Monument Valley staff helps bring 31-week-old baby into the world
March 29, 2017 was a normal day at the UNHS Monument Valley Community Health Center, until just after 1:30 p.m. when Dr. Patricia Spencer’s second patient of the afternoon arrived.
By 2:00 p.m. Dr. Spencer was closing the clinic and marshaling all the providers, nurses and anyone else who could help that second patient, as she struggled not to deliver a baby that insisted on being born only 31-weeks along.
“37 weeks is premature and 36 is not good. Anything less than that and babies are in great trouble when they are born at a facility that doesn’t have a NICU (neonatal intensive care unit),” said Dr. Spencer. “So I told the nurse to do an NST (non-stress test to measure the fetal heart rate and to measure contractions). I go see another patient and when I get back I go in and the contractions are every two minutes, and these are real contractions! I told her, ‘you close your legs,’ and I had my nurse get me sterile gloves because now I’m thinking, is this baby going to be born or not? They gave me my gloves and I went right back in there.
“And very carefully I started to touch because what I was touching was a bulging bag and she was already eight centimeters. Babies, when they’re term, it is ten centimeters. This is eight but this baby weighs half of the others. So this means this baby is complete, and that baby, right there, was being born. I just wanted to be very sure before I coded the place and I looked and it was the baby and I was alone, and I said, ‘don’t breathe, don’t push’ because if I stepped out that baby could be born with no assistance.”
At that point Dr. Spencer said she started running through the hall, telling everyone she saw to go to the procedure room because they were delivering a baby; a 31-weeker. She said when she got back and still the baby wasn’t born, “I was like, okay, this is for real and this was 2 o’clock. The baby was born at 4:45 p.m.”
Between 2:00 p.m. and 4:45 p.m. the Monument Valley CHC was closed, and everyone working that afternoon was called upon to perform certain duties to help keep the baby from being born any sooner. The nursing staff of Karen Blackwater, Bernadine Whitehorse, Ernestine Harrison and Talisha Biakeddy, along with PharmD Angela Konecki and Pharmacy Tech Jeanette Uentillie, and Radiology Tech George Jones, were all busy helping with whatever Dr. Spencer needed them to do. Karen and Talisha grabbed clipboards and started documenting everything that happened with the mother and the baby, respectively.
“It was pretty intense. We weren’t ready for it,” said Karen Blackwater. “Dr. Spencer was like, you do this and you do this and you do this. It was my first time doing something like that. I just wrote down whatever Dr. Spencer said. I was just given the vitals and I wrote them down.”
“It made our adrenaline run because we were so excited and then we were concerned about the baby’s condition because it was a premature baby,” explained Ernestine Harrison.
UNHS providers Dr. Phil Smith, and PA’s Revina Talker and Shyrlan Beck were also on hand, along with Dr. Spencer, as they tried to keep the baby from being born before a helicopter from St. Mary’s Medical Center, in Grand Junction, Colorado could arrive with a specialized NICU team.
“It’s unusual to deliver a baby that young at a clinic like Monument Valley,” commented Dr. Smith. “Credit needs to go to the mom, who was very compliant with the instructions that we gave her about not pushing because she was complete and could have easily, because the baby was small, could have easily delivered way early before the flight got here. She was willing to put up with the discomfort because she knew we didn’t want the baby to be delivered right away to allow the medication, like the steroids and other things, to be given.”
Dr. Spencer said an ambulance from Montezuma Creek was contacted so they could come, but she couldn’t transfer the mom because it was eminent she was going to deliver, during the trip to the nearest hospital, and that was dangerous.
“She had the contractions every two minutes but she wasn’t pushing and we started educating everyone and asking ‘do we have this’ and everyone would run and go, and come back; no we don’t. And I called Dr. (Val) Jones at the UNHS Blanding Family Practice and he helped me call St. Mary’s Medical Center in Grand Junction,” Dr. Spencer explained. “And they activated their team. Dr. White in the St. Mary’s NICU and a nurse from the NICU were with us on the phone, on speaker, and we had them with us for those three hours. And between times we asked our staff, do we have this? NO! We started brainstorming. What else could it be? Oh! We have this. It was very challenging because I was trying to stop contractions and the most concern was that if the baby was born, and they’re so small they’re not breathing, and I only had oxygen. I had nothing to intubate or a pressure mask to do resuscitation, because you have to seal it. But we didn’t have one so we brought scotch tape just in case. We also didn’t have a warmer, but every 15 minutes we were changing the sheets to keep them warm, using the clinic’s clothes dryer as suggested by Dr. Smith.”
“It was organized chaos. Dr. Spencer said, ‘we’re going to be delivering here pretty soon,’ and knowing it was a preemie we had to have all the providers in there,” said PA Revina Talker. “We couldn’t spare anybody. Everybody involved, with all the skill sets and all the components together in the room with us, made it all happen fairly easily. It was the best outcome we could wish for. It was nerve wracking and very stressful. We’re not equipped for that kind of emergency. We were trying to find drugs and I grabbed Angela from the pharmacy and they were in charge of drugs so we didn’t have to worry about that.”
“They wanted to have us there for the medication,” said UNHS PharmD Angela Konecki. “We used premixed medication and got an IV working. We stayed back to make sure we were there if they needed something. They just needed us the one time. Jeanette (Uentillie Pharmacy Tech) confirmed the dosage.”
According to Dr. Spencer, from 2:00 p.m. until 4:45 p.m. the mother went through contractions every two minutes, breathing through them, legs closed, laying back and not pushing, but once the water broke, within seconds the baby came and she said, ‘I can’t hold it any more,’ and the baby came out. Then everyone had something more to do.
