone hurting for this family, and no one to witness it all except me…new, and fresh off of orientation.  I didn’t know what to do then.  I didn’t know what I was supposed to do and I didn’t want to leave and have to tell the family waiting outside the room that their baby had been born without breath.

That day, I went to the bathroom with the extra scrubs I kept in my locker and washed the patient’s blood off my body.  And I cried and I cried and I relived every second from the moment the patient told me her water broke.  And to this day, I still remember the force of her body trying to deliver that baby and I think of all my failed attempts to give that family a different outcome.

Nursing isn’t just about nurses.  It isn’t just about patients or their families or their babies we witness being brought into this world.  Nursing is about teamwork and comfort and care and knowing what to do when things don’t go as planned and being surrounded by people who know more than you do when you need it.  It’s about crying when things don’t go as expected, no matter how hard you want something, no matter how hard you tried. It’s about comforting someone, even when they aren’t aware they need it.  It’s about all of us, every single person who works on a hospital unit, wishing and wanting the very best outcome for every woman and baby.

I love being part of the nursing profession.  I love knowing that no matter how many times we are blindsided by something unexpected, we still hurt for our families.  If you’ve ever been the patient who experienced something that didn’t go as planned, know that every single person on that unit wished and wanted and prayed for you to get the very best outcome. It’s never just another cesarean delivery for us. It’s never just another birth. When we think about any unexpected outcome, our hearts still hurt and our bodies feel weak and we remember you.

Until my next delivery ❤

Healthy Mom and Baby

AWWHONN Recommends Reducing Preventable Harm to Moms and Babies by Eliminating Overuse of Labor Induction


56 thoughts on “Just Another Cesarean Delivery in OB

  • March 25, 2015 at 4:24 am
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    As always so very well written.. Always look forward to reading your wonderful blogs. Please keep them coming..

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    • March 25, 2015 at 1:48 pm
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      As a NICU nurse, I have been to many C-Sections and the feeling is the same. All I want is to go back to my unit empty handed but if I have to bring a baby back all you can do is try to help scared and stunned family while trying to save their precious new baby. Adrenaline, emotions, training all kick in and that is what I loved about my job. I am retired now and still miss all those tiny little angels.

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  • March 25, 2015 at 6:15 am
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    Not an easy read…I can only imagine how it was to live it. Thank you for sharing– life is a miracle and I was very grateful for the nurses who took care of my family and I.

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  • March 25, 2015 at 7:23 am
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    Thank you for sharing your story. I am just finishing my orientation in labour and delivery and I feel anxious and scared at times before going into work and not knowing what to expect. I find your writing so beautiful and stories so comforting; it reminds me that it is all worth it!

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      • March 25, 2015 at 4:33 pm
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        Yes it is! For 24 years, I was the labor nurse. For the last 10, I’ve been the nursery nurse.

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    • March 25, 2015 at 10:51 pm
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      Stella-the anxiety and fear doesn’t go away soon after orientation (it took me a good year and a half and there’s still plenty of days I arrive at work a mess of nerves) and it’s totally NORMAL and good-it will keep you on your toes and help you be a great nurse. Just have confidence in yourself and don’t be afraid to ask for help…It very much is all worth it, even on the toughest days:)

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  • March 25, 2015 at 8:30 am
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    I always seem to have my jaw dropping open with each article of yours that I have read. They are so insightful and informative.

    I hope that this baby was able to start breathing again after it was delivered?

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  • March 25, 2015 at 9:18 am
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    As a fellow labor and delivery nurse I absolutely love reading your blog! I feel like I am standing right next to you experiencing all of this with you. You are an amazing writer! This brought tears to my eyes because I know exactly what it feels like to be that nurse under the OR drapes…an emotional real-life story indeed! Thank you for sharing your daily experiences with us! :)

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  • March 25, 2015 at 11:46 am
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    I love your blog! I just got accepted into nursing school and find myself thinking I want to be you when I grow up (even though I’m 27 lol).

    Heartbreaking yet beautiful story!

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  • March 25, 2015 at 11:52 am
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    As I read this and tears started pouring out my eyes I kept praying that I would eventually read “and then the baby cried!”…and when I realized that sentence wasn’t coming, tears came even harder. I don’t know how you do it. I don’t know how any health professional do it. This is one main reason why I never went into the medical field. I know I am not strong enough to handle these situations. I’m only reading about a situation and I have cried my eyes out while sitting at my desk at work.

