By Ms. Brandy C Ostanik (Army Medicine)March 22, 2018
FORT WAINWRIGHT, Alaska - Nikkie Carson-Gilmore, 38 weeks pregnant, was admitted to Bassett Army Community Hospital November 14, 2017 for the birth of her second son. Diagnosed the day before with preeclampsia, a potentially dangerous health condition during pregnancy, her doctor recommended induction.
With assistance and guidance from her obstetrics team, she was prepared to be induced for the health of both herself and her unborn son, but she was not prepared for what followed.
Thankfully, the staff at Bassett ACH was.
The morning after she was induced, Carson-Gilmore says she was doing fine as labor progressed with both her husband who had just returned a week earlier from deployment, Staff Sgt. Zachary Carson-Gilmore, 1-52 General Support Aviation Battalion, and her mother-in-law in the room when she suddenly didn't feel well.
"I started shaking and kind of feeling nauseous," said Carson-Gilmore. "When I got really shaky my husband called my nurse and she came right away."
Her nurse, Capt. Marie Bautista, thought Carson-Gilmore might be transitioning to active labor and wanted to check her dilation. According to Carson-Gilmore it was at this point that Bautista pulled up the sheet covering her legs and saw the umbilical cord protruding onto the bed. Bautista, realizing the gravity of the situation, quickly called for assistance from Ms. Dawn Chavez, the charge nurse for the maternal newborn unit at the time.
Chavez came into the room, putting on a pair of gloves.
"The next thing I knew, Dawn [Chavez] was on the table with me," said Carson-Gilmore. "Her hand is in me holding up the baby's head and she tells me, 'it's okay, plan B, we are going for a C-section,' and she was calling for a Code Violet [obstetric emergency].
Bautista and Chavez both recognized the need for a rapid response. Carson-Gilmore was experiencing an umbilical cord prolapse, an obstetric emergency where the umbilical cord comes through the cervix at the same time or before the baby is delivered.
According to the American Journal of Obstetrics and Gynecology, umbilical cord prolapse occurs in less than 1% of all births.
With a prolapsed cord, pressure needs to be relieved from the cord until the baby is delivered in order to prevent depriving the baby of oxygen, said Chavez.
"Immediately my instincts took over and I put my hand in to get baby up off the cord because his heartrate was going down," said Chavez.
As Chavez held the baby off the cord, she reassured Carson-Gilmore with the simplest of acts; tapping.
"She began tapping my son's heart beat onto my leg," said Carson-Gilmore. "Her tapping let me know he was okay. She kept telling me it was going to be okay, but letting me feel his heart beat reassured me. She was my calming force."
Chavez says this was the first time she had ever encountered a cord prolapse, and while she may not have been feeling calm, it was necessary to remain calm for the patient.
"In the face of chaos you have to maintain your calm," said Chavez. "Inside I was a wreck, but training takes over."
Thanks to having emergency procedures in place, neither Carson-Gilmore nor Chavez had to remain calm for too long. With the call of the code violet, a team of doctors and nurses assembled to prepare for an emergency C-section.
Carson-Gilmore was wheeled into the operating room, with Chavez still on the bed holding up her baby's head, where he was delivered 18 minutes after the prolapsed cord was first discovered.
"It was like they were waiting on me," said Carson-Gilmore. "I know it was an emergency and it happened so fast, but they did not make it feel like they were scrambling. Everyone was so calm. Dawn continued to talk to me during the C-section. She held him off the cord right up until they pulled him out," said Carson-Gilmore.
Chavez agreed with Carson-Gilson's assessment of the code violet response.
"We all did what we are supposed to do, what we are trained to do," said Chavez. "The whole team did that. Even the command team and the chaplain were there before we went into the OR to see if there was anything they could do."
While Chavez says the team was just doing what they are trained to do, Carson-Gilmore sees it as so much more.
"She saved my son. The whole team was great, but her quick actions, she just saved my son."