suprapubic pressure

[Mrs.S]

sorry if this just a really basic question but I need to ask!

I just watched a video that I brought home from work on emergency/complicated deliveries. I haven't really seen any complicated deliveries yet and chances are when I do it will be my patient, so I really would like to be prepared! Anyway, they were going through the different maneuvers for a shoulder dystocia, and the way they demonstrated suprapubic pressure has really got me confused. Using one hand, the nurse ever-so-gently nudged the pretend baby under the pretend pubic bone. Really?? I guess I was under the impression that suprapubic pressure needed to be done, um, a little more forcefully than that? I mean, like I said, I haven't seen anyone do it in a real-life situation but I had a very different image in my mind.

Again, sorry if this is a lame question! just don't want to do anything stupid!!

[farishtaRN]

Not a lame question! Sometimes those 'training' videos can be more confusing than helpful - everything looks so easy when they do it.

Suprapubic pressure is just what it says "pressure"! I don't think 'gently' is a term that comes to mind in conjunction with it. It involves some force, and is usually used in combination with the pt pushing while in the MacRobert's position, and while gentle downward traction is being applied on the fetal head.

If you look onhttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/AbnormalLandD/ShoulderDystocia.htm

they do a good job of explaining the process, and details surrounding it (you can also see in one of the pictures that the person applying the pressure is pushing pretty hard).

Hope this helps a bit!

[PegRNBSN]

It is also important when applying suprapubic pressure to have leverage./be doing it from above the patient. After a particularily horrific shoulder dystocia, we have made sure there is a stool in every room near the bedside for the nurse to stand on.

Shoulder dystocia to me is the scariest of OB emergencies. You can't rush off to do a crash c/s. We have drills on our unit to simulate a shoulder dystocia, just to keep fresh what needs to be done.

[NurseNora, BSN, RN]

That website was very good. I'm going to bookmark it for my staff to see. Near the end it says that if the various manouvers do not work, they may be repeated in various combinations with increased forcefulness. There's your answer. If mild pressure isn't working, push harder.

The reply about the standing stool is important too. I check to be sure the stool is on my side of the bed when I'm checking O2 set ups, infant laryngoscope, suction, etc as I'm getting the room ready for a delivery (which I do at the beginning of my shift or when the patient is admitted). I tell the patient she may use it to get into and out of bed if she needs it, but that it must remain on my side of the bed.