(Not) Just Another Shift in a Community Hospital

As the only pediatrician in house at a community hospital, I never know what challenges I will encounter during my hospitalist shift. Recently, I was awakened in my call room at 4:00 am for the imminent delivery of a fetus of 19 weeks’ gestation with strong heart tones.

A mother with a history of a previous fetal demise was again in preterm labor. Previous attempts to delay delivery failed, and she arrived 4 cm dilated. Delivery was imminent and the thriving fetus continued to have strong heart tones. Because of the emotional trauma from her previous experience, the mother did not want to see or hold her infant. There were no other family members in attendance. The mother wanted the infant immediately removed from her room. I was alerted about this impending newborn admission by the labor nurse.

As a mother of 4 healthy children, my eyes welled up receiving this call. I was heartbroken for this mother and child. As this infant’s physician, I was not sure how I would handle this. Because the gestational age was certain, this would not be a viable infant. A discussion of resuscitation versus comfort care was not warranted. However, I was unsure what to expect. How long would this infant live? Would it be born alive? Is there a protocol for this? We …