I was always taught that the most important things are to support the perineum, check for a cord, and bulb suction. And always remember McRoberts' maneuver for shoulders. Another good tip I learned from a midwife is to lower the foot of the bed if you think the pt is going to precip because it reduces the chance of perineal lacs. And always call for an extra set of hands.
Dec 1, '05
And always, always review your NRP. That is so critical. KNOW what to do and be READY if the baby comes out meconium stained or stressed! And make sure you call for help the minute you know a "precip" is happening!
Also, make sure you file an occurence report for risk management after the delivery. VERY important.
Dec 1, '05
Also, remember, an old midwife saying: "we dont' deliver babies, they deliver themselves"--- we just facilitate. This means, we are there to "catch"---these babies coming. They are usually the least likely to give you trouble coming out and may exit extremely rapidly----so the above post about supporting the peri is SO RIGHT ON------have mom pant if possible, if baby is flying out, this, too, will save her tearing.
And yes, yes yes....be prepared for a shoulder dystocia. Know the movements you need to make to relieve this, if you dont' already, then ASK. Know, like above, the McRobert's manuever, but also the Gaskin maneuver, which you employ by having mom turn over on her hands and knees, or stand, learning over her bed, to change pelvic angle and help baby come out. Knowing how to relieve a dystocia is so critical------you have only a couple minutes to act!
I have had a few precips in my 8 year career, and none of them gave me any trouble coming out----most often, I had to work to slow things down. Just remain calm, keep that cool head, and know your NRP. And also, like the poster before me said, CALL FOR HELP early on! Good luck. Let us know when your first "precip" happens for you.