Questionable delivery--mom with cardiac history

  1. We had a mom of twins come in a few weeks before term. Delivering vaginally, came in, babies on the way out, no time to do a epi, straight to the delivery room, mom had a cardiac history and was on several strong meds. Well anyway, baby #1 comes out, then mom starts going into SVT's, we're waiting for baby #2, for 21 minutes, each time mom pushes, HR comes down. I just knew we were going to have a code, with the baby stuck in the vag. canal. I wonder if the OB should have considered a scheduled csection, considering mom's heart condition. She came to visit us, post-natal, and brought the twins, twin #1 walking at 9 mos (wow), twin #2 slow, can't crawl, roll over, sit up, eat well........I feel so bad, even though I had no control in the situation, other than to assist the OB, your opinion?
    Last edit by rn/writer on Dec 3, '06 : Reason: Removed overly specific information
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  2. 9 Comments

  3. by   BabyRN2Be
    Wow, I don't know too many docs around here that would consider a vag twin delivery, much less under the circumstances you mentioned. I know that I'm playing armchair OB here, but I think that it might have been best to do a scheduled c/section. I'm really wondering why that doc didn't do that, or change to a c/section once mom's HR was looking suspect.

    Too bad for the baby. I hope that kiddo starts to catch up.
  4. by   HappyNurse2005
    Wow, I don't know too many docs around here that would consider a vag twin delivery,
    really? if they are vertex/vertex our docs will. they all deliver in the OBOR though, just in case. one particular OBOR is set up for that, has the 2 baby warmers in it,e tc

    i suppose whether or not it should have been a section depends. was her heart condition well controlled? had she had a previous delivery (maybe she'd had a baby before, and the SVT hadn't been a problem)

    and, if mom was on some meds in pregnancy, why couldn't she have been given any then at delivery, too?

    i dunno
  5. by   SmilingBluEyes
    vertex-vertex, our docs deliver vaginally, but in the OR incase complications arise. And they sometimes do, but we see a lot of successful twin vag deliveries when they are vertex-vertex.

    Sorry not enough information for me to formulate an intelligent discussion about what should /should not have happened in this case. I hesitate to even go there. I would say, more than likely, our docs would probably have discussed elective/scheduled c/section with a person like this, based on what you say here. But there are cases where c/section is indeed more risky than vaginal delivery, even in the presence of heart diseases.

    This is as much as I dare say.

    I would always caution against providing too much information on the internet. You would be surprised how many "lurkers" are online when we are -----1000s! And, many of them are your coworkers and supervisors!
    Last edit by SmilingBluEyes on Dec 4, '06
  6. by   Gompers
    Quote from HappyNurse2005
    really? if they are vertex/vertex our docs will. they all deliver in the OBOR though, just in case. one particular OBOR is set up for that, has the 2 baby warmers in it,e tc
    That's how our hospital does it, too. If the babies are in good position and the labor is going well, they can definitely try for a vaginal delivery. BUT they also do them in the OR, like you guys, just in case something happens.
  7. by   dawngloves
    You mean mom was in SVT for 21 minutes with fetal decels? And there was no C/S???
  8. by   CEG
    Maybe the doc and patient thought the difficulty in enduring/recovering from surgery with her heart condition outweighed the risks of a vaginal birth. Although obviously it didn't turn out well for the baby, it seems as though the outcome for mom was good.
  9. by   partyof5
    Background: I am currently a nursing student. Graduating BSN Dec 2007.

    From a patient point of view(me). I had open heart surgery when I was young. My first child now 13 was an emergency C-Section. I was young and the nurse kept asking are you sure your water broke!! Yes I kept telling her. NO I DID NOT PEE MY PANTS. (she kept asking me are you sure) She kept telling me I was not dialating after many hours of labor. On the phone the doctor told them since I was a cardiac patient id never make without an epidural. Already in labor for 7 hours. Got the epidural still in labor, still the nurse asking me a few hours later if I was sure my water broke. YES IT DID! After bleeding excessivly my mother and husband depanded the doctor! Within seconds of him being there.... He said this baby is breach and COMING OUT. Emergency C.

    Then 5 years later I became preganant again. Everyone including my doc was all about the vbac until....He found out it was twins. Then he said no way. A cardiac patient, twins with prior history of breach and long labor. I had an awesome doctor. He said he would not deliver my twins any ohter way because of cardicac reasons and if I was against that, I had to go somewhere else. Now I understan why. What a great doctor I had!
  10. by   midwife2b
    Just wondering where your anesthesia folks were during this???
  11. by   partyof5
    They were there to give me the epidural and thats it!!!! the nurse was to monitor me. (of course different hospital and doctor) The second time, they were there the whole time along with the cardioligist, the ped docs the ob and a huge team of nurses as a matter of fact I dont think another person could fit in the room

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