Precipitous Second Stage Question

Specialties Ob/Gyn

Published

Hi everyone,

So 2 nights in a row I had multip women w/ epidurals that couldn't feel a thing...no pressure, pain, nothing. I checked them after the epi and foley...1 was 6cm, one was 5cm.

Both gave no inkling of pain, discomfort, change, etc. The docs said (like usual), check in 2 hrs after epi if no pressure. Um, yeah....with one of them the baby crowned up to the ears while the husband frantically called out...this an hr after I checked her at 5cm..... and the next night, I went to check the pt. after 2 hrs (like the doc said) and the baby's head literally popped out at me right before I inserted gloved finger.

So needless to say, I don't trust multips now...but has this ever happened to you all? I am in my pts room a lot, but the MDs are making me feel (or maybe I'm allowing them to let me feel) like I'm neglecting them and letting them be "fully" for too long....holy smokes, it was 1-2 hrs from 5- fully for both of them practically!! I'm starting to get the "no second stage nurse" reputation! haha. I've been there for 6 months, but this has never happened before! Two nights in a row!

Tell me your stories....I need some re-assurance before I go back to work that I'm not the only one this has happened to.....or maybe I am!! :)

Thanks!

When you get a multip comfortable and she relaxes - look out! LOL It happens all the time.

The L&D nurses here deliver a lot of babies - esp. on night shift. We are pretty relaxed about it here. We have a great team on nights and the nursery nurses and L&D nurses work well together. I've even gotten so used to it I sometimes clamp and cut the cord myself before waiting for the L&D nurse to do it if I'm closest to the instrument table. The first time I did it, one of the L&D nurses joked, "You go, girl. You need to come work with us - ever think about doing L&D?" LOL We all had a good laugh.

Your doc's just need to get over themselves and get over it. Babies come when they come. If they (babies) are coming that fast, there is usually enough room for them to make it on out without too much help from us.

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Specializes in OB, lactation.

My last precip went from 4cm- birth in about 10 minutes with no pushing. The last part was so fast that we weren't even properly gloved and I did a one-handed 'guide the baby onto the bed' move! The MD took forever to come on in and then had the nerve to be mad that we didn't deliver the placenta!! :(

Sometimes things happen in bunches, so maybe you'll have a break for a while now! :)

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Specializes in L&D.

Once I saw a doc check his patient, say, "You're only 7cm and it's not time to push yet", turn around to throw his glove in the trash and she delivered before he got the glove all the way off. He was honest and admitted that if a nurse had told him she was 7 and then she delivered that quickly, he'd have scolded her for doing an inaccurate exam.

I once checked a multip who was 6cm; she got a contraction before I got my fingers out and I felt her dilate to complete, internally rotate, descend and deliver all with that one contraction. Very impressive.

Another patient had been stuck and had stopped dilating. I finally convinced her to try her hands and knees and delivered the baby two contractions later.

Multips (and sometime primips) can deliver quickly. Sometimes we can see it coming, sometimes not. Things do tend to happen in clumps, hopefully your clump is finished for now and you'll not have another precip too soon.

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Specializes in OB.

i once caught TWO of a docs babies in one night (within minutes!). Both were primips, had been checked by doc, both were 3-4 so he ordered his usual dose of Demerol (this was some years ago - demerol was standard at that time) and went to the call room. Pt. #1 woke up about an hour later, c/o increasing pain. I checked her and she was about 8. Wlaked across the hall and woke the doc, then grabbed my instrument table and went in to get everything ready. Unfortunately this doc was a heavy sleeper and after I woke him he rolled over and went back to sleep. When I got in the room the patient announce that she had to push. Within seconds I had a baby in my hands. By the time Doc realized I had called him and woke up all the way baby was on the warmer and we were waiting for the placent. When hecame in and started checking her for laceration, etc, the patient in the next room (#2) called me c/o : "I feel something down ther. As others have saidI lifted the sheet and saw the top of the baby's head. Didn't even get gloves on for that one, caught it with my hands under a chux.

After this I told this Doc that he was no longer allwowed to go to bed while working with me!

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Specializes in Emergency Midwifery.

I have a couple of stories...

When I was having my second the midwife checked when I wanted to push. Found me at 6cm. She turned and rang the doc who said he would come over (I wanted a c-sec at that point)! She turned back and said (and I quote) 'oh s*#t there's the head' went to get her gloves and my startled hubby delivered our son before she could open the packet. No drugs at all (there was no time)!

The second story G4P2 was at 3cm midwife went to lunch left patient in care of mid student who had only assisted at one natural delivery. Student yelled to me to get the midwife (I took 2min to locate her and bring her back) whe we got there baby was completely delivered by the student and begining to cry.

It happens!

Nicky.

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Specializes in Midwifery, Case Management, Addictions.

Here is an excellent article on the Maternal-Fetal Ejection Reflex. http://www.collegeofmidwives.org/prac_issues01/MFer_01a.htm

This term was coined by Dr. Michel Odent, a French surgeon who practiced obstetrics in Pithiviers and who is known best for his writings on physiologic birth and his work with waterbirth. I have seen many instances of MFER at homebirths, with both primigravidas and multips--a fantastic experience for all! My most recent MFER experience was with a Hypnobabies mama having baby #3 at home. She wanted no interventions during labor, including SVEs, but was agreeable to my checking fetal heart tones regularly. After about 5 hours of active labor, I could tell by observing her from across the room that she was getting close to complete. She had been in a dimly lit room, resting her head lightly on the side of the birthing pool while laboring in the water somewhere off in that zone known as "laborland." In a few minutes she looked up and said quietly, "Water broke." I checked FHTs and looked at the water in the pool; all was well. A few minutes later her breathing "caught" once in her throat, she looked up again and said, "Head's out." And moments later her baby was born.

I love births like this. And seeing them often is one of the reasons I love homebirths.

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Well, it happened to me today. Had a multip at 5cm and baby delivered 25 minutes later! Her epidural was so good...she didn't feel a thing.

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