Help with Presentation on PRECIPITOUS DELIVERY

Specialties Ob/Gyn

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Hi all,

I will be giving a 1 hour presentation at work ( I am an ER RN) on Precipitous delivery since we sometimes get one or two a month. I am very comfortable delivering myself; however a lot of my co-workers are not and have a lot of questions.

I am wondering if anyone knows any web sites that have downloadable videos that I could put into the presentation without requiring a web connection, and preferably free.

Also any tips on what to add...

THanks for any help,

Sweetooth

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i dont know about where you can find a video, but main things to remember are to support the perineum (if you have time... lol) as the head is coming out, then always check for a cord around the neck before delivering the body, then remind them to pull straight down to deliver the anterior shoulder. and after baby is born, dry and stimulate!! and suction if that's available. kudos to you! every hospital i've ever worked in has been terrified of pregnant pts and would rather wheel the lady from one end of the hospital to ours with the head hanging out than deliver the baby themselves.

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Specializes in LDRP.

some small points to keep in mind

-dont separate the mother and the baby. seen this on those trauma:life in the ER shows on DHC. mom delivers baby in hallway, baby whisked away to another room. give the baby to mom and take them to the same room!

-privacy and modesty! when someone delivers in an unusual place, people often come running to see whats going on (esp when she's making a lot of noise). she didnt intend her delivery to be a spectator sport, so please kick out any people who have no essential function. if she delivers ina public place, such as the hallway, cover her up quickly.

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Specializes in L&D; GI; Fam Med; Home H; Case mgmt.

I delivered my 2nd son precipitously - all 10.4 lbs of him in the hospital hallway - and they had to separate us. He had apgars of 1 and 2 and had to be bagged. It was not good. Blew out my bottom.

I am incredibly grateful to report that he is now a very healthy, goofy 19 year old. :)

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Specializes in CT stepdown, hospice, psych, ortho.
I delivered my 2nd son precipitously - all 10.4 lbs of him in the hospital hallway - and they had to separate us. He had apgars of 1 and 2 and had to be bagged. It was not good. Blew out my bottom.

I am incredibly grateful to report that he is now a very healthy, goofy 19 year old. :)

Blew out my bottom.

Boy can I relate!

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Specializes in L&D.

I don't know of any free web sites for videos. I have used myself to demonstrate the cardinal movements of flexion, internal rotation, extension, & external rotation by flexing my chin onto my chest, turning to face one shoulder, then gradually raising my chin (while explaining the head is pivoting under the pubic bone and that when you see this starting to happen, it's almost over), then turning my head to face front. You can even go on from there to collapse one shoulder to demonstrate delivery of the anterior shoulder. You can find some pictures in textbooks to copy and pass out (again, assuming you haven't found a video--perhaps the local nursing school has one you could borrow). You can even have them do some hands on practice with each other, remembering to support the perineum while flexion is happening and to check the neck for a cord before delivering the anterior shoulder.

Almost all of the out born babies I've received in L&D have been cold. Dry the baby the very first thing. This accomplishes two things, it stimulates the baby and it dries it off to prevent heat loss by evaporation. Then get rid of the wet towels and put something dry over the baby as you put the baby next to mother's warm skin.

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Specializes in Labor & Delivery.

For the most part when a baby is a precip delivery, the actual delivery is fairly straight forward. Like an above poster stated support the perineum. The two real issues i've seen when EMS brings in mom and baby is that baby is usually hypothermic. Keep baby warm. Dry well and place skin to skin, if possible, with mom. The second thing is most of the time they don't do adequate fundal massage and mom is either boggy and bleeding, or if not bleeding has clots sitting in her uterus that are expressed when we do aggressive(I mean correctly done, no uterine prolapse) fundal massage. EMS brough in a pt and the Paramedic stated proudly, "she's hardly even bleeding!" I grabbed pit on the way to the room and started fundal massage when we got mom in bed. We expressed a large number of clots then mom started really bleeding! I think the paramedics did a great job, just were'nt aware of what or how fundal massage works.

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Specializes in NICU,MB,Lact.Consultant, L/D.

not sure if this is exactly what you are looking for..

Precipitating Labor Ppt Presentation

http://healthtraining.inhs.org/uploadedFiles/EMS_Live_at_Nite/2009/September_8_2009/Sept%2009%20Handout.pdf

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When I have taught this class I stress mostly that you typically don't need ot do anything, baby is coming either way. No reason for an ER nurse to stress about the proper way to deliver an the posterior shoulder when baby is coming out either. Teach them to assess for nuchal cord and what to do in emergencies such as shoulder dystocia or PP hemorrhage.

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.
For the most part when a baby is a precip delivery, the actual delivery is fairly straight forward. Like an above poster stated support the perineum. The two real issues i've seen when EMS brings in mom and baby is that baby is usually hypothermic. Keep baby warm. Dry well and place skin to skin, if possible, with mom. The second thing is most of the time they don't do adequate fundal massage and mom is either boggy and bleeding, or if not bleeding has clots sitting in her uterus that are expressed when we do aggressive(I mean correctly done, no uterine prolapse) fundal massage. EMS brough in a pt and the Paramedic stated proudly, "she's hardly even bleeding!" I grabbed pit on the way to the room and started fundal massage when we got mom in bed. We expressed a large number of clots then mom started really bleeding! I think the paramedics did a great job, just were'nt aware of what or how fundal massage works.

I appreciate your trying to help by posting, but I am also a bit insulted by all your negative comments with regards to EMS.. We do the best we can, YOU need to remember we do not have an endlesss amount of people to help out like you would on your labor and delivery floor. And also do you think skin to skin is a good idea in a moving ambulance that can sometimes throw me around and I am a full grown adult? We do the best we can by cranking the heat and drying and wrapping the baby! Its not easy when your working in the outside, we do not have an endless amount of warm blankets and a baby warmer! We do not have an OB on hand either, directing our every move and believe it or not, some EMS protocols in some states do not allow fundal massage, especially for "aggressive" massage, and especially when the mother is not visibally bleading heavily, and again we have limited people in the back of an ambulance and sometimes we just can't get the extra hands to do fundal massage providing the bleeding is not copious. Please, next time you post, dont put so much effort in insulting and putting down other health care professionals, it is both unprofessional for you to do and unessassary.

If you are so concerned about the way EMS profesionals are delivery babies maybe YOU should offer to do a class!

Sweetooth

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Specializes in Cardiac.

And that may be the answer right there! Nursing staff might not be aware of what EMS IS or ISN'T allowed to do. Make sures Rn's are aware of that and they can prepare accordingly (Pit ready to hang, many blankets available/warmer).

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I And also do you think skin to skin is a good idea in a moving ambulance that can sometimes throw me around and I am a full grown adult? We do the best we can by cranking the heat and drying and wrapping the baby!

I'm curious about what you do with the baby that is safer than mom holding the baby? Do do you have a way of strapping the baby in as well? Skin to skin is proven to be very effective thermoregulation, assist baby with transition in terms of respiration and glucose control, and mom beginning to breastfeed can help control her bleeding. So it's something to consider in terms of minimizing stress for baby and mom. Not being critical just throwing some thoughts out there. I would rather deliver 25 babies with nuchal cords and shoulder dystocia in a dark alley with no equipment than have to drive up to the scene of an accident and know what to do :)

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