[lapink55]

I have a question and am just wondering tips on what to do in this situation. My last c/s I circulated was on a woman who made it to fully dilated, pushed for a half hour and I called the physician because there was so much caput and the baby was not moving anywhere. The baby was wedged inthe pelvis he aked me to "go down below" and push the baby up....any tips on how to successfully and safely help with this? It worked but was a little scary.

[feebebe23]

I have always heard it called a "vag-hand." It's very rare, but I fond it a little unusual that this possible situation was not ever explained during your L&D training. Any time I know I have a low baby I always have a steril glove ready.

As for tips....don't use your fingers like an exam....that hurts your fingers. Make a fist and PUSH!!!

It's very wierd when your hand touches the surgeon's hand!!! WIERD!!!

[RNLaborNurse4U]

I've had to "lend a hand" from below a few times....I use a sterile glove, and my whole hand goes up the vagina. I then spread my fingers out to sort of cup the fetal head with my fingertips, and push gently upward toward the surgeon. And it's VERY freaky to feel the surgeons gloved hand when you do this!

[SheaOBRN]

I agree-VERY weird to feel the doctor's hand move past yours!

[nurse79]

yea this is something they never tell you during training, i guess because it is not that common. but I had a delivery like this and it was so scary!! The patient went under general anestesia bc spinal was note effective..so usually u want the baby out within a timely manner. well unfortanely, baby got totally wedged in the pelvis (she too was complete and pushing for 3 hours i believe)...but baby came out after i pushed on the head to assist the surgeon. It took a good 20 seconds or so..but felt like an HOUR!! baby coded (i think got some anesthesia meds) but finally was revived. it was the scarriest delivery I have ever had.

[OzMW]

You see it needed sometimes with second stage sections if the PP is low in the pelvis. These sections are bad news as dragging that baby through the pelvis can extend the angles of the uterine incision and cause nasty nasty bleeding! I saw this happen with a woman once who had caput on view but the Dr couldn't budge the kid vaginally with intruments. She tore into the angles and further into other vessels, she bled and it took em a couple of hours to stop it! They tied off her internal iliacs and found the source. She kept her uterus but had massive transfusions and spent some time in ICU.

[crysobrn]

Just a warning we had a patient a couple of years ago that had a similar situation, pushed for a long time, went down to c/s. The one OB broke scrub to push the baby back up and the baby ended up in our intermediate care nursery, was later shipped and it was found that the kid had a fractured skull. Personally I'd rather have the OB doing anything that could cause trauma like that.