Complete patient and breech

Selke · Jul 7, 2006

Well I feel both very bad and very good about my nursing skills. I have been a L&D nurse since oct. Been on my own since january. Had my breech patient today. I thought the patient was vertex. Well let me jump back, the nurse before me thought she was vertex, the doctor that checked her at 7 cm thought she was vertiex, I checked her 8-9 I thought she was vertex, 9+ I thought she was vertex, baby started haveing big ol variable check her cervix, she felt complete but I felt something on the side that felt jaggedey. Had another nurse double chedk me her responce "I don't think that is a head" I felt like crap, But the doctor didn't catch it either and a couple of nurses told me at least you figuered it out I pushed a lady for 2 hours before I realized she was breech, hence the I feel lousy and good about my nursing skills.

Hey, don't feel bad about your skills!!!! Breeches are hard to come by in labor to examine in the first place. Those other "more experienced" people missed it. Do they feel bad? I bet the doc feels embarrassed. But, what made you think it was vertex? Did you actually feel a hard fetal skull? I've heard of the rare event of babies turning around while even in active labor.

I've diagnosed a couple of breeches in the past few years that were missed by the doc. The trick is to differentiate between a bulging BOW and soft presenting parts (butt), I think. Press upwards with your fingers (helps the more dilated the cervix is) until you can feel fetal skull -- if it's vertex you will eventually find the head. The first time I wasn't sure initially what I was feeling -- it felt like it might have been a bulging bag of water, soft and squishy, but as I pressed up with my fingertips, I could not eventually find a hard skull. It continued to feel soft and squishy. I palpated around, and eventually palpated two hard lumps (the "butt bones" :lol2: ). The other breech was also soft and giving to my fingers, no hard skull palpated as I pressed upwards, but I did feel the orifice which was like a small lump, and testicles which I made sure wasn't a pulsating cord. This lady was fully dilated upon admission so we had fun rushing to the OR.

texas-rn-fnp · Jul 7, 2006

On admission, if I can't feel suture lines then I will pull out the ultrasound. We have had more than one patient that was an induction and then later discovered to be breech. It is a good learning experience. If you can't feel sutures because of caput then run your fingers around the perimeter. Sometimes you will have to dig deeper. This can be more uncomfortable, especially for the mom that doesn't have an epidural, but without a good assessment then you are flying blind.

Deirdre · Jul 8, 2006

when I was new to l&d I called the md in because we were about 8cm w/a bbow..md delivered a breech boy!! needless to say, that was not a bbow!! It was pretty funny, doc had a sense of humor and it was a nice delivery; that was back it the day when they were more willing to deliver a breech.

SmilingBluEyes · Jul 9, 2006

I think you should feel very GOOD about your skills. Do not kick yourself here. This sort of situation has happened to all experienced l/d nurses at some point. I know from your posts how caring and conscientious you are. You can be counted on to have integrity and do the right things. I am sure you patients know this too.

Feel GOOD about yourself.

RNfromMS · Jul 10, 2006

One of our residents tells a funny story from his first year in OB: He was checking a cervix of a patient who was supposed to be 9 cm. He said his first thought was "she's barely fingertip" just as the baby sucked on his finger. The baby was a face presentation and the patient was complete.

JeanettePNP, MSN, RN, NP · Jul 11, 2006

One of our residents tells a funny story from his first year in OB: He was checking a cervix of a patient who was supposed to be 9 cm. He said his first thought was "she's barely fingertip" just as the baby sucked on his finger. The baby was a face presentation and the patient was complete.

Aw that's so sweet!

magz53 · Jul 11, 2006

One of my favorite managers tells the story of when she was a new L&D nurse learning VE's.......she told her preceptor that the patient was either a fingertip or fully, she couldn't tell. The patient was fully and she was also feeling the baby's orifice. I was laboring a patient not too long ago with a family practice doc who likes to do her own exams. Ok by me. Until I took the patient to the bathroom and what had been clear fluid was now meconium straight from the rectum to the pad !! Glad my shift had ended and I passed it on to the next nurse that the baby was breech, the doc was furious that she hadn't picked it up. She saw the mec for pete sake !!!!!!!! The next time she saw me she let me have it cause I didn't tell her I thought the baby was breech. Also once as a brand new orientee I admitted a mom who had a baby foot dangling out of her. I was shaking like a leaf as I flattened her bed and monitored the baby, also painted the foot with Betadine as I put the Foley in as I knew the foot would be dragged back up through the lady parts and into her uterus. Fun, fun. :nuke:

FLOBRN · Jul 12, 2006

Babies turn. Had one a couple of weeks ago that was definately breech - double checked by US. Got back to the OR, cut and there was a head!!. It may not have been a case of you not knowing what you were feeling earlier..the rascals do what they want when WE least expect it.

FLOBRN

RNnL&D · Jul 12, 2006

Press upwards with your fingers (helps the more dilated the cervix is) until you can feel fetal skull -- if it's vertex you will eventually find the head.

I've been lucky and haven't been surprised by a breech presentation, but we've had them while I've been at work. Because of that I make it a point to feel fetal head, no matter how uncomfortable it might be. Of course, if baby is floating way high, I can't always tell, but they're generally not in labor anyway.

Don't feel bad. Obviously, everyone else missed it too. Just use it as a learning experience. I'm sure you'll be poking around until you feel a head from now on. :lol2: Just wait until you get a transverse presentation. You get through the cervix and there's NOTHING there. :uhoh3:

Mimi2RN, ASN, RN · Jul 12, 2006

Just wait until you get a transverse presentation. You get through the cervix and there's NOTHING there.

I went to a c/s for a transverse baby a few days ago. That kid was JAMMED in there! The doc was really stressing as she tried to manipulate the baby to a good position to pull it out. It's back was against the incision so it had to be turned around.