Shoulder dystocia!!

[PegRNBSN]

We had two bad shoulder dystocias this weekend. Definitely my least favorite obstetrical emergency.

What struck me was how they went smoothly because the doctors stayed calm.

Both were excellent and both babies are doing well.

I had a new nurse with me on one of the deliveries and she was pretty shook up.

We talked afterward and she was wondering what do you do if the doctor isn't clam.

We have shoulder dystocia drills with a mannequin that actually delivers. While we concentrate on what our responsibilities are we as nurses need to know what the manuevers are for the doctors and suggest them if they seem to be panicking.

Also getting another MD if one is available is also very helpful as sometimes a fresh set of eyes and hands can do the trick.

[babyktchr, BSN, RN]

The whole key is staying calm....good for the physicians who kept their heads. It is a scary scary thing when that happens. It is also nice to have that feedback afterwards, especially for the newer nurses. Keep up the fabulous work!!!

[KellNY, RN]

Something in there air then, eh?

We recently had a few doozies, incl. one that required an emergency c/s. Yeesh. Never heard that doctor curse in front of a pt until that night. Baby came out floppy and blue.

[q12RN]

We had a real bad one a while back that 2 Dr's were in the room and one was Very calm and one was hysterical. I was nervous as heck but kept my jets cool. Dr broke the baby's humerus getting it delivered but the baby lived. :)

[roady]

As I was ready to deliver, I heard my OBGYN say "If I had known the baby was this big I would have sectioned her!" Not the thing a delivering mom wants to hear. Needless to say, they had to break her collarbone to deliver her. Fortunately she only needed a couple of months of OT. She's now a grown mother of a 2 yr old and recalls how "I almost died when I was born because my shoulders were too big"

[LAMSMOMRN]

It does help a lot when the doctor stays calm. We had an instance once where the head delivered, but the body didn't. Pt. had to be wheeled to OR w/ baby head out of lady parts and had to deliver (again) by c/section. There would be no doubt the baby would have died if the doctor didn't remain calm.

[AfghaniPrinzess]

I have only been in one dystocia delivery...but am curious as to what are the nursing responsibilities in different hospitals regarding what to do with a dystocia? One nurse i talked to who does traveling a lot told me some hospitals she worked at did not allow the nurses to do funal pressure and another MD or midwife had to do it....

obviously there are certain things that the nurse does and should do like putting the HOB down and doing the mcroberts....anything else you have found helpful??

[bagladyrn, RN]

I have only been in one dystocia delivery...but am curious as to what are the nursing responsibilities in different hospitals regarding what to do with a dystocia? One nurse i talked to who does traveling a lot told me some hospitals she worked at did not allow the nurses to do funal pressure and another MD or midwife had to do it....

obviously there are certain things that the nurse does and should do like putting the HOB down and doing the mcroberts....anything else you have found helpful??

This is one of those situations where "fundal pressure" is going to make matters much, much worse, not better. No one should be doing this! Fundal pressure (visualize this) is simply going to jam those stuck shoulders down against the pelvis. What needs to be done, if McRoberts position hasn't worked is "suprapubic pressure". This is pushing straight down into the belly just above the pubic bone. This can "pop" the baby's shoulder down under the bone and unstick him allowing delivery. It does frequently result in a broken clavicle, but a live delivered baby.

The nurse's function will be to assist with McRoberts (getting those legs up and back against the abdomen), applying the SUPRAPUBIC pressure (I usually have to jump up on the bed to do this as I am short and there is never a stool when you need one), calling for extra assistance for probable infant resuscitation, etc. Oh, and at the same time trying to explain to family why you are suddenly wrestling with and pummeling their family member!

[canoehead, BSN, RN]

Definitely a poop your pants situation because it's always a surprise, and always a life or death emergency. I once had a doc with both feet braced against the bed as she pulled like hell. I was CERTAIN that baby would have spinal cord damage. He came out and was bruised deep purple from the neck up for several days!

The slickest one was when the doc ordered the mom to get on her hands and knees after McRoberts didn't work, and the baby popped right out with some encouragement. She said that's what they do in 3rd world countries where manuvers that require specialized education aren't well known, and csections aren't an option.

[CEG]

The slickest one was when the doc ordered the mom to get on her hands and knees after McRoberts didn't work, and the baby popped right out with some encouragement. She said that's what they do in 3rd world countries where manuvers that require specialized education aren't well known, and csections aren't an option.

This is sometimes called the Gaskin maneuver after Ina May Gaskin who has popularized (or tried!) this after she learned it from Guatemalan midwives. The hands and knees position apparently opens the bones of the pelvic outlet, while supine positions constrict the pelvic outlet. I guess it makes all the difference. Another reason I love Ina May.