The Pregnant Patient: How Do You Handle?

[firemoose827 324]

I just recently had a surge in Pregnancy transports at my part time EMS job, and I noticed that every time we received the transfer they wanted us to respond DELTA....and when we arrived at the ED the doctor was pacing in the halls and more nervous than the father?!!! We just strolled in and received our report from the ED nurse, and the whole time the doctor was behind us urging us to leave quickly...Why?????

Our patients presented with contractions around 2-5 minutes apart, water had broken, and on the one the mucous plug did release but there was no crowning, no "urge to make number 2", and no real distress or urgent symptoms. But the doctor still wanted us to move...My Medic partner did request me to go Code 3 on one, but, she was "Immaculately Concepted"....she absolutely denied being pregnant and was adamant about the fact she didnt have Whoopie in 2 years so we dubbed her "mary"...but due to the fact she had no pre-natal care at all, she was presumed to be 2 months past due and she was in tremendous pain, my medic decided to not take chances and we transported code 3.

How does everyone else receive these transports? How does everyone handle the 911 pregnant calls? Just curious to see if anyone has any similar stories or experiences and how each agency handles these types of calls, either emergency or transports. Thanks in advance.

Moose

[Oswegowind 17]

Sounds like the doctor is a (not allowed to use the expletive here-insert your own)! I don't know where your part time j.o.b. is, but we used to have a problem with an Ob/Gyn in the City of Yonkers. St. John's to be particular...never wanted to hear our story, wanted us gone!

Until, we had a pregnant female that OD'd on a hallucinogen that was fighting with the EMS crew. They called for backup and we ended up "securing" this female for transport, at the hospital we moved point by point (extremity by extremity) to the OB bed and tied her down properly...a kicker! The doc got pissed so everyone else left the room (EMS) and I proceeded to cut off the restraints with my shears while running out the door. All you heard was the doc yelling for "HELP!", we came back in and re-restrained her...never had a prob since!

Unfortunately this is not an optimal way to teach a lesson or humble someone...Good Luck...some Doc's just can't see us on a professional level...we are their bastard step child too.!!!!

P.S. being pregnant doesn't mean they can't walk to the bus! I love how all of sudden someone can't walk, but they have done fine for the other 8.99 months!!

Edited August 29, 2007 by x635

[RescueKujo 130]

Moose,

As a Labor and Delivery nurse told me long ago, women have been birthing babies without doctors, nurses, paramedics or EMTs for millinneums. We are there to assist and help if anything goes wrong. There is no sense is getting worked up about it, you can't stop it. I've found that the people who act like that doctor are insecure in their own skills.

[INIT915 1,119]

Two months past due and no prenatal care? Did I read that right?

I do not blame the MD at all. Let me guess, a clinic or hospital not equipped to handle high-risk births? No surgical or high-rick neonatal back up? And contractions as quick as every 2 minutes with a 2nd child, I'd want to get to a tertiary care facility also, "code 3" as you say.

Ob nurses are right, we are there to passivly assist in 99.9% of cases. An 11 month gestation with no pre-natal care has a high probablity of being in the 0.1% left over.

[PFD165 1]

Two months past due?

[Goose 188]

Two months past due?

Think thats bad? I once got dispatched for a female w/ abdominal pains and vaginal bleeding who was 30 months pregnant, i called dispatch to see if we were going to the aid of an elephant. Turns out he made a little typo...turns out she was 30 weeks pregnant.

[OnTheWheel 43]

Just went through the whole "birthing" thing and 2 months past due is impossible, longest most DRs let you go is 2 weeks past due, i think 4 is the max period, musta been a misunderstanding. And when a woman is in "active" labor, the last thing they can do "well" is walk, they can, but its extremely uncomfortable and as far as i know, impossible during a contraction. And those delivery nurses are AWESOME! Hats off to them!

[ckroll 101]

Think thats bad? I once got dispatched for a female w/ abdominal pains and vaginal bleeding who was 30 months pregnant, i called dispatch to see if we were going to the aid of an elephant. Turns out he made a little typo...turns out she was 30 weeks pregnant.

OK, so here I am minding my own business when dispatch asks me if I'm busy..... turns out I'm 2 blocks from an 'unknown medical'. with a language barrier. Cops are on location, outside, tell me the woman is having a baby. Does not speak English. No problemo, seniora..... except this lightly built, blonde woman speaks something eastern european and the german, french and spanish I might have pieced together are useless. She is in excellent physical condition and pacing back and forth, has no use for me and does not need her blood pressure taken or an EKG or oxygen which is about all I have to offer a woman on the run.

