BOA's !!!

[nurse79]

Since i'm still pretty new to L/D, I was wondering what i definitely need to know if my pt decides to deliver without the doc present. We have that happen all the time, but fortunately it has never been my pt. Of course, our staff is very supportive, and they def. come running when we call for assistance. But, it'd be great to hear what I need to know in that situation...I know we never break the patient's bed if the doc isnt there...suppport the head...suction baby...clamp, clamp, cut right...help help help!! thanks

[SmilingBluEyes]

You have it pretty well down already. Remember, these kids "deliver" themselves for the most part. They tend to come fast, so support the perineum and have mom do controlled pushing or panting if the kid is literally flying down; this may save her a bad laceration....also....

Do remember to bone up on what you do in the case of a shoulder dystocia, however. Rare in precipitious deliveries, but still the potential exists.

Also, check for nuchal cord and reduce before having mom push baby out.....

And BREATHE, it will be ok...you will get a lot of such births under your belt in years of OB nursing. Keep your cool head and know your NRP procedures.

[nurse79]

thanks,,curious for a nuchal is there a certain technique to reduce it?? and yes..multips esp., completely FLY out! i have seen that many-a-time already!!

[magz53]

In NY state, it is a state reportable event if a physician isn't present at a delivery, so most times can be avoided. Of course there are those events that can't be avoided and we are "off the hook" so to speak. ( We have had docs rupture membranes on a multip and then go home for dinner! )Helloooooo. The more I read on this board, the more I realize it is the pits to work in a small hospital, but also the pits to commute more than an hour to "the city" in our horrible weather.

[Belinda-wales, RN]

As already said try and let head deliver controlled if poss eaiser said than done- then wait for Restitution of babies head which results in a realignment of the fetal head with the body. Check for cord around the neck if loose enough either slip it over head or push back over shoulders as baby is born if it is very tight around neck it may need to be clamped and cut to allow baby to be born. Hope this helps you sound like you are doing a good job already.

[burn out]

ICU nurse here...what is BOA ..I thought I was going to learn about snakes.

[nrse4evr]

Sounds like you got it down. Another really important thing to remmber is to stay as calm as possible, no shouting,yelling that sort of stuff. Mom takes her cue from you and if you want an out of control pt be an out of control nurse. She is already freaked out that her Dr isn't there, the baby is coming fast and she isn't sure that you have ever done this before. Use a calm voice, talk to your pt as if you have done this a million times. Talk to the baby as it is being born. That sort of stuff helps to keep the scene calm and less chaotic into which every baby deserves to be born.

As a previous contributor said, babies pretty much birth themselves and we are there to guide them with limited trauma to Mom.