Mom praises Lillooet team supported by RTVS after successful breech delivery
A mother from Lytton is praising the care she had during her emergency breech delivery in Lillooet.
Chantelle Nelson said she believes her family’s story could have been tragic if she didn’t get the support that she did. “If we didn’t make it to a hospital, or if Lillooet didn’t do as amazing as they did, my story could have been completely different,” she said.
The stay-at-home mom was 34-weeks pregnant when her water suddenly broke at home in Lytton, where there is no Emergency Department (ED).
Because she wasn’t in any pain and wasn’t having contractions, Chantelle wanted to see a doctor to find out whether it was a false alarm. Her doctor was not in community, so she called the local health clinic and they advised her to try to see a doctor at the Lillooet Hospital and Health Centre.
Rollercoaster series of days
Her boyfriend Doug Rough drove her to Lillooet—63 km away—and she was seen by the nurses there and the on-call locum, Dr. Suhana Kamakari.
Her baby girl, Brooklyn, was delivered a few hours after they arrived in Lillooet.
Chantelle said: “The people in Lillooet were absolutely amazing. They told me what was happening, what was going on with me, what was going on with Brooklyn, they were very helpful and informative.”
It was a rollercoaster series of days, with the team in Lillooet, a virtual team from the Rural Coordination of BC’s Real-Time Virtual Support (RTVS) program and a team in Kamloops all involved in the care.
Breech position
The story unfolded on July 31 when Chantelle and Doug arrived in Lillooet at about 10:30 a.m.
Suhana said: “We quickly confirmed that, yes, it was a rupture of membranes. Then tried to start working on organizing for her to get transferred to a centre with obstetrical services.”
The medical team in Lillooet made it clear to Chantelle and Doug that they were not set up to do deliveries and informed Chantelle they would be trying to transfer her. While the team liaised with the Patient Transport Network (PTN) to find a larger hospital that could deliver the baby, they ran some additional checks and discovered the infant was in breech position.
A breech delivery – in this case a footling breech – comes with higher risk of complications, particularly if the baby is premature.
They also discovered that Chantelle had started to go into labour.
The team in Lillooet quickly realized they had to pivot from arranging transport to getting ready for a really challenging delivery.
Instant Support
Luckily, they were able to get instant support from the RTVS Maternity and Babies Advice Line (MaBAL) pathway. MaBAL physicians can be accessed via iPads in rural EDs and can support a range of inquiries, including prenatal tests all the way up to deliveries.
Suhana, a new doctor only one year out of residency, was able to make the call to RTVS. Although she had plenty of rural ED experience, she had never assisted with a delivery on her own, let alone a breech delivery.
She said: “I had spent time on the labour and delivery ward during training but my experience was still limited. It was obvious however that her labour was progressing quite quickly. At that point we made the decision that we have to keep her in Lillooet, and there was not a way to safely transport this patient. That’s when I called for MaBAL, through RTVS, for support. Up until then, I was really hoping that she would be able to be transferred, especially being premature and breech.”
Among the nursing team in Lillooet were a couple of nurses who had delivery experience, and Suhana said they were a huge help.
Dr. Chris Naylor from the MaBAL team was also able to support with all the required steps.
Suhana explained that at one point they couldn’t get a fetal heart rate.
She said: “We set up the iPad so it was facing the patient, somewhat at the foot of the bed. I was at the side of the bed assessing the patient, and two feet had already presented, and then Dr. Naylor, through RTVS, helped walk me through what to feel for, what to expect as far as trying to position baby, and talked me through the slight downwards positioning required. I was able to feel for the umbilical cord as well, then we were able to palpate a reasonable heart rate through there, and the heart rate was present.”
“The people in Lillooet were absolutely amazing. They told me what was happening, what was going on with me, what was going on with Brooklyn, they were very helpful and informative”
Resuscitation
There was nothing standard about the delivery that followed.
Suhana continued: “With breech, as I’ve been learning, there’s not a ton that you can do. You’re just sort of waiting for baby to come out, and helping to adjust positioning.”
Suhana was able to adjust the baby’s position some more, including helping to guide the baby’s arms downward, and Chantelle was able to do the work of pushing her out. It was a stressful time for everyone, but the baby was born within an hour.