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  • March 25, 2015 at 11:58 am
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    Beautifully written, It takes a very special person to be a labor and delivery nurse. I was an l&d nurse for 28years and loved every minute of it. I have lived through the same experience as you except it wasn’t MY pt but a co-workers. I was the circulator in the c/s delivery and helped my coworker throughout the recovery of the patient, heart wrenching to say the least.Fast forward a few years and it was 4 days after our unit was moved from our old unit to the new and improved unit. I found myself in a room with a baby’s heart rate becoming sluggish, checked her and, of course, prolapsed cord. I will never forget how I felt….your description was almost EXACTLY what I felt- the exception was that I was a 20year L&D veteran at the time. That fact changed nothing….I felt completely helpless, feeling that cord pulsing slower and slower as my coworkers raced us to the OR. I was crying reading your words, reliving what it’s like under the drapes. When the baby was delivered, I crumbled to the floor, saw the limp baby girl on the warmer being coded. I didn’t know what to do, I felt like I was in a dream. I dried my tears, quickly changed my soaking wet scrubs, returned to the OR and discovered the baby had been revived…..THANK YOU GOD! Every year on that little girls birthday for 5 years the couple and that sweet baby girl came to visit me for a celebration, sweetest little redheaded baby ever!! I know this is long winded but just wanted to share. Keep up the great work you do and thank you for sharing your experiences!

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  • March 25, 2015 at 1:51 pm
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    It is sad and scary. Beautifully written. I know the family must be grateful to know you knew exactly what to do, and the rest of the team. Coding a baby can be scary for the family and the team. I was always on autopilot, my mind directing my body to perform and execute exactly what the moment called for, while staying emotionally present but not reacting to it until after the fact, later, crying, screaming, praying more, etc, but also knowing, knowing I did everything I could but still couldn’t shield my patient and family from the road ahead.
    Sigh.
    If you haven’t read Baby Catcher – Chronicles of a Modern Midwife, by Peggy Vincent, I think you would really enjoy it. She relates her experience in nursing school, to L&D, to Midwifery, and puts it all on the table.

    This family now has a Spirit Baby.

    Praying for her and her family.

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  • March 25, 2015 at 1:56 pm
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    Wow, well that brought me to tears on this chilly morning. I can’t even imagine what it felt like to literally feel that baby’s heartbeat slow and stop. How awfully tragic. :*(

    Beautiful post. Heart wrenching, beautiful post.

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  • March 25, 2015 at 2:13 pm
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    This was my patient a couple months ago. Terrifying. Fortunately, our outcome was a good one, but I remember tears streaming down my face as I drew cord gasses after I was able to climb out from under the drape. I remember how I willed that baby to cry, and the most wonderful sound when he finally did, and how tightly the dad squeezed me when I was able to go out and tell him that was his baby he could hear behind the doors. Their previous pregnant was a loss, and he was trying to find the words to say to her when she awoke from anesthesia. Your blog captures much of what we all go through that few understand. People say, “What a great job you have. ” Yes, but not for the reasons most think. On our unit it is either really good or really bad, but I wouldn’t trade it for anything.

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  • March 25, 2015 at 2:22 pm
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    I’ve been that doctor, but with an abruption and a uterus full of blood.

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  • March 25, 2015 at 2:40 pm
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    Never could be a nurse, but I read this and felt like I was right there in the OR with you and cried with you. Here’s to all good and caring nurses and all the wonderful work they do.

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      • March 25, 2015 at 3:15 pm
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        When my patients water broke and cord prolapsed, she was not fully admitted and had just climbed into bed and been placed on the monitor. She spoke no English and I no Spanish, but her poor little husband interpreted for us what was happening and what she needed to do. Their baby survived the ordeal and I was grateful for the outcome. This was a well written and very accurate depiction of the way things go in L&D. Thanks for the post.

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  • March 25, 2015 at 3:43 pm
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    Wow.. what powerful writing, I feel as if I was there with you…I was in tears while reading this, my heart broke for you and everyone in that OR.
    Thank goodness for the special people (like you) that can endure your occupation. Thank you.

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  • March 25, 2015 at 5:02 pm
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    Wow beautifully written. I can not imagine how scary that can be. But after being on strict bedrest in the hospital for a month before our twins were born, I remember thinking if I ever went back to school I wanted to become a labor and delivery nurse…because I remember how scary it can be in the hospital not knowing what giving birth would be like. Having two older children at the time added a bit to the stress but I remember the nurses always nice and understanding. It was very hard for me to be on bedrest but those nurses made sure I did what I was told. I hope to read more of your posts. Thank you!

