Precipitous Birth care

Can you be more specific? DO you want policies regarding nurse-assisted deliveries? What specifically, can we provide that will help you?

After experiencing 2 precip births of my kids, I can tell you there ain't no planning to it, lol! I'm not an OB nurse, so I won't offer any advice other than to always be prepared if this is your chosen area of nsg.

Well we try to have a "precip" pan ready. IN there, there are towels, bulb syringe, clamps and scissors. And we just "catch". Meaning, we deliver the baby and make sure we protect the perineum as best we can as we do it---to reduce tearing.

Important point: No nurse who attends or may attend precip deliveries should be without NRP training. We just then initiate our NRP steps w/newborn and let the placenta be til the dr gets there........

If placenta delivers before dr arrives, we give 20unit pitocin IM and massage fundus to firm, and wait for dr to assess peri for lacerations/cuts and that is really about it. It's not too complicated usually. You HOPE there is no dystocia, that is my worst nightmare.

These kids deliver themselves, as you know---in most cases. As long as you have NRP, you know what to do, really.

I delivered two of my own babies, myself, before the mw arrived. It was SO not a big deal. Childbirth is a normal, healthy process; not a medical emergency. I had my birth kit prepared, I had the warm towels, the hat for the baby and I wrapped her and kept her warm until the mw got there.

The problem with thinking that only specially trained people are equipped to deal with emergencies is that people either freeze or try to disrupt the birth process until the pro gets there. (As in "hold it in! Don't push!") When I realized that the mw was not going to make it on time I just relaxed and let my body do what it had to do. There was no panic involved, and that's what contributed to the positive outcome.

It's a different world in the hospital, Chaya. Liability is huge and yes, NRP-trained personnel do indeed need to attend each birth, particularly from a Risk Management perspective.

Does that mean we as nurses "panic"? Hardly, no, many of us have caught quite a few babies in our years of experience-------we know birth is a natural and normal process in most every case. We know babies won't wait for the doctors, in many cases, also.

But legalities and the litigious society in which we work, make it a different and imperative event in our environment. On top of that, being licensed professionals holds us to a different standard in the eyes of the State in which we practice, as well as the public, that lay people are simply not held to. Therefore, there is a big difference there.

Good answer, Deb (as always)

Chaya is thinking of term precips.

Most of our precips are preterm to very preterm, so 'knowing your stuff' is vitally important. We, too have a precip kit. We call a code if viable and deliver right there or transfer to L&D if there is time. We deliver and transport if there isn't time. We have infant stabilization rooms nearby and the level III NICU is on the same floor. Actually, all our units are on the same floor: APU, L&D and the NICU.

We recently had 18 week and 20 week deliveries in APU. This isn't the norm, but it is a huge and very busy unit (40+ beds, always full). Of course, there really wasn't much to do post delivery.

Yes very good point. there is quite a difference between term precip deliveries and pre-term ones.