When nature intervenes in an unusual way by giving and then taking at the same time, the role of the nurse is to provide skilled nursing care and support.
A G3011 patient pregnant with twins presented to triage at 22 weeks with bleeding. Ultrasound showed a subchorionic bleed with decreased fluid to twin A, a boy. Twin B, a girl, looked good. The patient was admitted to our high-risk unit until delivery ultrasounds continued to show bleeding and increased fetal distress. The family was faced with a decision: should they think about a stat cesarean at 24 weeks if twin A went into severe fetal distress and risk the life of twin B? Should they wait knowing that twin A would most likely die but give twin B a better chance for survival? A multidisciplinary, multifocused team approach of individualized care was applied to this complex patient. At 22 5/7 weeks, twin A went into severe fetal distress. The family stood by the decision to allow twin B to mature. At 26 weeks, the patient started running an elevated temperature and the decision for an urgent cesarean was made. Staff from the labor and delivery room and neonatal intensive care unit (NICU) were assembled and a cesarean was performed. Twin A, a boy, was born stillborn and twin B, a girl, was born screaming and fighting. Time was spent preparing twin A for presentation to the parents while twin B was stabilized. Both infants were seen and held by both parents. A nationally trained local photographer captured a picture of the sister holding her brother's hand in the NICU shortly after birth, and it became the only picture the family had of their twins together. Clergy from both parent's faiths visited and customs were observed. A memorial service was held in the hospital chapel where more than 150 attended.
This experience of caring for a complex patient highlighted teamwork and hospital wide excellence. Multiple departments came together to support this family.