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Heard a sad, scary story from my preceptor today

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Today I had a preceptor with about 17 years exp. She was quizzing me on what complications may occur with the patient we had. It was a big baby, and we got talking about shoulder distocia (sp?). She shared with me a story, and I was wondering if any of you have ever heard of this happening, or had it happen.

The pt was to deliver vaginally, and the head was delivered, but the shoulders wouldn't come. Apparently they tried everything (trying to put the head back in, cut the cervix, broke the clavicle, did the manuevers to get the shoulders through, etc. Not in that order I'm sure). She said they tried for over 20 minutes and could not get anywhere. The head was out and the baby was stuck. They (well the attending) had to decapitate the baby.

She said the resident left the room vomiting and she doesn't like to think about it to this day. I don't know how long ago it was.

What a horrible thing! I can't get it off my mind. Anyone know anything about this sort of situation?

Today I had a preceptor with about 17 years exp. She was quizzing me on what complications may occur with the patient we had. It was a big baby, and we got talking about shoulder distocia (sp?). She shared with me a story, and I was wondering if any of you have ever heard of this happening, or had it happen.

The pt was to deliver vaginally, and the head was delivered, but the shoulders wouldn't come. Apparently they tried everything (trying to put the head back in, cut the cervix, broke the clavicle, did the manuevers to get the shoulders through, etc. Not in that order I'm sure). She said they tried for over 20 minutes and could not get anywhere. The head was out and the baby was stuck. They (well the attending) had to decapitate the baby.

She said the resident left the room vomiting and she doesn't like to think about it to this day. I don't know how long ago it was.

What a horrible thing! I can't get it off my mind. Anyone know anything about this sort of situation?

Ever heard of a C-section? If the head was out and the shoulders were stuck how did cutting the head off help? Ever heard of Urban Legend? :rotfl:

gauge14iv

Specializes in ICU, ER, HH, NICU, now FNP. Has 23 years experience.

I have heard this story too.....

but the baby was supposedly breech, it was in the middle of nowhere and there was no anesthesia to be called in.

Dunno if it's true or not, but I have heard of some pretty strange things - it's possible I guess

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience.

I have heard this story too.....

but the baby was supposedly breech, it was in the middle of nowhere and there was no anesthesia to be called in.

Dunno if it's true or not, but I have heard of some pretty strange things - it's possible I guess

I absolutely don't believe this is true !! Maybe in Africa, the rice paddies of Asia, outer Mongolia, maybe even Russia, but not here in America. I did L&D from 1982-1994 and I can tell you it did not happen whether that baby was vertex or breech. It makes absolutely no sense what-so-ever. I think I'd be asking for another preceptor. Whether she believes this crazy story or not she should never have told you. That would be one fast way to run off a newbie!

I knew a nurse who told a variation of this urban legend. She was a real nut case. I hope J.W. is not your preceptor. If she is RUN!

She's not my regular preceptor, but other than that story, I found my experience with her today wonderful. It's nice to hear that that may not be true.

Her explanation to the c/s was that they were not able to get the head back in.

That story, or no preceptor, is going to scare me away from L&D. I love it too much. I know that there are bad things that can happen, but I think that almost fear keeps you on your toes. Or at least for me it does.

Thanks!

Oh, and it was a first hand story from her. Just wanted to add that if it wasn't clear.

There actually is an instrument called "decapitation scissors." We use it in the operating room for various things--NOT decapitation!!!

I think there is always a grain of truth to any urban legend. I SUSPECT that what actually happened--probably many, many years ago; perhaps in the '30s, '40s or '50s is that this baby (subject of the urban legend) was ALREADY dead--that is, a fetal demise---and that for whatever reason his intact head and body could not be delivered vaginally and also for whatever reason a C-section was not an option--Attempts to allow nature to take its course and expel it naturally were unsuccessful, and, hence, use of the decapitation scissors to separate the overly large head from the body WHILE IT WAS STILL HIGH UP IN THE VAGINA--NOT out. Hence, the decapitation of an already DEAD baby. I am only speculating; please do NOT quote me.

However, decapitating a LIVE baby due to cephalo-pelvic disproportion? NO WAY. I am certain that this has never happened, at least in MY lifetime, and I have been around since the '70s and did OB way back then, when our only tool to diagnose CPD was pelvimetry. CPD that would not allow safe vaginal delivery progressed immediately to C-section.

Gotcha! So could there ever be an instance where I guess it wasn't realized that the shoulders couldn't be delivered until too late? Would there be a time ever when you couldn't get the head back up to do the c/s? Is this a possibility, or not at all feasible?

Now that you guys are giving me so much help, I have my professional curiosity peaked!

gauge14iv

Specializes in ICU, ER, HH, NICU, now FNP. Has 23 years experience.

