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?
When I was in my EMT-basic class, a LD nurse came to talk to us. She had done work in lesser developed countries (I believe she said they were in Africa, but I am not sure where). She mentioned that when they had babies whose shoulders were too large that they would have to break the mothers pelvic bones. Obviously, in the middle of no where, you're not going to be able to do the c-section. -Andrea
I think I remember something about the pubic symphysis. I'm not sure how common the practice was, or how the force was exerted. -Andrea
It is called a Symphysiotomy in the uk it is rarely carried out I have never seen or heard of its use and as a midwife have attened hundreds of birth both in and out of hospital. It is more commonly used in countries where the risks of cs are high and in some culturally unacceptable my understanding is that it is used for cephalopelivic disproportion with a live baby. I have beeen at many births with difficultly delivering the shoulders and have always managed to use set manoeuvres to assist delivery only once have seen a poor out come baby came out using manoeuveres but was a long time on perineum causing brain injury.
a totally inexperienced person thinking about shoulder dystocia (inexperienced as a nurse that is, but my 3rd baby was mildly dystocia'd)... it seems like supra pubic pressure would also be likely to break a clavicle, is this the case?
Also, it's more the positioning/lack of proper rotation of the shoulders than the size of them per se, right? Hence the Wood's/corkscrew maneuver?
Many, many interesting comments compiled from listservs from midwives/cnm's/ob-gyn's about s.d. here:
Shoulder Dystocia literally means difficulty delivering the shoulders and body, this can be because of haste and not waiting for rotation and restitution to occur, the shoulders in the oblique position rather than anterior/posterior position.
However true shoulder dystocia is an obstetric emergency usually because of disproportion between the size of the mothers pelvis and the size of the baby. The anterior shoulder can get lodged at the brim of the pelvis and supra pubic pressure along the axis of lie of the baby can help to dislodge this, yes damage to clavicle can occur but weighed against a potential dead baby I would opt for the former choice every time.
The Woodscrew manouevre is used when the posterior shoulder is lodged at the brim, by rotating the body completely it dislodges the shoulder and allows delivery of the body.
True shoulder dystocia is a scary situation and time is of the essence, better to have assessed risk if clinical assessment indicates the baby may be large.
In the book "Immaculate Deception II" by Suzanne Arms (a GREAT book), she has some vignettes about birth through the ages. In one of them, a doctor from the 1850's recalled that OB/GYN had come a long way from when it was first practiced in America. He mentioned that there was a time (~1600's) when it looked like a labor had no end in sight, there were 2 options:
1. Let the labor go on and the mom would possibly die from exhaustion.
2. Use instruments to crush the baby's head and pull the body out in pieces.
Sounds very sad, but it's very possible.
I do think that the earlier scenario in the original post seemed to be an urban legend.
Aneroo, LPN
1,518 Posts
When I was in my EMT-basic class, a LD nurse came to talk to us. She had done work in lesser developed countries (I believe she said they were in Africa, but I am not sure where). She mentioned that when they had babies whose shoulders were too large that they would have to break the mothers pelvic bones. Obviously, in the middle of no where, you're not going to be able to do the c-section. -Andrea