shoulder dystocia

[Cindy-OB RN/CCE]

I've been at my new job in a LDRP unit for 8 weeks now and I have seen 2 shoulder dystocias. Those are really scary! Luckily both had good outcomes. How common are they and what do your docs do for them? I'm just curious. I've read in midwife books to turn mom in hands and knees position but in the ALSO manual it says that is not the norm with USA docs. The two I saw used corkscrew manuver.

Cindy

[KRVRN, BSN, RN]

What if none of that works? One time we had a mom delivering lady partslly (1st baby had been lady partsl, delivered unassisted), and got a terrible shoulder dystocia. Head was out but couldn't dislodge shoulders. He was stuck for some god-awful amount of time. Had L/D nurses putting her in various positions, doing suprapubic pressure and attempting to find the heartbeat during all of this. I don't know if they tried fundal pressure. They had cut the biggest episitomy they could and were trying their darnedest to fx the baby's arm or clavicle to get him out. When they finally got him out they had to code him for a long time (13 minutes without a HR I think).

What do you guys do if you've tried everything and it doesn't work?

(and I seem to believe that baby was in the 9 lb. range--apparently not much bigger than her first)

[at your cervix]

I've seen the zaphinelli (?spelling) twice. SCARY!! If you are not familliar, it is when the fetal head is pushed back in and mom is taken for STAT c section. (you know the kind where you throw betadine on her abdomen and pray that she has a good epidural and get to the babe in 3 seconds flat usually only with the OB and 1 scrub nurse because these things only happen when you don't have enough staff around!!) Both times baby turned out ok but it is very risky!!!

[Jolie, BSN]

At your Cervix,

I saw that (Zaphinelli) done just once in 11 years, thank God. The patient was very tiny, under 5ft tall, and only about 110lbs at full term. The baby's weight was estimated to be about 8 lbs. After a long, torturous labor, and several hours of pushing, the baby began to show signs of distress. The OB attempted an unsuccessful forceps delivery, and then was unable to remove the forceps. They ran back to the OR to do a C-Section and remove the forceps through the abdomen. Talk about potential for infection!

When the baby came into the nursery, the pediatrician asked to have an opthamologist paged. I double checked the name of the doctor with him, because I couldn't for the life of me figure out why he would need a STAT opthamology consult on the newborn. I paged the doc and went over to the admission nursery to look at the baby. He looked like he had a cleft lip and deformed eyelid. Turns out that his lip was TORN and eye injured by the forcep!

They checked the baby for corneal abrasions, and plastics stitched him up almost as good as new. Thank God the baby did not suffer any long-term problems, and, amazingly, mom did not develop an infection. I never want to see anything like that again!