In the version of the story I was told - the baby had already died - not that that makes it any better or more true....and I would bet based on the age of the person and the age of the person who supposedly told her, that this story was probably around in the 40's so who knows

ok it's late and i am not a nurse yet so maybe i just don't get it but, if the SHOULDERS are stuck then how does cutting off the HEAD help? (it's already out) Am i just being an airhead and not seeing the obvious here....

smkoe-

From what I understand, the shoulders can get stuck with a big baby at the pelvic bones (or that's my understanding - I'm new to this too, and have been out of nursing school for a bit!). The nurse that precepted me today prepared me for this by explaining some techniques to get the baby out if that happens. She said that there have been times the baby's clavicles have had to be broken to get it out. Basically, the head comes down and out, but the shoulders are too wide for the lady's bones, so either you use certain techniques to get the shoulders through, or you resort to other measures.

I don't look forward to the day that this happens to me. As sick as is sounds, I would have preferred the distocia (sp? again) to have happened today with an experienced nurse precepting me, than seeing it on my own in a few weeks! Not that I'd ever want to see it, but I just want to know how to treat my pt in the best way possible.

There actually is an instrument called "decapitation scissors." We use it in the operating room for various things--NOT decapitation!!!

I think there is always a grain of truth to any urban legend. I SUSPECT that what actually happened--probably many, many years ago; perhaps in the '30s, '40s or '50s is that this baby (subject of the urban legend) was ALREADY dead--that is, a fetal demise---and that for whatever reason his intact head and body could not be delivered vaginally and also for whatever reason a C-section was not an option--Attempts to allow nature to take its course and expel it naturally were unsuccessful, and, hence, use of the decapitation scissors to separate the overly large head from the body WHILE IT WAS STILL HIGH UP IN THE VAGINA--NOT out. Hence, the decapitation of an already DEAD baby. I am only speculating; please do NOT quote me.

However, decapitating a LIVE baby due to cephalo-pelvic disproportion? NO WAY. I am certain that this has never happened, at least in MY lifetime, and I have been around since the '70s and did OB way back then, when our only tool to diagnose CPD was pelvimetry. CPD that would not allow safe vaginal delivery progressed immediately to C-section.

Several of my coworkers and I have gotten into collecting old OB nursing texts (pre-1900's to 1940's), and decapitation is mentioned in some of the books as a "last resort" pretty much exactly as you speculated.

I have seen a decapitation of a premature infant delivered vaginally. The infant was 22wks gestation and had a heartbeat up until the moment of delivery. the infant was in footling breech position. The attending MD told me what most likely happened was a rare occurance of the cervix clamping shut on the head once the body has passed through. In essence, the doctor pulled, mom pushed, cervix clamped and the body/head separated. In order to get the head out, the mom was sedated, given muscle relaxers and forceps were used. It turns out that the infant did have some congenital anomalies so that may or may not have contribitued to the situation. (head was normal size for gestation). This case is not an urban legend.

I have heard stories that involve suction extractors, forcep deliveries and all sorts of incidents but I suppose it could happen. My opinion is that it would be very possible to pull the head off of a baby if you were crazy enough to pull that hard and the shoulders were hung up. Then again there are all kinds of accidents and problems which could occur that could possibly cause decapitation.

Mimi2RN, ASN, RN

Specializes in NICU. Has 27 years experience.

We had an on-call doc at a delivery, who did not know the mom. There was no hx of an ultrasound, and the baby turned out to be big. The head came out but the doc was unable to get the shoulders through (and we had a very experienced doc). An emergency c/s was done, the head had to be pushed back into the mom. The baby weighed over 12 lbs, but was stillborn.

This happened a few years ago. Not an urban legend.

Jo Dirt

Has 9 years experience.

ok it's late and i am not a nurse yet so maybe i just don't get it but, if the SHOULDERS are stuck then how does cutting off the HEAD help? (it's already out) Am i just being an airhead and not seeing the obvious here....
It would seem like the could break the mother's pubic bone if the shoulders would not come out.

mitchsmom

Specializes in OB, lactation.

I have a true story, sort of related - firsthand from my OB friend, just a couple of years ago. As someone described before, it was a fetal demise and the baby turned out to have multiple deformities. An ER doc had actually tried to deliver the baby at a neighboring hospital after the lady showed up (mexican migrant worker lady with no prenatal care)... she was transferred to our hospital where my friend had to finish delivering the body. She said she was trying not to get sick & that at the review later the ER doctor was in tears. I'm pretty sure it was determined that the doc wasn't at fault, that it happened because of the demise/deformities and he couldn't have known (I guess especially being emergent, no prenatal care, etc). I think a c/s would have been the only way to maybe avoid it, if they had known.

We did have a baby die when it got stuck (this is NOT urban legend) once many years ago. She was on her way to a section and then all of a sudden the baby moved down. The head was born and then they could go nowhere with this baby. They got the baby out by section, of course, but it did not live. I can still see the thought of terror in that doc's eyes when she has to deliver a baby with the potential for big shoulders. Funny that someone mentioned urban legends. I nenver would have thought about that for this story!

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