Precipitous Birth care

Specialties Ob/Gyn

Published

hi all

what is the management or plan of care for a patient experiencing precipitous birth?

Need information as to what management is necessary

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Can you be more specific? DO you want policies regarding nurse-assisted deliveries? What specifically, can we provide that will help you?

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Let say precipitous birth is occurring and you are the only attending nurse and the doctors or midwife are not within reach, patient is delivering her baby now. What is the correct steps to delivering this baby? In orders what management or care can a nurse provide until the doctors arrive or midwife.

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Specializes in Family.

After experiencing 2 precip births of my kids, I can tell you there ain't no planning to it, lol! I'm not an OB nurse, so I won't offer any advice other than to always be prepared if this is your chosen area of nsg.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Well we try to have a "precip" pan ready. IN there, there are towels, bulb syringe, clamps and scissors. And we just "catch". Meaning, we deliver the baby and make sure we protect the perineum as best we can as we do it---to reduce tearing.

Important point: No nurse who attends or may attend precip deliveries should be without NRP training. We just then initiate our NRP steps w/newborn and let the placenta be til the dr gets there........

If placenta delivers before dr arrives, we give 20unit pitocin IM and massage fundus to firm, and wait for dr to assess peri for lacerations/cuts and that is really about it. It's not too complicated usually. You HOPE there is no dystocia, that is my worst nightmare.

These kids deliver themselves, as you know---in most cases. As long as you have NRP, you know what to do, really.

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Specializes in Pediatric Pulmonology and Allergy.

I delivered two of my own babies, myself, before the mw arrived. It was SO not a big deal. Childbirth is a normal, healthy process; not a medical emergency. I had my birth kit prepared, I had the warm towels, the hat for the baby and I wrapped her and kept her warm until the mw got there.

The problem with thinking that only specially trained people are equipped to deal with emergencies is that people either freeze or try to disrupt the birth process until the pro gets there. (As in "hold it in! Don't push!") When I realized that the mw was not going to make it on time I just relaxed and let my body do what it had to do. There was no panic involved, and that's what contributed to the positive outcome.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's a different world in the hospital, Chaya. Liability is huge and yes, NRP-trained personnel do indeed need to attend each birth, particularly from a Risk Management perspective.

Does that mean we as nurses "panic"? Hardly, no, many of us have caught quite a few babies in our years of experience-------we know birth is a natural and normal process in most every case. We know babies won't wait for the doctors, in many cases, also.

But legalities and the litigious society in which we work, make it a different and imperative event in our environment. On top of that, being licensed professionals holds us to a different standard in the eyes of the State in which we practice, as well as the public, that lay people are simply not held to. Therefore, there is a big difference there.

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It's a different world in the hospital, Chaya. Liability is huge and yes, NRP-trained personnel do indeed need to attend each birth, particularly from a Risk Management perspective.

Does that mean we as nurses "panic"? Hardly, no, many of us have caught quite a few babies in our years of experience-------we know birth is a natural and normal process in most every case. We know babies won't wait for the doctors, in many cases, also.

But legalities and the litigious society in which we work, make it a different and imperative event in our environment. On top of that, being licensed professionals holds us to a different standard in the eyes of the State in which we practice, as well as the public, that lay people are simply not held to. Therefore, there is a big difference there.

Good answer, Deb (as always)

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Chaya is thinking of term precips.

Most of our precips are preterm to very preterm, so 'knowing your stuff' is vitally important. We, too have a precip kit. We call a code if viable and deliver right there or transfer to L&D if there is time. We deliver and transport if there isn't time. We have infant stabilization rooms nearby and the level III NICU is on the same floor. Actually, all our units are on the same floor: APU, L&D and the NICU.

We recently had 18 week and 20 week deliveries in APU. This isn't the norm, but it is a huge and very busy unit (40+ beds, always full). Of course, there really wasn't much to do post delivery.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Yes very good point. there is quite a difference between term precip deliveries and pre-term ones.

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If you don't mind me hijacking the thread I am a student with a question. I recently had a friend deliver her second baby. Felt a couple of contractions, her water broke, she headed to the hospital, felt the baby coming, he arrived about 10 minutes after she got to the hospital. She had about enough time to get to labor and delivery, get onto a bed, and get her pants off and baby arrived. During the three or so minutes she was in the bed the nurse attempted to put in a hep lock because it was "required". My friend was pushing, moving around, etc and ended up with huge bruising, blood on her arm and clothes, and no hep lock :o Was is reasonable for the nurse to do this? Couldn't she have let it go as it obviously there was no time for anything to be given iv before baby arrived? Woudl you do this in your hospital?

It just left a bad taste to me that the nurse was not focused on my friend but procedure.

Thanks!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I would have deferred putting in a saline lock myself----bigger fish to fry. You are right; the focus should be on the laboring mother.

Now just to play devil's advocate here: It would depend on the policy at her OB unit--in some, saline locks are required on all patients. Some are really held to that standard and others are just inexperienced and focused on all the possible complications like hemorrhage, that can occur.

But that is not something you need do when a patient is pushing out a baby.....there are other priorities to tend to besides starting IV/saline locks on people.

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