jub

Yes, Kday, I am talking about my baby. He is the one who was injured at birth. I didn't want to say that I was the mother and this happend to me because I wanted to get unbiased opinions on how nurses deal with this type of emergency. I know how often mothers are blamed for these injuries and didn't want that to be an issue here. As you've read above, however, it's second-nature to blame the patient and protect the doctor. Also, I am an RN, so I know full well what varying/variable decels are as well as turtling. Also, I'm sure I am "intense" and "vaguely hostile" about this subject, and that's because it's my child who's injured. I'm a little offended that you'd think you could "teach me" anything about this injury at this point. Once my child was diagnosed as having this lifelong disability, I had no choice but to become the subject matter expert. I've read many of your posts and generally enjoy them and agree with a lot of things you have to say. All I'm asking is that you, and others, learn all the facts concerning brachial plexus injuries before you make snap judgements and place blame. Thank you.

For the record, this mom did receive proper prenatal care starting at 6 weeks gestation and never missed an appt. Try as you might, you simply cannot blame any part of this on the mother. I agree that it's a shame when women don't get prenatal care and then blame the doc when things go wrong. However, there is no excuse for a doctor to use excessive traction on an infant's head. If he's gotten himself into a situation where he's ignored the red flags and the head is delivered, o2 is compromised and the shoulder is still stuck, well, then he's put himself AND the baby in a bad spot. In my experience, it's the baby and not the doc that comes out on the bad end of a situation like this. It's interesting though that you would automatically assume the mom had been remiss in her responsibilities and not the doctor. [This message has been edited by jub (edited April 09, 2001).]

I apologize if I seem to be attacking anyone, that is not my intent. I'm just dumbfounded and saddened at the "at just happens and can't be helped" attitude. It can be helped! There are many warning signs long before the childs head is delivered - fetal macrosomia, maternal diabetes/gestational diabetes, maternal obesity, gestation over 40 weeks, short maternal stature, platypelloid pelvis, maternal weight gain of more than 35 lbs., protracted first stage of labor, prolonged second stage, breech birth (or other abnormal presentation), history of dystocia births, history of large babies, ALL of these are warning signes that occur long before the head is delivered. I've never known a doc to notify a mom of the risks of delivering a baby when these warning signs are present. To answer your questions, the specific case I have in mind involves a 1st time pregnancy, mom gained 75 lbs., was never tested for gestational diabetes, u/s showed 10 lb. at 36 weeks, prolonged 1st stage, induced with pit, deep varying decels on the baby, prolonged 2nd stage, "turtling" of the head, shoulder dystocia, and finally the baby was pulled out so hard the cord snapped. Apgar was 2 at 1 min, baby was intubated and resuscitated and mom was told feel lucky he was alive. He weighed 11 lb. 6 oz., right arm limp, no clavicle fracture. C5 - C7 torn and mom was told to go home and wait 3 years to see what happens with the arm. What would you do?

I'm interested in hearing why you think most brachial plexus injuries cannot be avoided? Are you aware of the warning signs, red flags, maneuvers to safely dislodge the shoulder? Or are you stating this from a strictly "deny the malpractice" point of view? The poster above stated that a doc left a child stuck, deprived of oxygen for 23 minutes! Where is the outrage?? What if that was YOUR infant? No one is agruing that a dead baby is preferred over an injured one, that's just ridiculous. The fact of the matter is that the warning signs are there 99% of the time. Who's job is it to appreciate the risk involved? I'm just baffled here. I couldn't live with myself if I watched a doctor permanently disable an infant and did nothing about it. That's not what I got into nursing for. Is it what nursing becomes??

I appreciate both replies on this topic, but I'm not convinced the injury couldn't be prevented. I'm not worried so much about the broken clavicle, I'm concerned about brachial plexus injuries, when the nerves are damaged, leaving the arm, shoulder and hand paralyzed. The injury comes from excessive traction on the head, not being stuck. There are warning signs when an infant is too big for the birth canal and I've seen too many cases where those warning signs have just been ignored. At some point, someone has to be responsible for failing to appreciate the danger in delivering the babies lady partslly. I can't even imagine how a doc would justify leaving an infant oxygen deprived for 23 minutes. How can that be anything BUT malpractice? Maybe I just don't understand, is there some kind of code where nurses don't utter the m word even when it's blatantly obvious? Please respond to this because I genuinely want to hear opinions.

No one has ever encountered a shoulder dystocia???

How do ob nurses handle deliveries where a shoulder dystocia has resulted in a brachial plexus injury? Could it have been prevented? How? Did the doc just pull too hard too hard on the infant's head? Why does the injury occur? Is it malpractice? Thanks so much for any input on this!