Precipitous Second Stage Question

Specialties Ob/Gyn

Published

Specializes in Labor & Delivery, Peds Cardiology.

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!

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Specializes in Labor & Delivery, Peds Cardiology.

PS...they both were AROM'd and GBS pos, so I didn't want to check every 5 min....:)

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It just goes to show that women can deliver a baby without people screaming "push" at them. I suppose it makes the poor doctors feel kind of insignificant.

I think these are the best kinds of births. Keep doing what you're doing.

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It just goes to show that women can deliver a baby without people screaming "push" at them. I suppose it makes the poor doctors feel kind of insignificant.

I think these are the best kinds of births. Keep doing what you're doing.

Love this! Maybe the docs are mad becuase they owe you some money;)

I wouldn't worry, I think anyone who's being reasonable would realize this could happen. And you were being very considerate of good practice by not checking these ladies too often. Plus, what bad came of it? Mom and dad have a cool story, presumably the babes are fine.

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Specializes in L & D and Mother-Baby.

I had a multip the other night that went from 6 to complete in about 15 minutes and pushed once. Thank goodness the CNM was in house!! It happens and you shouldn't feel bad about it....what a nice easy birth for the moms!! GOOD JOB!

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Haha, don't feel bad. I started getting that comment when I had to deliver 4 babies in 6 weeks:lol2:. It happens to most everyone in spells. All had their babies in less then 10 mintues and the ob was en route.

I only got in trouble for one because triage had called the doctor to say she was 4cm and being admitted and she delived 5 minutes after walking in the door. He called right after the delivery to say he was on the way and I told him she delivered. He was mad at me because she was only 4 cm. I told him she was, 5 minutes ago and he was less then amused but really what was I going to do.

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Specializes in OB L&D Mother/Baby.

I've never trusted a multip LOL... Especially one with an epidural. I make sure to check them with changes in the strip and even that is obviously not fool proof.

Don't feel bad. One of my favorite stories is of a coworker that had no reason to check her patient, went into the room and the patient is conversing with several family members, munching on ice, and the dad says "are the sheets supposed to be wiggling like that" My coworker peeks under the sheets to see the baby's head completely out and moving around, trying to wiggle it's body out. So, we often tease eachother that we better get it together before the sheets start wiggling!

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Specializes in L&D, High Risk OB, OR, Med-Surg, PHN.

] Love multips one push have a baby I'm happy, pt happy, baby happy. Have delivered 14 babies s MD or CNM because they didn't make it several G1 no problems. What an experience. My last 2 kids all I pushed was 3 times each. Wonderful Love an epidural.

Lisa :p

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Specializes in LDRP.

when i was on orientation there was a g2p1 with epidural, 8cm at last check, which was fairly recently. We don't do routine foley's w/ epi, but periodic i&o caths. nruse i was with inserted cath and pt says 'oh i feel something!" and there was teh entire head out. push call bell. pt says "oh!" and there is the rest of the body, on the bed. 8lb baby, no voluntary pushing. the dad even has a pic of the baby head hanging out, with the catheter hanging out of the urethra.

the doc was down the hall so they made it 2 secs after baby.

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Specializes in L&D.

Sometimes babies deliver themselves quickly, so don't beat yourself up about it.

My favorite story at work was when a patient called out on her call bell "I think....I hear....my baby..crying." (Say it slowly, with pauses every two words.....it's makes me crack up laughing every time another nurse at work says it!!!) Baby was delivered, on the bed. Mom had a very heavy epidural. (Note, this is NOT the first time this has happened at my hospital either!)

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Specializes in OB, Med/surg, PICU.

Just had this happen to me TWICE in the last week. First was a grand multip x7 admitted at 3cm's epidural at 5cm's. Of course I THOUGHT I was watching her like a hawk. Noticed some decels in the strip and lifted the sheet to check her and was greeted by a little blond noggin.

Second was a G2. OB checks her and she's 7cm. He tells me she had a very prolonged 2nd stage with last baby due to small pelvis (was induced at 38weeks this time) and to let her labor down a bit at complete since she has an epi.

Well, murphy's law.... she precip'd on me as I was calling down for anesthesia to bring a refill on the epi. I hear from the room dad yelling "nurse! I think somethings coming out" and run in to see him catching his son. Oy

These things happen, and like a pp said it's just proof that women CAN still deliver babies without us screaming push and counting.... nature knows what it's doing.

Kat

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Specializes in Midwifery.

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!

Thanks!

Ignore them, and applaud the women who are so brilliant at birthing their babies! Multis can progress so quickly its amazing. And if the "experts" (i.e. the obs) haven't worked that out yet, well maybe they need go back to school!:angryfire

The quickest multi I ever saw started pushing with me at the end of the bed, no epidural. By the time I took the two or three steps to get to her side, she'd gone from no head on view to baby birthed! I got there in time to scoop him up and pop him on mums tum! Brilliant stuff!

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