When I was pregnant with my first child, I worked full time as a physician in the emergency department. I worked mostly 9-hour shifts, but some 12-hour shifts as well. Days, evenings, nights, holidays and weekends were divided up amongst the entire group of physicians. I worked my share of those shifts as well.
I have worked in the ER while pregnant twice now, and while I am proud to be an emergency physician and love my job, I didn’t love it when I was pregnant. I found the ER a challenging work environment for a pregnant woman.
Unfortunately, I had a lot of nausea and morning sickness for the first trimester of both of my pregnancies. Working in the ER, there are strong smells: vomit, diarrhea, pus, stinky feet and unbathed homeless people, to name a few. There were many a time when I would run to the bathroom to vomit and have to come right back out and see the next patient as if nothing had happened.
Even just working night shifts would confuse my circadian rhythm enough to the point of making me more nauseated. I was lucky, however, that one of my colleagues would offer to work some of my night shifts. You are also on your feet a lot. I would walk into a patient’s room, and there were only a few considerate family members who would give up their seat for me even when I was obviously pregnant in my third trimester. I was always grateful for the ones who would let me sit down.
Then there are all the procedures I still had to do while pregnant and working. I remember being hunched over, my growing belly in the way, while doing lumbar punctures, intubations, laceration repairs and chest tubes.
My colleagues were good about taking dislocated shoulder and hip patients as I got further along, but there were times when I was the only one there to do them. Reducing shoulder and hip dislocations was always interesting while pregnant. I would be sure to give a good amount of sedation and pain medications so I wouldn’t hurt myself straining to get the shoulder or hip joint relocated.
I recall during my first pregnancy doing a chest tube on a patient with a spontaneous pneumothorax and having my sterile glove break while my hand was inside the patient’s chest cavity. I took my finger out to find his blood on my skin.
It was a fluke and to this day I’m not sure why it happened. I was upset and worried. What if I contracted HIV or Hepatitis while pregnant? How would that affect my unborn baby? Thankfully, the patient tested negative for HIV and Hepatitis, and when I followed up with my occupational health department afterwards for exposure testing, everything turned out fine.
A lot of things made me nervous, especially that first pregnancy. I worried about the infectious diseases I could potentially be exposed to. Patients with TORCH infections (a set of infections known to harm unborn fetuses), like CMV, could walk through the door at any moment. If I caught it, I didn’t want my baby to be affected.
I was also pregnant during the peak of the H1N1 influenza epidemic in 2009-2010. It was a particularly bad flu for pregnant women. Those who caught it were more likely to end up critically ill in the intensive care unit or even dead than non-pregnant adults. Patients were coming in droves concerned they had H1N1 and sometimes would cough on us while examining them.
There were portable x-rays being taken around the department as well. I always made sure that I was far away when the x-rays were being shot, but worried that I was still being exposed to some amount of radiation.
Of course, every ER has intoxicated or violent patients. I remember seeing quite a few of those, always keeping my distance and having security officers nearby as I would examine them. But even small children posed a risk. I made sure to have a nurse hold uncooperative toddlers so that I would not accidentally get kicked in the belly as I looked at their ears for an ear infection.
The day before my second child was born, I was 39 weeks pregnant and working my last scheduled shift. After an early nine-hour day shift, I didn’t feel the baby moving very much. When I got home exhausted from a stressful day on my feet, I called my obstetrician, and she told me to go to the hospital. She ran tests and everything was reassuring with the baby. The labor and delivery nurse told me the doctor would probably send me home as I was most likely dehydrated, and that was why the baby wasn’t moving as much. Also, she had grown, and there wasn’t a lot of space left for her to move, they said.
But for some reason, my doctor decided to keep me in the hospital and wanted to induce me. I listened to her advice and at midnight the Pitocin began to run into my veins. I was so excited to be giving birth soon, but I also felt I wasn’t ready to have a newborn right at that exact moment. I had been up since 4 a.m. that morning, and all I wanted was one last night of decent sleep before the baby came.
So I asked for an epidural and slept as my cervix dilated. I slept for 6 hours and then it was time to push, and my nurse wanted me to push the baby out before her shift ended at 7 a.m. Our healthy baby girl was born at 6:52 a.m., and I was so thankful that my doctor had decided to induce me. The umbilical cord was wrapped around my baby’s neck twice, and perhaps that was why I wasn’t feeling her move as much, she told me. Had she waited to induce me, something tragic could have occurred.
As crazy as it was being pregnant working in the ER, there were plenty of pregnant nurses working alongside me who understood what I was going through. We would commiserate and celebrate and countdown to our due dates together.
My colleagues, ER nurses and staff would also watch out for me and would not let me see certain patients, like aggressive ones or patients who might have shingles (even though I was immune to varicella and had chicken pox as a kid). And at home my husband was amazing and would let me rest and would give me ginger ale and crackers when I was nauseated.
I really appreciated all the people who were looking out for me and my baby. And despite everything I experienced and was exposed to during those months being pregnant, I had normal pregnancies and my children turned out healthy and are now 3 and 5 years old.
Every time I was at work, my unborn children would get really active, and I would feel them kicking and punching inside of me. It was a reminder that even with my unpredictable schedule and challenging work environment, I wasn’t alone. I knew that they were there with me experiencing the ER from inside my womb. “It’s me and you, kid,” I used to say to them as I would drive into my hospital. “We are going to work and going to save lives.”
Archana Reddy is an emergency physician who blogs at Emergency Care for You. She can be reached on Twitter @AReddyMD.
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