I had a multip with a history of quick deliveries come in. She walked in and was pushing. The doctor had been called to come immmediately but I knew he was not going to make it so another nurse came in to help with the delivery. The head came out and there was a tight nuchal cord, which is where the problem came in.
It took me about 30 seconds to decide to clamp and cut the cord. I tried to get it to slip over the baby's head first and I couldn't. I didn't want to clamp the cord though for fear of cutting baby's O2 supply then having a shoulder dystocia.
So my question is did I take too long to decide that I could not slip the cord over or should I have tried a little longer?
The baby was born immmediately after without a dystocia but was stunned. now I am questioning whether it was the quick delivery that caused this or me. The cord gases we did were also fine.
So has anyone had this happen, what did you do and does anyone have advice for me for the next time?
Last edit by eden on Mar 10, '07
Jan 6, '07
Just from what I read here, you acted appropriately. You don't have a whole lot of time to decide whether you can reduce the cord or not---and it's a tough call for us, who are not super-experienced in actually delivering babies. The initial apgar could well be due to the rapid passage or tight nuchal cord. But either way, outcome and pHs good. Sounds like you did well. This is just why having two NRP prepared nurses at each birth is so important!!!
Jan 9, '07
So I talked to 2 different dr's and they both gave me different answers.
Number 1 said that he never clamps and cuts the cord before delivery, that you are always supposed to either deliver through or deliver with the cord around the neck. His explanation is that while it will momentarily tighten around the neck, it will loosen while keeping baby's O2 delivery system intact while cutting it immediately cuts off the baby's O2 supply and if there were a problems with shoulder dystocia then it is a true emergency.
Number 2 says that if you can't slip the cord over the shoulder or head you should just clamp and cut as a tight cord cuts off baby's O2 supply anyway so leaving it around the neck could just hold the baby in the birth canal when it really just needs out.
So I am just as confused as when I strated this trhead. I mean I can see both of their points of view but that doesn't help me for next time.
Jan 11, '07
I think you did good. I would have done the same thing. we are taught at our hospital if it is a tight cord to clamp and cut and deliver. And that is what I have seen all our docs do in the same situation.
Jan 11, '07
When I delivered babes in Zambia, policy (if such a thing really even existed) was to clamp and cut in that situation. I only had to do it once, thankfully. It's pretty scary until those shoulders come out!
Jan 11, '07
30 seconds seems reasonable to me, given that you tried to slip the cord from around the neck - that did not work, so you went with the other good option and that was the - clamp and cut.
I would have done the same thing.
Try not to sweat it too much. We all should learn everyday.
It sounds like the babe did okay, so kudos to you.
Jan 12, '07
Sounds like you had no choice but to cut the cord. In a precipitous delivery situation, we are supposed to get the ER doc up to our floor. ( Small hospital, 1 ER doc. What does that tell you ?? ) Our OB's go wild when they "miss" a delivery because an "unattended" delivery is state reportable in NY state. Ok, lets use Cytotec twice on a multip with a history of rapid deliveries, then rupture membranes and go home ( 7 miles away ) for dinner !! No time for anyone to get at the bedside with one push. Rapid descent plus the tightening of the cord is what stunned your little one. No time for secondary apnea thank heaven. Your patient was lucky to have you there. We clamped the cord and left the baby who was in very good shape on the abdomen. Nurses have been reprimanded for cutting the cord as it is a "medical" procedure. Funny how they let dads do it. Had we had to resucitate the neonate, we would have had no choice but to get it to the warmer...........hard to do while still attached.
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