Earlier this year, three COVID-weary NICU nurses were relaxing on a flight over the Pacific Ocean, just a few hours away from a much-needed vacation in Hawaii, when they heard a panicked voice asking for a doctor.
Soon enough, the three friends were facing a multilayered emergency: A woman, previously unaware she was pregnant, was giving birth to a premature baby in the bathroom. The plane had limited medical supplies.
Mimi Ho, Amanda Beeding and Lani Bamfield relied on their NICU expertise and ingenuity to care for the tiny baby boy and his mother. They were aided by two other passengers they met on the flight: a family doctor and a physician assistant. They became the major players in a story of unconventional solutions -- including shoelaces, trash bags and an Apple Watch -- and an epic test of teamwork.
Spoiler alert: They passed with flying colors. Continue reading to learn how they managed this unusual emergency, thanks in part to the special bond these incredible nurses share.
How long have you been working together at North Kansas City Hospital (NKCH)? How did you become friends?
Mimi Ho: I have been friends with Lani since college when we were in the same sorority together. We both met Amanda when we started at NKCH almost two years ago in the NICU.
How do you complement each other's strengths? How do you look out for each other?
Lani Bamfield: We all work very well together. We work the night shift and always pride ourselves on teamwork. You get to the point where you can read each other’s minds and anticipate needs before they’re even asked. We always bounce ideas off each other and look to each other in times of need. Working in critical situations definitely creates a different kind of bond.
Mimi: The good thing about being on the flight with these two is that our brains are wired to work with each other. We work many shifts together in critical situations, so the flow of our work complements our strengths. We are always one step ahead, because someone is always thinking about the next step to care for the infant.
You were on a flight to Hawaii when the emergency arose. How did you learn about the situation with the mom, Lavi Mounga, in the bathroom?
Lani: The flight was around seven to eight hours from Salt Lake City to Honolulu. We were almost exactly halfway through the flight when Lavi's sister-in-law started screaming for help.
When you realized what was happening, what were you most worried about? This wasn’t a normal NICU situation.
Mimi: Our biggest concern was keeping the baby alive. We didn't have any of our usual equipment to work with, so lack of supplies was definitely a concern.
Lani: The two most important things that we didn't have were oxygen and a heat source. Although there were oxygen tanks on board the plane, we needed a smaller mask, as well as blended oxygen. Infants this premature often require CPAP or intubation. We usually also have radiant warmers and isolettes that help regulate body temperature at delivery. On the plane we only had plastic trash bags, several blankets, and we were able to do skin-to-skin. We use something similar to trash bags for premature infants at deliveries called neo wraps as well as heated mattresses.
The three of you, together with a family doctor and physician assistant on the plane, came up with some unusual ways to provide care. Did they work?
Mimi: We were coming up with solutions as we went, since we had very little to work with. One of us would state something like, "OK, we need to keep this baby warm. What can we do?" Then, we would start brainstorming ideas quickly.
Lani: Lavi's family, the flight crew and other passengers on board were all an amazing help with gathering and offering supplies as we asked for them. We wouldn't have been able to do it without their help.
Amanda Beeding: We knew we needed to quickly cut his umbilical cord and get oxygen to him as soon as possible, so asking for shoestrings to tie off the cord was fast and easy. The flight attendant gave us a small pair of scissors to cut the umbilical cord.
When we knew we had three hours left on the flight, we anticipated temperature stability would be an issue, so we thought to use heated water bottles to give him active warmth and not just passive warmth with blankets. Infants lose a lot of heat from their head, so we asked for an infant hat and a passenger offered a clean pair of socks that we cut to shape his head. Then we insulated the hat with plastic wrap for added protection. We had a stethoscope, but with the engine noise we wanted to confirm his heart rate, so Dr. Dale Glen thought of using his Apple Watch to confirm heart rate.
After respiratory and temp control was established, we started thinking about glucose control. Since we had no supplies to start an IV and he was unable to feed due to his prematurity and respiratory distress, we placed him skin-to-skin with Mom, which provides needed warmth and is also proven to help infants with glucose utilization. Later, when Mom and baby arrived at the hospital, we were told his temperature was good and his glucose was normal, so we were happy to hear our unconventional efforts were effective.
How did the mom, Lavi, handle all of this?
Amanda: She was handling the situation very calmly and very well. Her placenta delivered easily, and she wasn't bleeding an excessive amount, which was especially important since she remained on the toilet in the tiny restroom, so there wasn't much room.
What did you learn from being a part of this emergency situation? What will you always remember about it?
Mimi: I learned that we are able to help during a delivery anywhere in the world. If we can do it on an airplane for that long with little to no resources, then we can do it anywhere. It is nice to know that our skills and knowledge really helped during the emergency. You always wonder what you would do if something like this were to happen, and we got to experience it firsthand. I will always remember how grateful Mom was after we were able to put the baby skin-to-skin. He looked great, and she was so thankful for our help. There is not a better feeling in the NICU world.
Lani: I will never forget responding to Lavi's sister-in-law's cry for help and seeing Lavi holding a tiny baby in the bathroom of an airplane. The adrenaline rush I had in that moment was something I had never experienced before. I will also never forget the emotions that were all tied to this. When the plane landed, everyone applauded and the team high-fived. We were all just so relieved to be on the ground and know that help was waiting for us. And when we were able to go see Lavi and Raymond in the hospital, we were all so overwhelmingly happy and relieved to see them both doing so well.
Amanda: I learned that critical care nursing is so important and that I was extremely thankful we had that knowledge and confidence we needed to have a healthy outcome for Mom and baby. I will always remember the stress level in those three hours and what joy and pride it brought to be able to help them in that scary situation.
When did you see Mom and baby at the hospital? What was that like?
Lani:We got to go visit them two days later in the NICU at Kapiolani Medical Center for Women and Children. I think we were all overwhelmed with happy emotions and relief. It was so good to see both of them doing so well. They were in the recliner doing skin-to-skin. Lavi was smiling ear-to-ear and baby Raymond was snuggling with his momma. They both looked so comfortable. There were a lot of happy tears and smiles.
OK, last question, and it’s important: After all of this, how was your vacation in Hawaii?
Mimi: We had a great time! We spent a little time doing interviews and such but spent a lot of time on the beach and relaxing. We went on hikes and went boating. This is definitely a trip we will never forget!
Amanda: We had a great trip! Oahu is, of course, beautiful and full of adventure and relaxation. I think after the stressful start to the trip, we definitely ended up doing more relaxing and less adventuring than we had originally thought we would, but we loved our time there.
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