Precipitous deliveries

  1. I came very, very close today to delivering my pt myself (a primip who had stalled all day and then suddenly said, "It feels like something is coming out", and um, it was . . .) and I was just wondering how many precipitous deliveries you ladies had done (if you keep count), if you ever feel comfortable with them, and any advice you have. My preceptor said that "we" ought to let me deliver one with someone else with me - like how often does that happen where you have enough time to say, "Can someone get Rae to come deliver this baby that is falling out???"

    Thanks!
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  2. 14 Comments

  3. by   RNLaborNurse4U
    I have personally caught 4 babies who have precipted. And I caught 2 under controlled circumstances - one with a midwife present, the other with a doctor present - both had offered for me to catch the baby...of course, I accepted!! It's been my life long dream to be a midwife and do this for a living.

    #1 - Multip came in pushing and crowning.
    #2 - Multip at 2cm all day and half the night, kicked into labor very quickly - cervix changed as I examined it - all of a sudden SROM (mec) and delivered a few minutes later - doctor was at home, and was too lazy to come in when I called him to tell him that she was dilating rapidly. I delivered the placenta too. Doctor came in 24 minutes after delivery. Took him aside and gave him a good talking to about his slow response in coming in!
    #3 - Primip was 3cm going into the tub, complete 10 minutes later - got her into bed and pant-pant-pant - SROM of a bulging bag (mec). Doctor was at another hospital, and came in about 2 minutes after I delivered the infant (tight nuchal, I had to clamp and cut - talk about scary!)
    #4 - Multip, heavy epidural - doc in house, but went to go round on postpartum patients. Pt 10/100/0 with a heavy epidural when he left. Baby descended quickly with no maternal effort at all. Doc paged stat. I caught baby as doc comes back in the room. This lady's uterus was honestly doing all of the work - the patient wasn't doing a blessed thing - she couldn't feel ANYTHING!

    So, 4 precip deliveries in my 4+ yrs in L&D. Not too bad, I guess. My first 3 were in a very tiny community hospital that did not have in house docs/midwives most of the time. They had to run between our hospital and the bigger one across town to do the deliveries. Needless to say, we ended up with too many nurse deliveries! My current hospital is a very large tertiary teaching facility, so we almost always have a doc on the unit at all times. RN deliveries are rare.

    Jen
    L&D RN
  4. by   RNnL&D
    In 2 1/2 years, I've had three, personally. And several other nurses have had them as well. Usually it's a multip coming in the door complete and doc doesn't have time to run in. Sometimes, it's doc taking his dear sweet time getting there.

    #1 I was still on orientation. Doc walked in, looked, said it will be another hour, and walked out. About 10 minutes later baby crowned up and came right out. Baby had a nuchal cord but would hang around for me to pull it over, so he just flipped over through it.

    #2 34 weeker who went from 6 to complete and started pushing on her own. I was really just there to catch as the baby came out on his own.

    #3 Term primip with plenty of time for doc to get there. I called doc at 6 cm said she's feeling really pushy. Called her again when she was complete, told me she'd be there in 15 minutes. Had Mom blow through contractions as long as she could, then told her if she couldn't not push, to just do little tiny pushes. As I kept looking over my shoulder, expecting doc to walk in any minute, I realized baby was coming regardless. I delivered a 7 pounder with a nuchal hand over an intact perineum (for a doc that ALWAYS cuts an epis). I was pretty proud of that one. It was a beautifully, smooth birth. Doc got there 35 minutes after I called. With mug of coffee in hand, purse on her arm, and baby on the stabilette. Later found out, "I went downstairs, made some coffee...... I figured I had an hour."

    Just because you read it in a textbook, doesn't make it so. :wink2:

    Forgot to add my #4 precipitous delivery. That was my own. We didn't make it to the hospital, and I delivered in my bathtub. Really I just caught him, he birthed himself with no pushing from me.
    Last edit by RNnL&D on Nov 4, '05
  5. by   Spidey's mom
    I've said this before on another thread but PLEASE GOD DON'T DO THIS TO ME.

    It has never happened to me in 6 years of L&D (granted this is part-time since most of the time I'm on med/surg and we only do about 5 deliveries a month).

    I like my role as nurse - don't wanna be the doc.

    PRETTY PLEASE WITH SUGAR ON TOP - OK?

    steph
  6. by   SmilingBluEyes
    I have delivered several in 8 years. The best thing you can do for yourself is to rehearse in your head what would happen if a dystocia took place, and if the baby comes out bad----know your dystocia drills and NRP---well. That is the best you can do. Most "precips" come out easily and very uncomplicated. They deliver themselves----we just assist, after all. Protect the perineum in a really fast-delivering baby. Have mom pant, and NOT push if baby is flying out---fewer tears happen this way.