The ambulance arrives, I ask the kind officer if maybe the next time she paces towards the door we if we could pace her into the ambulance. I call the hospital to ask them if they're prepared for delivery and a language barrier and they ask is she going to have it, I say I don't think anytime soon, but yes, she looks full term and mad as....well, lots of things. They say "Sure." And to their endless credit, they cleared a double bay and ordered down an infant set.

I ask if anyone speaks the language and an officer finds me a neighbor to accompany. The patient and neighbor start chattering like starlings, but no one talks to me. We manage something about 2 children, but I am not sure if she's had 2 or is having 2. Contractions are close and the moment we get her in the ambulance she howls like a coyote. No crowning, so I tell the EMT we're OK. I start a line between contractions, she does it again. No crowning. We pull onto hospital grounds and she does it again, I check and say 'Well, hello there.." EMT looks stricken, asks what do we do and I say drive like hell and unload and go. We push her through the doors at a trot, tell the staff we've got 1.25 patients. The nurse shoots back 'You, told me she wasn't going to have it' and I reply, 'Well, I lied.' We go to move her over to their bed and I stick my hand under her rump, it is real wet and warm. She's shot the bundle almost to the end of the stretcher and the only thing that stopped it was the end of the umbilical cord. MD runs over for a clamp and cut. It's over. Beautiful baby in the bassinet.

So, yeah. babies have been squirting out of women for years with no assistance whatsoever. It's a baby, not an emergency.

Unless of course, it is. Like any other call, if the hair on your neck stands up, you've got a 'worker'.

[helicopper 1,050]

Just went through the whole "birthing" thing and 2 months past due is impossible, longest most DRs let you go is 2 weeks past due, i think 4 is the max period, musta been a misunderstanding. And when a woman is in "active" labor, the last thing they can do "well" is walk, they can, but its extremely uncomfortable and as far as i know, impossible during a contraction. And those delivery nurses are AWESOME! Hats off to them!

If she didn't have any pre-natal care and they're estimating her to be long past-due that would certainly explain the doctor's angst to have the patient removed and the need for a tertiary care facility. It would also explain how she got to be so far past due.

Sounds like Mary must have cut health class!!!

How did she ultimately make out???

[Guest partyrock]

P.S. being pregnant doesn't mean they can't walk to the bus! I love how all of sudden someone can't walk, but they have done fine for the other 8.99 months!!

The first thing the maternity ward will have a woman do after she's been assessed on the floor is walk. She'll be doing laps on the floor until she either goes home or drops a baby.

[firemoose827 324]

If she didn't have any pre-natal care and they're estimating her to be long past-due that would certainly explain the doctor's angst to have the patient removed and the need for a tertiary care facility. It would also explain how she got to be so far past due.

Sounds like Mary must have cut health class!!!

How did she ultimately make out???

MY FAULT!!! I just noticed MY typo....she was two WEEKS past due!!!Not two MONTHS!!! BIG difference!!!

She delivered shortly after we got her there, probably within 5 minutes of two sweat covered pale EMT's pushing her through the door. We understood the need for urgency in this case, I was talking mainly about other pregnant calls where everyone seems to be in a rush to get things moving, we get the pt to the hospital, and they are released before we even clear the ED and return to service.

With pregnancy there are sometimes so many false alarms and false labor pains. I try to go on assesment of the PT and what she actually called us for...on transports we listen to the Nurse in the ED and hear what they have to say...we have a small hospital here that cant do much for a lot of patients...OB being one. We tend to transport a lot of them to Albany or Cooperstown.

My main reason for this question was to see if anyone else had similar experiences and how they have handeled them in the past. Another story of mine...we were called at 2:20AM for a 22 FM "In Labor, Water broken, contractions 3 minutes apart"...OK, we respond to the call and as we are pulling up to the house we see a woman standing on the front porch with her suitcase, jacket on, waiting???? We jump out the back of the amb with the gear and stretcher and head for the door as she climbs into the side door and sits on the captains chair???? I approach her and introduce myself, than ask if SHE called the amb. She smugly says "Yes, I need to get to a doctors apt at 8 AM but I had no ride so I called the amb...the hospital said I could spend the night." !!!!!!!!!!!!! I carefully and politely explain to her what we do on the amb and that we were called for a woman in labor, and that we dont provide taxi service. Than ended with the fact that someone else in our district could very well be in danger and need us...she shrugged and said "But I called 911, I have stomache pain."

