shoulder dystocia

  1. I've been at my new job in a LDRP unit for 8 weeks now and I have seen 2 shoulder dystocias. Those are really scary! Luckily both had good outcomes. How common are they and what do your docs do for them? I'm just curious. I've read in midwife books to turn mom in hands and knees position but in the ALSO manual it says that is not the norm with USA docs. The two I saw used corkscrew manuver.
    Cindy
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  2. 14 Comments

  3. by   canoehead
    We use McRoberts, suprapubic pressure, then Woods (corkscrew) manuvers. Only once saw a doc have a mum go to hands knees position but it worked wonderfully. One drawback of that though is that is takes a little convincing to get the mum to turn over with a baby head hanging out, so I don't know if the time makes that manuvere less desirable.
  4. by   fergus51
    LOL kday! EXACTLY!!!
  5. by   canoehead
    Oh yes- THAT voice. I remember having to teach each new orientee how to get mums to roll over, or get up to the shower for labor, and most of the technique was tone of voice. FYI it works well on new post ops too, but really sucked when I used it as a new supervisor- no one was fooled. (It was fun while it lasted)
  6. by   rdhdnrs
    Hey, anybody ever heard of using FUNDAL pressure for shoulder dystocia?
  7. by   bbnurse
    Fundal pressure was the method utilized for shoulder dystocia for years but is NO LONGER used. It can rupture the uterus, cause the fetal presenting part to become impacted into the pelvis (most likely) and not change the outcome into a positive by any manner of speaking.
    SOME practioners, who have failed to keep up, ask for fundal pressure out of panic when they go into automatic mode...we make an effort to just do the lateral suprapubic or suprapubic without adding to their stress with a confrontation. It's a difficult habit to break in us Older OB nurses, but one that is vital to meet the safety of our patients.
    It just isn't safe to do!!
  8. by   nurs4kids
    ummmmmmm, one small question..

    I'm ignorant when it comes to OB, except for my own personal experience..

    How on earth do you get mom in hand/knee when she can't feel her legs???

    btw..with my first, natural, they put me in hand/knee..I was in enough pain, I would have turned cartwheels, whatever it took!! lol
  9. by   fergus51
    We're prety stingy when it comes to epidurals because of a lack of anestesiologists (ARGH the spelling again!) so most women can feel their legs and everything else all too well.
  10. by   Jolie
    As a brand new labor nurse, I once had a patient with a very effective epidural, and a prolapsing cord. The OB said to get her into knee-chest position immediately. Once she understood the urgency of the matter, it was amazing how well she could move, even with the epidural. Her husband, a very large and strong man, offered to flip her over, but that wasn't necessary. They had a beautiful baby girl a few minutes later by C/S. We did let dad help us get her on the table!
  11. by   HazeK
    "SOME practioners ask for fundal pressure out
    of panic when they go into automatic mode...we make an effort to just do the lateral suprapubic or suprapubic without adding to their stress"

    GOOD FOR YOU! I cannot begin to tell you the number of times the panic-stricken MD has asked for fundal pressure during shoulder dystocia!

    Once again, nurses, GIVE THE DOCs WHAT THEY NEED...NOT WHAT THEY ASK FOR!!!
  12. by   HazeK
    two other recomendations:

    1) PRAY!!!

    2) prior to delivery, instruct your family photographer that, if there is an emergency, they will be asked to stop videotaping and move back...
    then, do just that! Not only does the videotape of a shoulder dystocia emergency look horrific to families...and juries...it is distracting when every member of the delivery team needs to focus the very most!!!
  13. by   kids
    Originally posted by HazeK
    [B]...Not only does the videotape of a shoulder dystocia emergency look horrific to families...
    I agree 100%

    A couple of weeks ago on TLC there was an episode of L&D...older OB...baby's head got stuck...vaccume didn't work on several tries-just got the baby stuck worse...doc called for the OB resident to do fundal pressure.

    I know it was a life of death situation but was incredibly barbaric...resident looked like she was gonna pass out...video running...Mom passing out...family screaming.

    Luckily all were ok.
  14. by   KRVRN
    What if none of that works? One time we had a mom delivering vaginally (1st baby had been vaginal, delivered unassisted), and got a terrible shoulder dystocia. Head was out but couldn't dislodge shoulders. He was stuck for some god-awful amount of time. Had L/D nurses putting her in various positions, doing suprapubic pressure and attempting to find the heartbeat during all of this. I don't know if they tried fundal pressure. They had cut the biggest episitomy they could and were trying their darnedest to fx the baby's arm or clavicle to get him out. When they finally got him out they had to code him for a long time (13 minutes without a HR I think).

    What do you guys do if you've tried everything and it doesn't work?

    (and I seem to believe that baby was in the 9 lb. range--apparently not much bigger than her first)

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