Precipitous Labor

Oh yeah that has happened before. I had a pt who was G2P1 and had a normal length labor with her first baby. She came in and was 3cm,70%, -1, intact and contracting about every 5-7 min, but rated her pain at a 6 and wasn't even breathing with her ctxs. The dr said go ahead and admit her give her some Phenergan and nubain and I will be there in 2 hrs. I gave her the med (checked her before I gave it, still 3cm) and was in the room q15 mins to assess her. She was sleeping the whole time. About 1hr and 10 mins later she calls out and c/o's of pressure. She is still very calm. I look and the head is on the perineum! Well I got yelled at for not calling him when she was 6-7 cm. Umm.. I guess I should have kept my hand up there the whole time just in case.

We also had a nicer dr who checked a G5P4 and she was complete, +2 and walked back out to the nurses station. Well, the nurse pulled back her legs and before she could even push once the head slid out. He ran back in but all he could do was deliver the placenta. He was like "oh... I guess I shouldn't have walked out". Yeah you think?

Do you write incident reports on unattended deliveries? We have to and if the dr has had a lot recently they can get mad and blame you. They need to realize that if they are nice the nurses write the report nicer. "Pt had uncontrollable desire to push" vs. " MD called but did not attend delivery".

Just shake it off and know that you did all you could, sometimes pts just deliver fast like some deliver slow.

Yep. And I tell them, the solution may be for them to stay in-house. They know as well as I DO you cannot always predict these things. Tell them you did your best and to get over it.

Yes we do do "occurence reports" for ALL NON MD-attended deliveries.....they are considered "out of the norm/high risk" occurences. That is to cover ourselves and the hospital in the event of questions later on.

HEY poop happens...and so do babies. We do our best and it's a fact IF you are an L and D nurse very long, it will happen to you time and again. As long as it went well and you did what you could to get the Doctor to respond, hey, that's all you can do. it's not YOUR fault if babies won't wait!

Can I hijack? What is considred precipitous? Peds gets called to precip deliveries and I look at the admit sheet and it was 3 hours ago. Doesn't sound so precipitous to me.

Where I work, when it's a precip we get a call "we need you NOW". We've had one in the elevator, one at the registrar's desk. One was delivering in the wheelchair, as she was being rushed to a room. We had to untangle the baby from her panties! Several times, premies have delivered in the bed......"she was only 7cm a half hour ago".........29cm heads slip out really easy. That usually gives us a popsicle baby, as nothing is ready.

Sometimes the doc has been called, but gets in too late. They only want to be called if you can see hair!

Oh yeah. We've had many a preemie born in mom's pants, (although I don't know how they manage with such little room)