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  • March 25, 2015 at 6:11 pm
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    I went through 2 c section. . I was never given a reason why.. the last was nearly 30 yrs ago. . All I can say is God bless the nurses

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  • March 25, 2015 at 6:45 pm
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    As a still fairly new l&d nurse, this scares the begeebus outta me! During orientation I was caring for a primip who came in with srom. After a couple of hours of laboring I checked her cervix again. I felt a new and squishy “lump” and quickly asked the spouse to push the call light. I was terrified I was touching the cord. My preceptor came in to find me sitting there with my hand in the vagina and asked if everything was ok. I told her what I suspected. She very sweetly said, “I don’t think so.” She checked and announced to a wide-eyed me that it was a forebag. Outside the room she explained that baby’s heart rate was way too pretty to be a cord prolapse. I had never heard of a forebag nor had I even thought to pay attention to baby’s heartbeat! Very good and memorable lesson. Always pay attention to baby!

    On a different note, before l&d I was a palliative care nurse. I truly loved working palliative care, but I knew that I belonged in l&d (that was my goal during nursing school). In palliative care your goal is keeping the pt comfortable and a peaceful death. Death in l&d is NOTHING like that. The closest they come to each other is inducing a fetal demise. It really is true when people say l&d is most wonderful when it’s happy and terribly sad when it’s sad.

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    • April 18, 2017 at 9:32 pm
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      Interesting that you worked in palliative care prior to L&D. I was a hospice RN prior to L&D. I disagree that they are nothing alike, however. Our Hospice Medical Director was a retired OB/Gyn and he said ushering them in and ushering them out were very similar. Both are a process that can be uncomfortable. We all have to be born, and we all have to die. The goal is either a peaceful death or a controlled delivery. Most of the time it is not something that takes place rapidly, but over time. We can provide comfort in both situations. You are right, loss in L&D is difficult. I feel strangely comfortable taking care of these patients, however. Providing loss support was second nature to me, so I often am assigned IUFD patients. It is never easy, but someone has to do it.

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  • March 26, 2015 at 12:25 am
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    I couldn’t stop the tears.. such a touching story…as a mommy who has lost a baby, the kindness and compassion of certain nurses made the beginning of my journey a little less engulfing. The quick thinking of one nurse allowed me to have my much treasured pictures of Davis. Kudos to the nurses everywhere that help welcome lives into this world…and my deepest gratitude to those who help as that life leaves as well….

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  • March 26, 2015 at 2:11 am
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    L & D nurse for over 20 years. I can relate. How many times have I/we heard, ” Oh, you have such a fun job!”. My reply was, “When it’s good, it is very, very good; when it’s bad it’s horrid”. I am retired now but I can still remember so many specific patient situations. My pledge early on was that no matter the outcome, I would try to make it as good as it could be for the patient and family.

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  • March 26, 2015 at 7:33 am
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    I was an L & D nurse for 18 of my 28 years in Nursing. This is so well written, and like many, I have my stories of death and often, of lives saved. But terrifying, every one. And then we come back and do it all again for the next shift.

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  • March 26, 2015 at 1:31 pm
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    After losing three babies, I made it to 38 weeks with my rainbow baby. At 5cm, my dr broke my water and almost immediately alarms started going off because her heart rate decelerated so quickly. My nurse called for help, my dr had his hand up in my vagina trying to relieve the pressure of my baby’s head against the cord and my cervix. My room was filled with SO many people, hanging bags of fluid, I got a shot in my arm, and then someone put an oxygen mask on me. The staff literally ran me to the OR. Thankfully I had received my epidural – I can’t imagine how painful this would have been without it. My doctor did everything possible to keep my baby off the cord, but by the time I was prepped and draped, there was no heartbeat…. nothing.

    7 minutes had gone by; in those 7 minutes I went from 5cm to 9cm. Just like your patient, my body tried to get that baby out. As the OR dr went to cut me open, a heartbeat popped back on the monitor. It was THE most beautiful sound I have ever heard. “Blump, blump, blump, blump, blump” and the monitor started reading 115, 121, 135, 146 and finally baselined in the 140’s after a minute. The surgeon stopped. No incision was made. Just about everyone stopped and stared at the monitor and listened to the heartbeat fluttering away. The doctor that had his hand in me somehow managed to move the cord – I’m not sure how, but he removed his hand and my daughter’s heartbeat confined to have normal accelerations and had a gorgeous strip for the hour I was monitored in the OR. After that hour, I was wheeled back to my room in L&D. The shot they gave me stopped my contractions so they let me rest for a bit and get my body back into laboring.

    My sweet girl made her appearance shortly after my contractions started again. She was posterior and I only pushed for 15 minutes. I don’t know if it’s because we almost lost her, or due to her position, but she spent 10 days in the NICU from pneumonia and having fluid in her lungs. My nurse said I was the only patient to ever go to the OR and not deliver there via c-section. She also said that delivering a posterior baby after only 15 minutes of pushing was one of the shortest she had ever attended.

    Things could have turned out so much differently. I could have four angels in heaven instead of three. We lost her and she came back. If it had not been for that hospital staff knowing exactly what to do in these situations, she wouldn’t be here.

