Help please! Second stage/delivery questions

Lilnurse0803, RN · Apr 11, 2007

Interesting question. I will be starting orientation in L&D soon and could use the same advice.

Thanks for the post.

GingerSue · Apr 11, 2007

these are some headings in my chapter on Childbirth at Risk: The Intrapartal Period

-dystocia related to dysfunctional uterine contractions (hypertonic labor patterns, hypotonic labor patterns)

-precipitous labor and birth

-postterm pregnancy

-fetal malposition

- fetal malpresentation {brow presentation, face presentation, breech presentation, shoulder presentation (transverse lie), compound presentation}

-macrosomia

-multiple gestation

-nonreassuring fetal status

-placental problems {abruptio placentae, placenta previa, succenturiate placenta, circumvallate placenta, battledore placenta, placental infarcts and calcifications}

-problems associated with the umbilical cord { prolapsed cord, congenital absence of umbilical artery, insertion variations, cord length variations}

- amniotic fluid-related complications {hydramnios, oligohydramnios}

- cephalopelvic disproportion {contractures of the inlet, contractures of the outlet}

NurseNora, BSN, RN · Apr 13, 2007

This is a time of major multitasking. You have to keep an eye on the monitor strip, the doctor, the patient as a whole, the perinium in particular. While you're tying the provider's gown, watch Mom's bottom, I've seen babies precip while the MD has his/her back turned putting on gloves. Have your meds ready: local (even is she has an epidural, she may need some for any repair), oxytocin, etc. Is she at higher than usual risk for PPH--large baby, long labor, infection, grand multip--if so you might want Methergine, Hemabate, or Cytotec in the room. You've prepared the infant warmer, you checked it at the beginning of your shift or when you admitted the patient, but check it again for O2, suction, the laryngoscope (is the bulb screwed in tightly, are the batteries fresh, do you have 2 sizes of blades), tubes, airways, and so on. Watch the delivery closely, glance at the clock when the head is delivered in case the shoulders get stuck, you want a good idea of how long. Did he cut an epis? Get the suture ready.

Tell your preceptor that you're feeling shakey on deliveries and perhaps you can spend a day just doing deliveries (depends on the size of your unit) Reherse different scenerios with your preceptor. What will you do if this happens, then what next?

Relax. This is a scary time. You're starting to develop some comfort with your skills, but you're still scared you'll forget something important. Remember you're never alone (or shouldn't be). There are more experienced nurses around, ask for help. Share your fears. You'll do well.

Lilnurse0803, RN · Apr 13, 2007

NurseNora,

This is fantastic. Are there any more other basic things to remember to have at the bedside in anticipation of the delivery or any other complications?

Thanks for the wonderful pearls of wisdom.

mandykatrn · Apr 13, 2007

Thank you to all those who responded! This is very helpful!!

Susgu · Apr 19, 2007

MelitaRN,

NurseNora had a great suggestion of going over different scenarios with your preceptor. Talking through different deliveries can be helpful. And, to be truthful, you will learn as you get more experience. Every delivery is different, and sometimes out of the ordinary things happen that you may be unprepared for. As long as you maintain a calm and professional attitude, you will be able to think clearer and prioritize better. Always ask questions, and always ask for help when you need it!

The best to you! :)

Lilnurse0803, RN · Apr 19, 2007

Thanks, Susgu, for your advice as well. I am new to this world and want to be prepared, as best as I can, for as many scenarios as I can. I agree that a preceptor is a great person to start with by asking these sorts of questions and reviewing scenarios on different types of deliveries. Every situation is unique, but having a general idea of what to expect is really helpful.

I have made some notes on the information presented in this thread and will definitely make it a point to discuss with my preceptor as much as possible.

Thanks to the both of you for your kind advice.

SmilingBluEyes · Apr 19, 2007

Lots of great advice here. I wish you the best!

strn96 · Apr 20, 2007

I would also suggest asking your preceptor what happens if you do have a bad baby. Do you have NICU available for help? What will your responsibilities be in a neonatal code? Who will be helping you? Do you need to have Narcan ready for baby (if mom has had narcotics recently)? And of course ALWAYS make sure you have all the equipment to resuscitate baby. As was suggested earlier, check at beginning of shift or when pt is admitted. The one time you don't have equipment set up is the time you'll have a bad baby.

Also, be prepared for things like shoulder dystocia (McRoberts manuever, etc.)

Best of luck!

magz53 · Apr 20, 2007

After awhile you develop your own routine and can quickly eyeball a room that you didn't set up. I check for an O2 mask, meds for potential PPH, etc. Simple things like can opener for Xylocaine and a stool in case McRobert's maneuver is necessary will become automatic and you will not "feel at home" unless you know where all the things you need or could need are. Knowing the docs and their particular preferences........aka "quirks" takes time too. We probably all stay in OB as no 2 deliveries are the same and no 2 shifts are the same.

lucey9 · May 5, 2007

You might try the book "Intrapartum Management Modules" by Lippincott, amazon.com has the book. This book is great for the nurse who is starting out or the nurse who needs to review. You can turn the quizes and tests in for CEU's. It goes through labor and delivery and different scenerios that can occur during labor and delivery. It is broken up into modules. It has step by step suggestions of what and when to initiate nursing interventions. It explains things from a nursing point of view. Good luck!