Without Rosie, the outcome for this patient and her family would have likely been tragically different. This patient, at 38 weeks, had called our counterpart L&D in Walnut Creek stating that her water had broken and that she also felt what she thought was the umbilical cord protruding out of her body with a likely cord prolapse, which is an obstetric emergency that can result in the death of the baby. The patient was instructed by the nurse with whom she was speaking to call 911 and come to the nearest L&D. The patient misunderstood the instructions, and instead, chose to drive herself by car to the Walnut Creek hospital (unbeknownst to the RN), which was not the nearest facility and was approximately 30-45 minutes away. The Walnut Creek RN then called our Antioch L&D to inform us that the patient was on her way to us by ambulance. Rosie was the nurse in Antioch who fielded this call from the Walnut Creek RN.

With this information from the Walnut Creek RN, Rosie called downstairs to our ED to ask for the ETA of the ambulance. The ED replied that they had no 911 calls incoming. From there, Rosie deduced that the patient was driving herself. Rosie then called the patient confirming this was the case. She then instructed the patient to redirect her car to Antioch and to get on her hands/knees to alleviate any compression on the umbilical cord. She told the patient we would meet her in the ambulance bay. This call was at 0027. From there, Rosie mobilized the OB MD, pediatric MD, surgical tech, pediatric RNs and anesthesia to be prepared for arrival of this patient.

We met the patient in the ambulance bay. We placed her on a gurney, and after properly covering her, Rosie performed an exam confirming that the baby was a footling breech presentation with a foot coming into the vagina and approximately 2 feet of umbilical cord prolapsing outside of the vagina. Rosie elevated the presenting fetal parts to alleviate compression off of the cord. At which time, Rosie announced that she was not certain if umbilical cord pulsation was present, indicating that the baby may not have a heartbeat. However, we proceeded to move the patient emergently to L&D. During transport, Rosie reported out that she could feel faint pulsations in the cord.

On arrival to the L&D OR at 0038, I performed an ultrasound showing a fetal bradycardia. Our team quickly prepped the patient for an emergent cesarean. Rosie continued to elevate the presenting parts off of the cord during this time. Incision time was 0045 and delivery time was 0046. APGARs were 2 and 9. The infant and mother were discharged home on day of life 2, and at his most recent well baby check is doing well and meeting all milestones.

If it were not for Rosie's incredible foresight, intuition, speed, and initiative, this baby would have likely died in utero. She exemplifies a true leader and role model, but most of all, she is one of the strongest patient advocates I know. She is truly irreplaceable.