Long story short we took her to the hospital, ( Due to the "Stomache pain" ) and documented the holy heck out of it.

Sorry for the mis-understanding with my typo....Not getting a lot of sleep. Thanks all.

Moose

[Guest alsfirefighter]

I got a call in one of our high rise projects for 'abdominal pain'. Got up to the floor off the elevator and was greeted by a woman (patient's mother) who told me her daughter was in the bathroom. Got to the bathroom and found a 17 year old sitting on the toilet in moderate discomfort telling me she's had "hard cramping" for about 8-10 hours. I asked her the standard stuff...nausea? no..vomiting? no...diarrhea? no. OK.. How do you feel right now...still cramped but I want to get off the toilet...as I walked over to help her up, I asked her "is there any chance you could be pregnant?" I got the standard "no"...she stood up and....SPLASH!! Out came a baby girl. Always remember...feces happens (man I wish I could use the regular word). Mother didn't like the fact she had to stand for a few minutes in the bathroom (which jail cells are bigger) while I suctioned. Baby did fine, got her on the stretcher...clamped and cut.

Yes I did have an interesting conversation with the patient. For one she did have her menses at least twice in the timeframe. Remembering that this can occur in a fair percentage of women. She also had a petite frame that even I can honestly say by sight did not look like she was showing. Not to mention the fact her mother looked somewhere between surprised and pissed.

[tunaFish 0]

Sounds like the doctor is a (not allowed to use the expletive here-insert your own)! I don't know where your part time j.o.b. is, but we used to have a problem with an Ob/Gyn in the City of Yonkers. St. John's to be particular...never wanted to hear our story, wanted us gone!

Until, we had a pregnant female that OD'd on a hallucinogen that was fighting with the EMS crew. They called for backup and we ended up "securing" this female for transport, at the hospital we moved point by point (extremity by extremity) to the OB bed and tied her down properly...a kicker! The doc got pissed so everyone else left the room (EMS) and I proceeded to cut off the restraints with my shears while running out the door. All you heard was the doc yelling for "HELP!", we came back in and re-restrained her...never had a prob since!

Unfortunately this is not an optimal way to teach a lesson or humble someone...Good Luck...some Doc's just can't see us on a professional level...we are their bastard step child too.!!!!

P.S. being pregnant doesn't mean they can't walk to the bus! I love how all of sudden someone can't walk, but they have done fine for the other 8.99 months!!

Shame, shame there are some bad words here.

Some things were edited and some were left behind. You may be sent to the corner Hmmmmmmmm.

[STAT213 332]

Let me chime in about this transport. You should have never left the sending facility. I am assuming that it was some form of a hospital.

The danger in taking care of a female with NO prenatal care by yourself in an ambulance is insanely high. Again, assuming here no OB staff went with you because you didn't mention any. And, by you stating that she delivered almost immediately after your arrival makes this even clearer.

The physician is nervous because he wants you out of his ED. He THINKS that his responsibility is over once you leave. He is wrong. EMTALA is quite clear that the sending physician carries the liability of the transport. Once you explain to them ALL of the things that can go wrong and that they own the patient until arrival.

We don't have to do all these transports. The places where I have done CCT, we flat out told the sending facilities that anyone actively laboring would deliver - unless there were some mitigating circumstances. That patient is not stable and should not leave the facility. Additionally, any female who was contracting more than every five and was dilated more than 3cm would not be a candidate for transport. The risks are just too great. Thankfully, the agency I work for stands behind me when we are called to perform these types of transports.

There was just a great document on IFT published by nhtsa. It outlines what we should and should not do, and the law. If you want a copy, email me, and I'll send it to you electronically.

RA

Edited August 30, 2007 by STAT213

[helicopper 1,050]

Let me chime in about this transport. You should have never left the sending facility. I am assuming that it was some form of a hospital.

The danger in taking care of a female with NO prenatal care by yourself in an ambulance is insanely high. Again, assuming here no OB staff went with you because you didn't mention any. And, by you stating that she delivered almost immediately after your arrival makes this even clearer.

The physician is nervous because he wants you out of his ED. He THINKS that his responsibility is over once you leave. He is wrong. EMTALA is quite clear that the sending physician carries the liability of the transport. Once you explain to them ALL of the things that can go wrong and that they own the patient until arrival.

We don't have to do all these transports.

You're so right, 213! Unfortunately, it is very unlikely that EMS crews will have the fortitude to stand up to the doctor for fear that their agency will not back them and in many cases they're right.

