By Shelly Lopez Gray, RN

On my first day of orientation in OB, I watched a delivery for the first time and was in awe. That day, I watched everything unfold as it should. The mother delivered a pink and screaming baby, which was placed immediately skin-to-skin. The patient and her family surrounded me with a surge of emotions. They laughed and took pictures, talked about the baby's hair and whose lips the baby had, and they were so overwhelmed by the beauty of it all, they cried. That day, I watched three other mothers deliver, and witnessed the same process unfold at each delivery. And it was that day, my first day of orientation, that I became hooked on the beauty of OB. But that isn't this story. It wouldn't take me long to find out that OB is not always about birth and babies. Sometimes no one is smiling, cameras are left untouched and tears fall freely from faces.

The next day I eagerly went to work, ready to take part in the magical moment of each patient's delivery. Our patient and her family were excited about the birth of their first boy. Her daughters were fascinated with the fetal monitor and the baby's heartbeat, which they said sounded like galloping horses. The mother allowed me to place her IV, even though she knew I was a brand new nurse, and I was so grateful I went to the gift shop and bought a little plastic horse for all three of her daughters.

I still remember this family and their delivery as if it happened yesterday. When her water broke, blood spread quickly, saturating her blanket. From the fetal monitor, we heard the sudden drop of the baby's heartbeat. It was slow and sluggish, as if the baby was trying as hard as he could to keep going. My preceptor pulled the emergency cord and told whoever was on the other end to call any doctor, to open up the OR and to get four units of blood. At the same time, she threw an oxygen mask on the patient and started bolusing her with fluid. Other nurses inundated the room, repositioning the patient and pulling anything out of the wall that was holding the patient hostage. Underneath the non-rebreather, the patient looked frozen and frightened. Tears escaped from her eyelids, squeezed so tightly shut.. Her husband stood dazed in a corner, not fully understanding what was happening, but recognizing the urgency of our actions. I didn't know what to do, so I touched his arm and whispered that we were going to the OR. But before I could even finish the sentence, the nurses and the patient and the bed were all gone... it all happened that fast. And as that patient's mother ushered her granddaughters out of the room, the littlest one looked at the fetal monitor and asked what happened to the horses.

From the time the silent abruption declared itself to the time the doctor pulled that limp and lifeless baby out of that woman's abdomen had to be less than four minutes. But it was four minutes that he just couldn't keep going. When the baby was brought to the warmer he didn't make a sound, he didn't make a move and it hit me... this family would not take him home in four days. I watched as the nurses began to compress his chest, never taking their eyes off of him. I remember looking down at that mother, her eyes closed under general anesthesia, so afraid she would wake up and have to be told that her baby was dead. In the background, I could hear the nurse's calm and steady voices -- One and two and three and breathe. And after a minute or two, when I thought for sure that there was no hope, I watched the work of nurses compel a cry from that baby.

That day, in that delivery, I was engulfed by different emotions. Witnessing everyone's efforts to save that baby, witnessing the urgency in everyone's actions, I felt overwhelmed with gratitude and a sense of responsibility. Being a new nurse, I didn't know what to do with it all, so I stayed in the corner and choked on the fear of what had almost just happened.

Nurses are in a secret kind of club. No one knows the work we really do, and the struggles we face every day we come to work. I couldn't tell that patient that if we had taken a few more minutes to get to the OR, her baby would not have survived. I couldn't tell her that if all the nurses had not worked together, she wouldn't have taken her baby home. Sometimes our days are so bad and our patients are so sick. Sometimes our outcomes aren't good, regardless of the hard work we do. As nurses, we can't even talk to our own families about our bad days. We aren't allowed, and it wouldn't matter, because they wouldn't understand anyway. Instead, we keep it all inside. It bottles up inside of us, exhausting any energy we have left. But we keep coming back to work for the love our patients and for the love of our profession.

Different events throughout my career as a nurse project in my mind like a reel from a movie. But my eyes only focus on one constant: the patient. Our goals have to be driven by improving outcomes for the people we take care of. As we enter into the new year, I hope every single nurse knows that they are the only ones that can limit their potential. Do not let bad experiences or poor outcomes or busy days weight you down and tire you out. Use that to fuel the fire inside of you to enact change for our patients, for ourselves and our profession. Imagine everything you could do that could affect your patient, or your hospital, or your community, or an entire population. Do not limit yourself, because I have seen what nurses can do when there is a sense of urgency, and I know that we are capable of anything. If you are a patient, know that you can also fight for better care and for better outcomes. We impact each other. We can change things together. And we have to work together to create a sense of urgency, because if I know anything from labor and delivery, it's that minutes matter and everyone deserves a chance to witness the beauty of OB.