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?
Let it go, this is a story I did hear from a preceptor, true, urban legend, or none of the above.
I posted an honest question, and hoped to hear from others who may or may not have been through it. I've heard enough to know it's not necessarily true. No need to bring snipes into it.
Let it go, this is a story I did hear from a preceptor, true, urban legend, or none of the above.
I posted an honest question, and hoped to hear from others who may or may not have been through it. I've heard enough to know it's not necessarily true. No need to bring snipes into it.
Let what go? My response was in reference to this being a bad thing to put a new person through, which I agreed that it was. Do you know what a snipe hunt is?
Pulling your leg is what she is doing, having a little fun at your expense. My preceptor told me I had to give a mentally challenged 340 lb 44 y.o.a woman (mental age of 7 ) shower...not bed bath, not even a shower chair but stand her up and get EVERYTHING clean ( folds, crevices, nooks, crannies, wax outta ears, you name it I cleaned it ) When I was done I walked out of the room with a sparkling patient and I was SATURATED, hair dripping mascara running and all the floor nurses laughing so hard they couldn't speak. :rotfl: ( Did I mention that while walking from her bed to her shower the pt gave me a code brown in little increments the whole way there ) It's an unfortunate right of passage that some love to mess with the new nurses ( I also got the nurse who pushed on the abd of a recently passed pt so I thought she exhaled and about jumped out of my skin ):rotfl:
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think this thread has outlived its usefulness. I for one, have never seen or heard of such a thing as an OB nurse. I cannot imagine in modern hospitals anywhere this happens. I just cannot. But let's leave insults and jibes at other countries out of it, please.
I too was told a version of this story in OB orientation. Some nurses were talking about dystocias and I happened to ask, What's the worst thing that can happen in a delivery such as that, besides a broken clavicle? The nurse replied, "If the shoulders get stuck long enough and the baby's hearttones are lost and there is no hope, and no one can maneuver the head back in the lady parts, the only thing that can be done is remove the head and then remove the rest of the baby's body by C-section." I was horrified. Just wanted you to know I heard it too!
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 Saw this happen just a few weeks ago. Baby was 17 week demise, many abnormalities. Bladder of baby was so destended and when head came out, cervix clamped down. Baby's head came off while trying to deliver. Needle aspiration was needed to pull fluid off baby's bladder in order to deliver the rest with forceps. Not a great night for the berevement team. We were able to get some beautiful picutes of the baby's feet and hands, but not much else.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I can see this happening in preemies and fetal demises, but never in 7 years ---some of which have seen hairy deliveries, have I seen a decapitation of a live term baby to get it born!!!
I'm sorry Nurseguy for jumping on you like that. That was out of line, and I do apologize. I guess being a "newbie" in L&D and being duped has me a bit sensitive!
BTW I do know about snipe hunting! I fooled my younger cousins into thinking that was real several times!
I work in the UK and tucked away on every labour ward is a destruction set, I have never seen it used I hasten to add.
Shoulder dystocia is not an indication for decapitation, however impacted shoulder presentation is one of the reasons given for decapitation, in a very old midwifery text book, if uterine rupture is imminent. The other reasons given is in the case of conjoined twins. I think with improvements in surgical deliveries and advances in ultrasound, the cases where this would be necessary in the Western world are probably now non existant.
So, at the nurse's desk today I heard an interesting conversation, which I can't wait to ask the nurse who told me the story I shared with you about. Basically to question if this is where the tale came from...
NICU nurse was visiting us, and on of the RNs asked her if she remembered the so-and-so baby, and if so, how was she/he doing?
NICU nurse did have an update, and in the story they were discussing, I asked a bunch of questions and learned a lot.
This lady (the L&D nurse's estranged cousin-the one who brought it up, not the preceptor in the original story; follow?) had been to another area hospital originally. They refused to do a vag delivery bc of the size of the baby. They recommended a c/s. She basically said "It's my (*@& baby and I say how it's born." (words from the L&D cousin of her, during the conversation I was listening to). ANYWAY, she left AMA and waited at home for awhile. She came to our facility crowning. Apparently this was a 12lb baby. They were not able to deliver lady partslly, and went to attempt a c/s. They were not able to get the head back from the cervix enough for that, so apparently they kept trying both.
I asked some more questions, and was told that a certain nurse had hands small enough to reach around to get the shoulders out lady partslly (don't question me too much, b/c I didn't ask more about that).
Mom was fine, and baby was delivered. Kid is basically a vegetable to this day. The MD that took care of her has left the clinical OB setting for academics since that.
I, being skeptical since reading these threads, wondered if that was true (even though they weren't discussing it with me, only answering my questions). But when other midwives, older nurses, etc would walk up, they were like, "are you talking about dr. so-and do and that pt?" So I think this story is probably true.
So long story longer, my best guess until I can ask that preceptor I had that day is that this may be the story she based her tale on. I'm going to ask her if she "remembers" the MDs name, and just go from there. I won't accuse her, since she is one of the clinical lead/charge nurses on the unit. I will just know for myself...
I have heard this too, and "back in the day" I can see where this most likely happened albeit rarely.If the head is delivered and the shoulders are stuck and McRoberts, woods ect have all failed, and baby is dead, would you rather them decapitate the baby then deliver the body via a c/s or surgically cut the pelvis apart? Then mom would be dealing with significant physical pain and long recovery in addition to the loss of her baby. (not that c/s are painless) but I have read this somewhere, I have a very old Ob text somewhere around here but can't find it to see if that was where I saw this. It also seems like I have heard an "old" OB doc talk about this. If the kid is truely stuck,as in it aint coming out and it aint going back, they would HAVE to get it out, lets face it it wouldn't be compatible with the moms life to do anything else. The preceptor was probably just trying to illistrate how EXTREMELY dangerous a "true" shoulder dystocia is.
EDITED TO ADD:
Also I believe that in the story that you were told the baby had been stuck for 20 minutes, this kid was almost assuredly dead.
It's an unfortunate right of passage that some love to mess with the new nurses ( I also got the nurse who pushed on the abd of a recently passed pt so I thought she exhaled and about jumped out of my skin ):rotfl:
pebbles1977
86 Posts
Sarcastic much nurseguy?
Let it go, this is a story I did hear from a preceptor, true, urban legend, or none of the above.
I posted an honest question, and hoped to hear from others who may or may not have been through it. I've heard enough to know it's not necessarily true. No need to bring snipes into it.