[Guest paramedico987]

baby = urgent

no baby = not urgent

[firemoose827 324]

You're so right, 213! Unfortunately, it is very unlikely that EMS crews will have the fortitude to stand up to the doctor for fear that their agency will not back them and in many cases they're right.

Oh...I do stand up to the doctors here, trouble is my company doesnt. Both my medic partner and I were in the nurses station for 5 minutes trying to explain to Dr. Death that the transport could very well backfire in his face, and explained the COBRA laws that are similar to what stat213 stated, that the PT was HIS responsibility untill the receiving doctor RECEIVES the PT. He just kept waving us off saying "Yes yes yes, Im aware, now GO." We took a nurse with us, forgot to mention that.

See, you need to understand the capabilities of the hospital we serve here in Schoharie County....its a first aid station! It has a small 7 bed ED with one Doc, a Radiology dept, Lab, outpatient clinic, and a small 20 bed inpatient unit. They are very limited to what they can do, but the nurses there are the best, and we try to help them every chance we get. The nurse that went with us ranted and raved about the doc the whole trip...out and back...saying he was a moron!! She didnt want to go back afterwords, she wanted to ride along with us the rest of her shift!!

But, yes, I do understand all of this. Just wanted to hear some more war stories from everyone about OB calls/transports and how you handled them. Good stories so far!!! Thanks.

Moose

[MoFire390 118]

You know I haven't been on many EMS runs where I have had to deal with pregnet women. When first started to ride as an attendent a women in labor was my first pager call. She had just gotten released from the hospital (WMC) and was on her way home (or so she thought), when she started having contractions with were 3-5 min. appart.(I was the second person on scene) Too make a long story short she denied that she was going to have the baby that day, she said that there was no way in heck that she was going to give birth it was just too early. When we got to the hospitial the doctor told us to go up to materanity (talk about a DO NOT PASS GO, DO NOT COLLECT $500 situation) so the crew on the rig brings her upstairs and she has the baby. That is the first and only time that I have been on a call like that.

I've been on many car accidents, stroke, dibetic emergencies, but I have never seen that much chaos in one area.

[ckroll 101]

Just wanted to hear some more war stories from everyone about OB calls/transports and how you handled them. Good stories so far!!! Thanks.

Moose

It is not my story, but it is one that bears repeating. PIAA. Car is off road, has hit a tree and a woman is sitting on a stone wall, self extricated, a laceration on her forehead and no recollection of the accident. Interview reveals she is 8 months pregnant, no complications or pain. The medic calls for stat flight to the medical center, is given some grief for this being as it is a stable, ambulatory, patient.

He gets a call several days later, expecting a complaint, is told that the woman's placenta abrupted, she delivered in the ER, mother and child -- in neonatal unit-- doing fine. The medic involved is excellent, claims there were no physical findings, only mechanism.

Anything unusual needs to be viewed as a potential emergency and any potential OB emergency where fetus is viable needs to be not at any hospital, but one that can manage neonates. After his experience, I take all third trimester patients with complaints other than expected, uncomplicated, full term delivery to WMC. If they are not at the destination facility, the option is possibly having to separate mother and child post partum. I did a couple of those transports, and it breaks your heart to watch a mom say goodbye to a sick new born so he or she can be sent to a better facility.

[Guest]

P.S. being pregnant doesn't mean they can't walk to the bus! I love how all of sudden someone can't walk, but they have done fine for the other 8.99 months!!

The first thing the maternity ward will have a woman do after she's been assessed on the floor is walk. She'll be doing laps on the floor until she either goes home or drops a baby.

Well my original post on this got shot down (my bad) but let me tell ya if you are indeed in labor you won't be walking too far before you are trying to hunt down an anaesthesiologist.

[ckroll 101]

Well my original post on this got shot down (my bad) but let me tell ya if you are indeed in labor you won't be walking too far before you are trying to hunt down an anaesthesiologist.

I do recall from labor and delivery rounds in paramedic class that any time a woman said that she wanted a natural, no drugs delivery that inevitably it was her first child. The ones yelling that they wanted their epidural and they wanted it NOW, were repeat customers.

Back in the day, when handling proto mothers with limited prenatal care, I ask whether they want a boy or a girl and if they've chosen names. Anyone who goes on for a couple of paragraphs about boys vs girls and names... well she isn't delivering any time soon. If she looks at you with hate in her eyes and yells back, ' I WANT IT OUT!' that one is having a baby.

[firemoose827 324]

I do recall from labor and delivery rounds in paramedic class that any time a woman said that she wanted a natural, no drugs delivery that inevitably it was her first child. The ones yelling that they wanted their epidural and they wanted it NOW, were repeat customers.