Chantelle said the hardest part was when she saw her boyfriend crying. “He’s a big, tough construction worker, he doesn’t show his feelings much, typical guy, and to see him cry, that was the most devastating part.”
By this time, Lillooet-based Dr. Memoona Akram had arrived at the hospital to support the delivery and newborn.
Memoona and the rest of the Lillooet team used the iPad to call the RTVS Child Health Advice in ReaL-time Electronically (CHARLiE) pathway to support baby Brooklyn. CHARLiE is a pediatrics pathway available to all rural providers.
CHARLiE pediatrician Dr. Pavan Judge worked with Memoona and the ED team to resuscitate and stabilize the 34-weeks baby. He was also able to talk Suhana through insertion of an umbilical venous catheter (UVC) line to provide IV fluids to the infant. Suhana had never performed the procedure before, but remembered practicing it on a dummy during residency, when she took part in another RCCbc program, the CARE Course.
Chantelle said: “Hearing them on the computer screen, I’m like, okay, they’re figuring out what they have to do to make sure Brooklyn’s okay, and I’m okay, which was amazing. It seemed like that really helped them, just because it’s been so long since they had done a delivery there. Everybody was a little nervous and probably a little on edge about it.”
Pavan said: “This case was a great example of teamwork across the RTVS lines and the team at bedside did a great job in delivering timely care to both the mom and neonate.”
While Memoona and the nurses continued to care for baby Brooklyn, Suhana was still liaising about Chantelle with Chris from MaBAL on her smartphone.
It was discovered that mom Chantelle needed a higher level of care for postpartum complications, and the team was quickly back on the phone with PTN, this time getting the RTVS physicians to assist.
““Being separated from everybody was the hardest part of it all. And just not knowing what was going to happen, like, are we going to be okay, or, like is Doug just… now a single dad, like, how is that surgery going to go?” ”
Transport
A transport plane was dispatched to bring Chantelle to Kamloops where she underwent surgery.
Chris from the MaBAL team reported that the Lillooet team did an amazing job caring for Chantelle and making sure she got the surgery she needed. He said: “It was a pleasure to support such an amazing team on the ground through what would be a challenging delivery and postpartum course at any site.”
The Infant Transport Team could not arrive at the same time so it wasn’t until the following day, August 1, that Doug and baby Brooklyn were able to join mom Chantelle in Kamloops.
“Being separated from everybody was the hardest part of it all,” Chantelle said. “And just not knowing what was going to happen, like, are we going to be okay, or, like is Doug just… now a single dad, like, how is that surgery going to go?”
So it was a huge relief when the surgery was successful and she was reunited with Doug, Brooklyn and her nine-year-old son, Abel.
Chantelle said she believes she got a really high standard of care in Lillooet, despite the fact that the team did not have the resources for a delivery.
She said: “I believe they did such an amazing job, even though they weren’t set up for it. They didn’t have the high-end equipment that, like, Kamloops would have. But they tried so hard, they were so compassionate, they were so concerned, and just making sure I knew every single thing that was going on.”
Suhana said she was grateful that RTVS was there for her. “I’m super grateful for having had access to RTVS for it,” she said. “I have no idea how I would have been able to manage otherwise. Certainly I would have called whoever was on call [in Kamloops], but to be able to get that degree of support for managing the delivery, in real-time, and to have them help organize transport while all of this was going on as well, for that to be offloaded off of me was so helpful. And for the pediatric resuscitation aspect, that would have been much more challenging without having someone more actively present, so I can’t even imagine.”
For more information about RCCbc’s RTVS program visit Real-Time Virtual Support (RTVS) – RCCbc.
“I'm super grateful for having had access to RTVS for it,” she said. “I have no idea how I would have been able to manage otherwise. Certainly I would have called whoever was on call [in Kamloops], but to be able to get that degree of support for managing the delivery, in real-time, and to have them help organize transport while all of this was going on as well, for that to be offloaded off of me was so helpful. And for the pediatric resuscitation aspect, that would have been much more challenging without having someone more actively present, so I can't even imagine.”
