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 lady partslly, 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?
I have seen a decapitation of a premature infant delivered lady partslly. 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.
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.
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.
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!
It would seem like the could break the mother's pubic bone if the shoulders would not come out.
Ouch! Wouldn't that endanger the baby's head if you were to break the pubic bone given the fact that the head would already have to be in the birth canal in order to decipher it's not coming out?
when I was in nursing school I witnessed something similar.
Mom came in with c/o cramping. We asked her last fetal movement is it normal, etc, Whe was 36 weeks. She was telling us she felt movement all over the place. But we couldn't get any fetal heart tones. ultasound and exam revealed that the baby was engaged and had suffered fetal demise. (the ob said as much as 3 days earlier) She had a fever and was in active labor. It took 20 minutes.
The baby had "softened" so much that when the baby was born (no pulling, forceps, or vacum involved) the poor things head just kinda "fell off". And I know this sounds terrible, but I really saw it.
Mom didn't believe until that time that the baby was gone.
It was horrifying for me. Thank god my instructer had the compassion not to ask me to write a paper on that case. Instead we did a lot of talking.
Even with the birth of both of my dtrs I was terrified it was going to happen to me.
I have seen a decapitation of a premature infant delivered lady partslly. 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.
This, now, I have heard of happening, fairly recently, and I too, know that it is not urban legend. Apparently there is some phenomenon--quite rare-- that causes the cervix to clamp down prematurely on a baby's head, perhaps mid-contaction while pushing. I recently read of exactly such an event--the nurses carried the finally delivered baby over to the Kreiselman and noted that it "looked funny." In fact, it had no head--the brainstem and spinal cord were what was protruding from the neck. The body had multiple anomalies. It was no one's fault, and unavoidable, just a rare and unfortunate incident. In fact, the baby may have suffered a fetal demise even before its head was trapped in the cervix--no way of knowing, as there was no autopsy done. I am sure the OB doing the delivery felt haunted by the incident; sure that he had done SOMETHING wrong--tugged a bit too hard, perhaps--but, in reality, I suspect it was unavoidable.
I think what we are calling "urban legend" are the stories about LIVE babies being INTENTIONALLY decapitated with decapitation scissors due to cephalopelvic disproportion--not already DEAD babies who could not be removed any other way. There is a HUGE difference.
As an Ob nurse with over 30 years L & D experience I can add that the situations described above (shoulder dystocia with undeliverable body and closed cervix after delivering a breech with head yet to be delivered) are theoretically possible. In the distant past I have encounterd both situations, both resolved without decaptiation.
Severe shoulder dystocia, that is not resolved with the traditional flexing the woman's knees to "open up" the pelvis, suprapubic pressure to encourage shoulder delivery, gently rocking of baby's head to encourage shoulder deliver (all of which may result in clavicle fracture), etc. can be "treated" with the use of sterile glycering to lubricate the undelivered shoulder. The lubrication, maternal postion change, gently rocking of the head, and suprapubic pressure all should be effective. The key is everyone has to work together and be ready for a compromised and possibly injured child. But not a decaptitated baby.
For a cerix that closes after delivering a breech, administration of general anesthesia to the mother is an effective method of treatment. While under the influence of deep anesthesia, the uterus (cerivx) will relax enough to allow for delivery of the baby. Of course the infant will have receive the general anesthetic and this is certainly not good.
Accurate maternal-fetal assessment for these rare but serious risks happens today with advances in technology (i.e. ultrasound). Diagnosed before stage II of labor the infants can be delivered via C-section. In the bad old days before technology and the acceptance of C-section as an appropriate treatment method (not a sign of an incompetent Ob-GYn) the situations you decribe could have occured. However decapitation was reserved for situations in which fetal demise had already occured.
unikuelady, RN
141 Posts
I have seen a decapitation of a premature infant delivered lady partslly. 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.