“Everyone was really great. The helicopter came 15 minutes later,” Dr. Spencer said. “The baby came with eyes open and when I delivered it, it started breathing in front of me, so we had PA’s Shyrlan Beck and Revina Talker that were in charge of the baby, and they knew what to do and they did such a great job.”
Beck said the events of the afternoon were scary but exciting. He said he was impressed with the way everyone worked as a team and everyone had a role to play.
“Nurses were writing stuff down, and everyone was willing to help, and the thing that made it good was Dr. Spencer and how calm she was and everything. It really helped out the situation. She showed confidence in all of us,” Beck said. “Dr. Spencer did a great job of helping Revina and I evaluate the infant. She handed the baby off to us and we were wiping it down and exchanging blankets and making sure it kept breathing. It was good. She was coaching us, and we’d say what vitals were.”
Most of those involved with the birth of the 31-week-old baby had something good to say about an EMT, who helped coach the mother through the ordeal the entire time.
“Debbie, the EMT from Montezuma Creek, was fantastic. She kept holding the mom’s hand and telling her, ‘you’re doing good.’ She was great,” Talker explained. “She coached her through the contractions. It was really good to see how great she was with the mom. She just got in there and found her niche. We didn’t have to ask her. She just got in there and it was very much appreciated. It was just natural for her. When baby came out and cried and peed we were elated. We just had to keep it awake and breathing.”
Debbie Benally said she was filling in for a co-worker in the non-emergency Medical Transport unit at the Monument Valley clinic, when she heard a commotion in the hallway.
“There were all these people running around in the hallway and they were saying something about a young mother in labor and we need an ambulance. That’s when I got up and I told them I was the only EMT,” Benally explained. “They asked me if I had a crew and I said not now but I could get a crew. They were getting anxious and asked if I had ever delivered a baby and I said yes. And they said, we need your help. So I went to the ER room and the mother was there with the husband and he was holding her hand and she was relaxed and calm and she was a really good patient. She’d been through this, I think it was maybe her third baby, and she was getting anxious.
“I would time her contractions and I could tell from my watch when the next contraction would start. Every time it would start she’d just squeeze my hand or grab my arm and the father was there, and we had eye contact,” Benally continued. “I was her focus and I told her don’t look at anybody else just listen to my voice and I’ll talk you through the contractions. I’d talk her through it, ‘here we go. We’re going to go hard through this contraction and I’d count, 1, 2, 3, 4, 5 and then I’d say you’re peaking and now we’re going to go back down, 1, 2, 3, 4 and I’d tell her how to breathe. When it was over I’d tell her take a deep breath. Then I’d tell her to rest because your next one is going to be here shortly. So she would rest and I said okay the contractions are going to get really intense, but we’re going to get through this. And I’d tell her if you need to yell, yell, don’t hold anything in.”
Dr. Spencer said when she saw the baby come out and it started breathing, she was able to clamp the cord and then let the father cut the cord. The baby was so stable that at the 10-minute mark, she gave the baby to the mom so she could hold it.
“It was very emotional because it was a 31-weeker. The helicopter came about 15 minutes after the baby was born and when we heard the helicopter it was like in the movie when the rescue comes. I was like, please land,” Dr. Spencer related. “And they had to get all the cars out of the parking lot, and they landed right there. They came in and took care of the baby. Mom went to Blanding in the ambulance and I continued to see mom and the next day I let her go. She went to Grand Junction to see the baby, which by then was not needing oxygen.”
“I was really excited and blessed to hold the baby and see it open it’s eyes, and I said, there you are and welcome to this world,” Benally explained, having been rewarded for her efforts with a chance to hold the baby. “I congratulated the mother and dad and I told the mother, ‘you did an amazing job. You are really a strong woman and you did exactly what we asked of you, and your baby came out perfect. We just need to make sure it continues on getting the best treatment. The mother was amazing!”
According to Talker, after knowing the mother was okay and everything was good, mom did get to hold the baby for a while. The family came to see the baby, and they let them go in one at a time to see it. Not too long after that the NICU team showed up in the helicopter.
“I want to stress how everyone took it to heart and everyone was – this is your role this is what your going to do, and everyone had something to do,” Dr. Spencer said. “Everyone was there; Dr. Smith, Revina, Shyrlan and all the nurses and the pharmacy and everyone. It was very stressful.
Everyone was professional and everyone was there doing their job, working together and out of the way of others. Their professionalism is what made this all work. I don’t think I slept well for three days because my adrenaline was still running high, but it was great.”
“There was always a consultative physician from St. Mary’s Hospital that was on the speaker phone so we were able to say ‘this is what’s happening’ and they were able to say ‘have you given this, have you given that?’” Dr. Smith added. “And after the delivery the neonatologist was on the line, saying how’s the baby breathing, what’s the pulse rate and we were able to provide that information. They were able to make suggestions about what we might need to watch out for. Dr. Spencer and the nursing staff and the support staff were exceptional in my opinion.”
The afternoon of March 29, 2017 is one the providers and staff at the UNHS Monument Valley Community Health Center will not soon forget. The outcome was a tribute to the professionalism of each provider, nurse and support staff member, and their devotion to the medical field. It was not only the first baby born at the clinic, but a 31-week old infant whose life they helped save that day. It was also a tribute to a devoted mother whose courage and strength helped save the life of her child. Revina Talker said every emergency is a learning experience, and this, she noted, is no exception.
“What we learned is how to organize people and use their skills and what they have. Just learning to make sure we’re prepared for next time this happens. And for any other emergency codes,” she said. “This was a blessing and an answer to prayers. ‘Please let this be an okay situation.’”