Prolonged second stage and arrest of descent

[JoyfulRN14, BSN, RN]

Newer L+D nurse here... Had an experience yesterday and looking for tips.

Primip, young teen, term, Cytotec induction with early on epidural, Pitocin, AROM, etc.

I come in to her being complete for 3 hours and laboring down. She's 0 station, we labor down 2 more hours and she's feels pressure and urge to push, MD says to start pushing. Push 2.5 hours total: 30 mins lithotomy (the "standard" blech), then side lying and switching sides q30 mins. Baby makes it to maybe +1 but mostly just its caput is that far.

Mom has been pushing effectively, feels her contractions and feels the urge to push with them. Baby looks beautiful on strip.

MD speaks with her and convinces her to have a Csection. Baby has caput, very molded, and bruising around head. Apgars 8/9.

In my newness, I can't help but feel like, what else could I have done? I'm thinking baby was probably malpositioned, can you share tips for getting baby to turn at this late stage? I think it just got so wedged in there that it was unable to.

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[queenanneslace, ADN, MSN, APRN, CNM]

I have seen SO MANY persistent OP babies and primips and epidurals - and yes, they all end the same way. In the back for a c-section.

Once that kiddo is wedged in their after laboring down, or just being in the OP position for pretty much the entire end of pregnancy, I really don't know what there is to do. Oh, and if a primip changes her cervix from 1cm to 2cm, it's time for that ***glorious*** epidural! So yeah, they're hooked up and immobilized pretty early on.

I would like to track how many OP babies come out lady partslly in primips with epidurals. Because I'm guessing it's somewhere around 10%. Or less.

It used to be really hard for me to be with women who are healthy, normal, fit, positive and ready for birth - then end up epiduralized with this OP baby and having a c-section after a long labor. Now I just expect it. Primip + OP baby. = section. It sucks.

I think we need to try to do more to help turn the baby prior to 2nd stage - help rotate the baby before someone gets in their with their amnihook. It seems futile, though, once their to the point of laboring down. I try though, lots of positions, the peanut ball. Hands and knees.

Make sure you have your gloves on when they ask for you to dive under the covers and push that kid up from below.

I have felt your frustration - now - sigh - I feel just helpless and resigned. I think women deserve to know that this is a reality and a possibility - and maybe they would make some different decisions instead of coming into the hospital ASAP for their epidural. Not sure if that would help - who knows.

[obrn2]

It can be really trying to be a nurse caring for an OP baby. Go easy on yourself. You are not the make or break it person for the mom. We can feel that we are, but there are so many factors that go into this! My first thought is the mother has to be prepared to labor hard, even with an epidural, because that back pain can be tremendous.

I've had the partners do lots of counter pressure during the contractions. Once you get the counter pressure going, the mom will basically demand it during the contraction. I also place them hands/knees, side lying with the opposite leg propped on the stirrup, etc. I wish we had a peanut ball at our facility! One of our nurses flips them completely on their stomach with lots of pillows to support their tummy and legs.

A doula I've worked with made a comment that pregnant moms need to get off the couch. She said they cannot sit for hours every day on the couch because gravity will naturally pull the baby into OP position and then it's really hard during labor. Do I have evidence for that? Nope, but I thought it was an interesting observation.