The birth of a child is a joyous occasion that parents and family anticipate. Though most parents plan even the smallest details of their deliveries, most do not give a second thought to planning for medical complications during the labor and delivery process. This happy occasion can change to one of fear as unforeseen complications arise, and the mother's life is threatened. Patients need support, education, and a multifaceted approach. Emotions such as fear can cloud patients’ thoughts and affect decision making. Education needs to come from a calm knowledgeable team that is protective and supportive for each individual.
Three cases presented at our 7,000 delivery level III labor and delivery room in the past year, allowing for case plans to be established. The expertise of the maternal fetal medicine staff and the neonatal intensive care unit perinatologists attracts patients and allows for case plans to be implemented for complex patients. The first case was a G6P4 inpatient with a known placenta increta/accreta. A care plan was established outlining surgical, obstetric, and nursing responsibilities, but even the best strategies cannot prevent complications. The second case involved a G1P0 who became pregnant through in vitro fertilization. Labor went as expected, with an uncomplicated vaginal delivery of an infant girl, but when the placenta would not separate, a placenta accreta was suspected. The last case was a G3P2 with a known placenta previa; the scheduled cesarean took an unforeseen turn as a placenta accreta became apparent.
Doctors and nurses worked side by side to solve each complication as it arose. Individually these three women had specific complications and hurdles to overcome, but the outcome for each became similar as they all were discharged from the hospital to care for their infants.