    She’s a beautiful and healthy 6 year-old today and I always wonder if my L&D nurse thinks of us. We moved right after she was born & several times since then thanks to her dad’s military career, so I never had the chance to go back and thank the staff. I will never forget them!

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  • March 26, 2015 at 7:19 pm
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    I feel for you so much!!! I’ve been the post partum nurse for mommies like this. Unfortunately, some ended up on the regular post partum floor. Where happy families were excited to see their new babies.
    We walked these girls at night so they would be less likely to see all the joy surrounding their pain, they would be drawn to the nursery windows like a magnet, and break down, all I could do was cry with them, they had all the hormones telling their bodies to produce milk and bond with a little one no longer there. How do you comfort? The best you can! You pray and cry and comfort in the best way you can. C-sections stay on average 3days but, We sent them home as quickly as possible.
    We helped them grieve, called the chaplain whenever they or their families needed it (When something like this happened, the chaplain service was alerted and put on “high priority” call). And sometimes just sat and hugged them while they cryed
    Its a privileged time to be in a family’s life, the best and worst part of nursing all at the same time. These are the stories that are locked behind a door in my head that is labeled, ” too sad too look at everyday” . But there are times those memories need to be shared. Like now.

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  • March 29, 2015 at 12:22 am
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    I had a C-section and did not go home with a baby 8 weeks ago. Prom and sepsis kept me in the hospital for 14 days. If not for the care and nurture of the L&D nurses and my OB I don’t know how we would have overcome what life threw our way. I am so thankful for all the wonderful nurses and the entire unit that took care of me night and day.

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  • March 30, 2015 at 6:17 pm
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    Thank you for posting this. I am a mama who lost her only daughter (stillborn at 21 weeks) and it means so much to know that behind the masks and the uniforms, there are people who care.

    I so wish that I would have had someone compassionate with me at the time. Sadly, we were not permitted to get pictures even though we had a NILMDTS photographer lined up and ready to go (because visiting hours were over when she finally made her silent appearance).

    Your article makes it a little bit easier to take. Thanks for sharing this and making it okay to be simultaneously both medical staff and human.

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    • March 30, 2015 at 6:21 pm
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      That is the most disgusting thing. My blood pressure seriously just went up. I hope you wrote to administration of that hospital. That is shameful. I am so so so sorry for you. Heartbreaking! !

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  • March 31, 2015 at 11:29 am
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    Thank you for all you do!

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  • March 31, 2015 at 9:07 pm
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    I am crying reading this post. I am a retired OB nurse. I know, have seen, and felt the pain and happiness you are talking about. Having to be on the delivery of a baby that had died before birth, is so hard. We once had a baby born with downs syndrome, The parents first child. As I stood in the nursery with the father, cleaning and doing vitals, The doctor looked at the father and said I am so sorry but your baby has down syndrome…I braced myself…but the father only said Ok..but look…..ain’t she so beautiful! Yes! and yes he knew what the doctor was saying. another birth was s set of twins so very small, panting to breathe, nothing can be done the doctor said, they are too small….Then he filled a medicine Cup with warn water and……baptized them..after asking God to bless the water and the children. To be with the parents as they viewed their children. Some of u may not agree with that but……the parents did…God did….Nuff Said!

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  • April 1, 2015 at 5:49 pm
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    This was a difficult read. I can only imagine how difficult it was to write. I am struggling to write a similar story from an alternate perspective.

    On October 30th, I was the one on the operating table. My son, Owen Benjamin, was the one being taken from my tummy. He was the one who needed to be resuscitated. My husband and I are the ones now trying to pick up the pieces.

    We are so thankful for the medical team that acted as quickly as they possibly could, giving us a beautiful 5 days with our son. I just wish the outcome had been different. I yearn for it to be. It has been 5 months since Owen was born and the days are not getting easier. We do have moments where we are able to smile, and focus more on our son’s continued presence in our lives, but the grief is always lurking.

    Thank you for what you do and continuing to do what you do in spite of potential sadness. For us, it was the difference of 5 days. Time we will always cherish.

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    • April 2, 2015 at 10:50 am
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      I keep waiting to respond because I wanted to try to find the right words to say. But I still can’t find them. But I’m sad for you, my heart breaks for you, and I just wish it were different. I’m sorry that you didn’t have a different ending.

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  • March 16, 2016 at 6:40 pm
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    Tears are streaming down my face as I read this post. I’m approaching the 2nd anniversary of my own maternal near miss. This never goes away and I’ve worked REALLY hard to heal over the past two years. But it’s always with you. I find solace in believing that others remember my story too. Thank you for the message I needed to hear today!

    Reply

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