    Dystocia---that is truly the only thing that scares me about the precip; that small possiblity literally makes my hair stand on end. Even in a precip, you can now and again you see a stuck shoulder-----know what to do if/when this happens to you. That is my best advice.
  7. by   Labor Nurse
    I've delivered many babies myself over the years. I worked three years as a night shift RN at a small rural hospital. MD's had to be called in from their rural homes. So I caught many. One night an MD was delivering a primip in one room while I delivered a multip in another. Birthtimes called were exactly the same. Probably the most exasperating (and recent) was a delivery where I had called the MD to come deliver. He came in and gowned up then pronounced that "she is not crowning yet, call me when she is crowning." Shortly thereafter I delivered the baby myself and there was a mild shoulder dystocia. Fortunately I had another RN in the room as the baby needed more than usual stimulation and O2. Now that I am in a large hospital working the day shift it doesn't happen as often. Kind of miss it!

  8. by   4theBetterGetter
    I remember when I was working L/d. Part of the "orintation" was to deliver one yourself..with the MD in the dept. I didn't know this when I was called to a pt. that was crowning! I bout had some things "crown" too! I was soooo scared I just lay the infant down on the bed when the MD came out of hiding..knees shaking I told him he could take it from there. I walked to the warmer and got the blanket to receive the baby. I knew how to do that!!LOL. Truely a learning experience!
  9. by   storkbynight
    You watch the same deliveries, over & over & over. You know how to do it, you just have to be calm & think it through. All you have to do is what you see done every day & know what to do in the exception. If you're a labor nurse long enough, it WILL eventually happen to you! A lot of nights when I'm driving to work, I think through situations, like, okay, if this situation were to happen tonight, the first thing I would do would be....
  10. by   1996RN
    i've been working in L&D for over 6 yrs and it was part of my orientation to deliver a precip baby by myself... lol. we just pushed the lady and called for the doc a little late, oops, i delivered it. it was a teaching hospital though and they dont mind cuz that's less work for them to do. over my 6 years, i've probably delivered close to 50? two on christmas night 2 yrs ago. and i just finished my last travel assignment a week ago and had a thick mec, tight nuchal cord, primip delivery that i had to do myself cuz the MD had just scrubbed into a c/s. i always get a little bit of nerves, but mostly i love it. the huge adrenalin rush. and the pts and families always have a good story to tell.
  11. by   KarryRN
    When I was having my second baby my nurse was 6 months out of nursing school. She was really sweet and was very encouraging of my wanting to go natural. I became complete quicker than she expected and when she realized the baby was coming she ran out the door yelling for help. Some other nurses came in and told me not to push, and my son came out just after the doc got there. My nurse later told me she was nervous that I was going to be her first delivery on her own. I could see the look on her face and she did seem a little worried.
  12. by   babynurselsa
    My best one was my own. He turned 1 on Nov 2. Had him in the ambulance in teh hospital driveway. DH got to catch him. I DELIVERED HIM. I still tease the ER doc that they pulled out that day. Baby was lying on the cot between my legs and the doc and the medic were deiscussing cord clamps I am watching the baby, waiting for a breath. I finally picked him up and started stimulating and drying him myself.
  13. by   Spidey's mom
    Quote from babynurselsa
    My best one was my own. He turned 1 on Nov 2. Had him in the ambulance in teh hospital driveway. DH got to catch him. I DELIVERED HIM. I still tease the ER doc that they pulled out that day. Baby was lying on the cot between my legs and the doc and the medic were deiscussing cord clamps I am watching the baby, waiting for a breath. I finally picked him up and started stimulating and drying him myself.
    Wow!

    steph
  14. by   RNnL&D
    Quote from babynurselsa
    My best one was my own. He turned 1 on Nov 2. Had him in the ambulance in teh hospital driveway. DH got to catch him. I DELIVERED HIM. I still tease the ER doc that they pulled out that day. Baby was lying on the cot between my legs and the doc and the medic were deiscussing cord clamps I am watching the baby, waiting for a breath. I finally picked him up and started stimulating and drying him myself.
    :roll He'll have a great story to share. :chuckle I'd say my best was my own, also. I got to that point of feeling lots of pressure and knew we wouldn't make it to to the hospital. Luckily, I was smart enough to think of getting into the bathtub before he came sliding out. Easy clean up. :chuckle My husband did call the squad, but by the time they got there, baby was in my arms, skin to skin, nice and warm and perfectly pink. I told them thanks, but no thanks and sent them on their way. We both were fine. If only I had known it would take 2 1/2 hours to birth the placenta.........

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