SENORITA PLACIDA

I arrived on shift at 5 pm.
The nurse said, " Clara! Im so glad you are here. We have been so busy. Please check her tones." And she pointed to a young laboring mother in one of the four beds. There were two other women laboring as well.
I introduced myself to the mother and asked if I could listen to her baby's heartbeat. Her name was Placida. She said this was her first baby. We waited through a contraction, during which she stood on the floor and leaned over the bed, breathing while I rubbed her lower back.
Placida laid back down and I put the doppler on her belly. I moved it around for about 3 minutes. I tried all the places I knew a heartbeat could hide, but nothing.
I crossed my fingers that I was doing something incorrectly, or that the machine was malfunctioning. I said to the nurse, "Amiga, no escucho los tonas." The nurse sighed and left her paperwork. She tried for several minutes, but likewise could not hear a heartbeat. I apologized to Placida for so much interference with her labor, as it is difficult to concentrate thru contractions when people are pressing on your belly.
The obstetrica came in, could not find a heartbeat, and asked for another machine. The nurse wheeled over another machine, and still no heartbeat. At this point all of us became very concerned, especially Placida. Her eyes kept getting wider and she was trying hard to listen to the nurses through her contractions. The OB asked her if she could feel her baby moving and she said "Si". Not knowing what else to do, and I guess not wanting to call the doctor, the OB put a metal bedpan underneath her, inserted a long thin tool into her vagina, and ruptured Placida's membranes (i.e. broke her water). I could not stop myself from gasping. I know I am supposed to keep a poker face, or at least be optimistic, but what flowed out of this mother was dark, greenish-black, thick meconium laced amniotic fluid.
A baby's first feces are called "meconium". When babies are in distress they will often defecate while still in utero. Depending on the amount of meconium, the amniotic fluid can become a very thick, greenish substance. It can be very harmful if aspirated into a baby's lungs.
This was the first time I'd seen such a bad case of meconium. And I think I must have gasped or else someone gasped, and I heard the OB sort of give a quick knowing moan. Immediately the mother knew something was wrong and began crying and shaking. The OB kept trying to check for the baby's heartbeat, and at one point landed on 125 bpms for about 3 seconds, but then it faded away.
Soon after, the doctor came in and led the woman to the ectografia room, which is where ultrasounds are performed. I followed, as did one of the nurses. The doctor sat her on an examination table and moved the wand across her belly. The room was very quiet except for Placida's breathing through contractions. The doctor began to talk and say something about malformation and it turned out the umbilical cord had been wrapped around the baby's neck 3 times. He told her that her baby was dead.
I have never, ever, ever, ever seen someone scream the way Placida screamed. She sat up on the table and screamed and cried and moaned and berated the doctor and the nurses. The doctor told her to calm down and breath (which made me want to punch him in the face). One of the nurses tried to embrace her and hold her still. I just stood there and watched. I had just met this woman 30 minutes ago and now here I am suddenly witness to the most awful moment of her entire life. I knew she did not want to be held or comforted. I knew she wanted to tear the place to pieces. Finally the doctor and nurses let her be, and she just sat there screaming and crying. She was holding on to one of the leg stirrups and violently rocking it back and forth. I hoped she would break it. At some point her husband came in. He did not go to Placida. He stood across form the doctor and demanded to know why this had happened. His fists were clenched at his sides.
Everyday for the past 3 days, he and Placida had come in to the hospital because she had felt something strange. They had been told it was just nervousness and had not been given an ultrasound. They were told "Everything is fine. Go home." And on this 3rd day she had finally dilated enough to be admitted. At some point during her labor the obstetric unit became very busy with deliveries and they stopped checking Placida's vitals, and so they missed the fact that her baby was in distress.
Literally, the doctors excuse was that they were "too busy" That's it.
For some reason, we all went back to the dilation room where the other two women were still laboring. Placida's entire family came in, as did all the nurses, obstetricas and several doctors. They yelled and argued. The doctor started shuffling thru paperwork to find out when the baby's heartbeat was last on record, to find out who to blame. Basically, no one had checked her for about 6 hours. They saw that she was having contractions and assumed all was well. They doctor basically forced Placida's husband into signing a waiver and then, instead of letting her deliver naturally, he sent her for a cesarean.
I followed as they wheeled Placida's gurney across the hospital yard, down the winding sidewalks towards surgeria. Her family surrounded te gurney and her cousin peppered her with questions while videotaping the whole thing. The staff did not allow any of her family to attend surgery. In fact, they had to bar the door as her family kept trying to barge in with the camera. The doctor who took her ultrasound would be performing the surgery. I asked him if I could observe. He shook his finger at me and said no. I turned around so he could get dressed in green scrubs. He walked past me into the hallway and stopped. His head was down. I put my hand on his shoulder and said, "Doctor?" He looked at me very sadly, took a deep breath and went to deliver Placidas baby.
I went out into the hallway and sat next to some of her family. I did not know what to say. They made phone calls and texted family members. I walked outside and cried and made my way across the grounds back to obstetrics.
I worked for a few more hours and went home.
I was on shift the next day and saw Placida sleeping in the maternidad. I wanted to tell her how much I was thinking of her, but then I thought, she probably has no idea who I am. She only knew me for about an hour. I just happened to be the person who couldn´t find her baby´s heartbeat. Would my face even register? I don´t know.
I did not wake her. I think about her everyday.´