The OP baby..a question

Published

This is my first post although I have been "lurking" for months. I am a fairly new RN in L&D with about 6 months experience, 2 on my own. The other night I had a mama G2 P1 , came in in labor at 4/80/-2 at 11pm. she progressed well, no interventions got to 9 by 2 am. Baby was dirrect OP. She stayed at 9 with a very thick anterior lip for the next 2 hours. I changed her postions Q 20 min. Side to side. She is having an overwhelming urge to push for these last 2 hours and breathing through her contx. Finally, as im getting anxious that the MD is going to choose c/s ... my charge nurse helps me out. She goes in checks the patient, puts both hands (2 fingers each hand) inside and manually rotates the baby from OP to OA and she has the baby in 10 min. (she still had the thick anterior lip). So I guess my question is, what are other RN's experiences with manual rotation of a OP baby. My charge RN says she was just gently pushing the baby's head to rotate. Is this safe? What is the best wasy to rotate an OP baby? Tricks of the trade? Thank you in advance for all your imput.

There are a ton of good postitioning tricks for turning an OP baby. I won't explain all of them but the general idea is to keep mom moveing and to expand the room baby has to move within the uterus. You can do these postions before and during pushing and many times they do the trick.

I have seen some doctors do what the poster is explaining here. Most cannot do it but a few can and sometimes it works. Weather or not it falls within a nurses scope depends on where you are and what other nurses are doing in your area. In my state nursing scope is self defined which makes it kind of wide but also brings up allot of questions. here if there is a question weather or not someone has steped out of their scope you go before a peer board. some of the board will be from your specialty but others will not, so I always think about how other nurses would see it.

That beign said, there is allot of grey area. I don't think manually rotateing a baby would be seen as within the scope of nursing practice. Still if a nurse feels she is skilled enough to do it and it is in a fairly safe situation (tones are good and no complications) I don't think it is going to come into question. I wouldent be willing to manualy rotate a baby but I do something similer with good success and I feel fairly safe doing it. If i have a patient who is complete (or one of the nearly complete variations you see with OP babies) and I have tried all my positioning tricks as well as lots of passive decent I'll try to help turn it. What I do is have her push either on her back or on her side and useing my index and middle finger put gentail presure on the babies occiput toward the direction they need to turn to go to OA. Is this out of my scope? mabey but I feel pretty safe doign it becuse #1 I don't use enough force to harm the baby #2 I dont draw attention to myself while i do it "i just say lets get your baby to turn".

the other thing to think about is that baby's can be born OP. Ive seen many come out sunny side up just fine. Some patients have pelvisis that can occmadate an OP baby and some seem to be shaped so that the babies end up that way. I had a lady who had had 2 other babies both OP before delvering twins and they were both OP. She described all her delveries as "easy" and the twins sure looked that way. 2 pushes each and they both came out looking up at the sky with open eyes (was pretty cute).

One thing I continualy notice on this borad is that there is such a huge variation of autonomy in L&D. Some hospitals seem to reley allot on doctors and residents while others don't. You have to get the feel of your faclity and attendings and always question what the attending will back you up on.

Up Vote Up Vote ×
Specializes in Lactation Ed, Pp, MS, Hospice, Agency.

You made some very valid pts Dayray! Great post!

-it is always good to have mom up & moving (and she was, until she fainted & told NOT to get up. Yes, she was eating, she just hyperventilated)

-all 3 of my babies were OP & delivery 2 & 3 weren't as difficult

-autonomy can vary from facility to facility

Can I share your post (the portion about OP) with my Doula friend?

~MJ

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I practice much as you do, Dayray, and I admire your finesse and experience!

But then, I think your philosophies and mine parallel for the most part. Keeping mom moving is key--I agree 100%.

I had an acynclitic op baby yesterday, in a mom with an epidural. Mom got "stuck" at 4cm for several hours........

I began "logrolling" her from side to side and then helping her to sit up every 30 min or so. I explained to her and her husband the rationale for this, and they were all for anything that would help. Well----This did the TRICK!!! She progressed from 4 to complete in about 3 hours after I started the rotations, and the baby corrected his own position and came out with only 40 min pushing total--------------very good for a first-time mom with an OP/Acynclitic babe!

I was very happy, as this easily could have been "declared" a csection, if we had not tried, at least, to help the baby turn a bit---and had I not had a very patient OB dr. who trusted me when I said I would do the best I could to help mom progress. It was a beautiful delivery! Mom and baby are fine.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

A GREAT book for ANY Doula or Labor nurse:

The Labor Progress Handbook by Penny Simkin

It's a must-have in my opinion. Its philosophies and principles are ones I have adopted in my practice as much as possible.

Up Vote Up Vote ×
+ Join the Discussion