Back in the day, when handling proto mothers with limited prenatal care, I ask whether they want a boy or a girl and if they've chosen names. Anyone who goes on for a couple of paragraphs about boys vs girls and names... well she isn't delivering any time soon. If she looks at you with hate in her eyes and yells back, ' I WANT IT OUT!' that one is having a baby.

Funny!! A word of advice for new EMT's....dont ever ask that question when taking a BP, I did and it took 5 minutes to re-gain my hearing after she picked up the stethoscope and flicked it with her finger!!

Ahhh, the joys of EMS and helping people...

[Guest]

Anything unusual needs to be viewed as a potential emergency and any potential OB emergency where fetus is viable needs to be not at any hospital, but one that can manage neonates. After his experience, I take all third trimester patients with complaints other than expected, uncomplicated, full term delivery to WMC. If they are not at the destination facility, the option is possibly having to separate mother and child post partum. I did a couple of those transports, and it breaks your heart to watch a mom say goodbye to a sick new born so he or she can be sent to a better facility.

Agreed. You never know when it can turn nasty so it is best to be in the right spot just incase. WCC NICU is excellent. It is a pity tho that they didn't build a new maternity section with the new NICU in the childrens hospital. That old once is pretty dingy.

[ny10570 745]

Thats a story ckroll, hopefully people will also see that a bird isn't necessary and a bus to the med center would be perfectly acceptable.

Here's something I picked up new for after the birth. Anyone who gets an epidural (or spinal tap for that matter) even without complications has a high potential for severe headache, neck and back pain for up to 3 days after the event. Biggest flag is when supine there is no pain, but as soon as they sit up the pain starts and only gets worse. I had only been aware of this with complications from spinal taps.

[RescueKujo 130]

I do recall from labor and delivery rounds in paramedic class that any time a woman said that she wanted a natural, no drugs delivery that inevitably it was her first child. The ones yelling that they wanted their epidural and they wanted it NOW, were repeat customers.

You know, this would all be a moot point if qwomen wouldn't take seriously whats being poked in fun

[gss131 212]

I got a call in one of our high rise projects for 'abdominal pain'. Got up to the floor off the elevator and was greeted by a woman (patient's mother) who told me her daughter was in the bathroom. Got to the bathroom and found a 17 year old sitting on the toilet in moderate discomfort telling me she's had "hard cramping" for about 8-10 hours. I asked her the standard stuff...nausea? no..vomiting? no...diarrhea? no. OK.. How do you feel right now...still cramped but I want to get off the toilet...as I walked over to help her up, I asked her "is there any chance you could be pregnant?" I got the standard "no"...she stood up and....SPLASH!! Out came a baby girl. Always remember...feces happens (man I wish I could use the regular word). Mother didn't like the fact she had to stand for a few minutes in the bathroom (which jail cells are bigger) while I suctioned. Baby did fine, got her on the stretcher...clamped and cut.

Yes I did have an interesting conversation with the patient. For one she did have her menses at least twice in the timeframe. Remembering that this can occur in a fair percentage of women. She also had a petite frame that even I can honestly say by sight did not look like she was showing. Not to mention the fact her mother looked somewhere between surprised and pissed.

1 of 2 i wont soon forget happened on post and livingston with it seemed like every kid on the block waiting for a school bus coming in for a looksee,i mean she just let out her stuff right in the middle of the living room.wacky sh*t.

[ckroll 101]

Thats a story ckroll, hopefully people will also see that a bird isn't necessary and a bus to the med center would be perfectly acceptable.

If memory serves, 'transporting' agency would only go to closest, which was not appropriate in this case. A 40 minute ride would have ended badly, so it was a lucky break. Again, I wasn't there, but it brought up a discussion locally concerning thinking harder about destination hospitals and OB emergencies. 10 minutes may seem like an eternity in the back of an ambulance, but if there is defense in depth waiting for you at the ER, it is worth it.

[Guest paramedico987]

dont ever ask that question when taking a BP, I did and it took 5 minutes to re-gain my hearing after she picked up the stethoscope and flicked it with her finger!!

I even go so far as to make sure they're not having a contraction when I ask them ANYTHING...

[Guest]

You know, this would all be a moot point if qwomen wouldn't take seriously whats being poked in fun

LOL I was going to say something but thought I'd better not.

And from a woman who has has contractions point of view; never, ever ask us anything when we are having a contraction. It HURTS and if you can't help - keep it zipped until the pain stops!