Something told me to be prepared for a shoulder dystocia. I honestly can't say what exactly told me to be ready. The pushing was going good, albeit slow. The baby was thought to be LGA (large for gestational age), but shoulder dystocia can happen with even the smallest of babies.
But nevertheless, I pulled the step stool next to the bed, and visually located the emergency button. I also made sure the regular call bell was within my arm's reach.
I had a family member holding each of the mom's legs with pushing, leaving me free to be able to call for help and perform suprapubic pressure if needed.
I had the attending in the room, watching over the resident who was catching the baby.
Then.......*the sign*.
The turtle sign: when the head slowly emerges, but then seems to be partially sucked back in to the vaginal opening. In other words, the anterior (top) shoulder of the baby is stuck and the baby cannot fit through and finish being born.
Shoulder dystocia.
I jump up on the step stool, tell the family members to pull mom's legs back even more (McRobert's), and look at the resident, who nods his head for me to do suprapubic pressure. I hit the call bell (can't reach the emergency one - it's on the wall) and yell out "SHOULDERS!!!!". This is the key point where additional staff come in to assist.
No one comes.
McRobert's continues, I apply suprapubic pressure, and the resident does his thing with maneuvering the shoulders. Time from head delivery to complete delivery is about a minute. It feels like time moves so slow when it's happening though.
Baby's out! Clamp and cut (ugh, how do we convince docs to leave it intact for the extra blood, especially with a compromised baby?!?), and I work on resuscitation of the baby under a warmer.
Wipe off the baby (tactile stimulation).
Bulb syringe (clear airway of mucous).
Rub baby some more (tactile stimulation).
(Where are my helpers? Hello? Anyone coming??)
Baby cries a lusty cry and pinks up.
Whew!!
Excellent Apgar scores. Physical assessment of baby shows equal strength and movement to both arms. Clavicles feel intact. Quickly weigh and measure baby, then wrap her up and give her back to her mother.
All in a day's work folks. All in a day's work.
14 comments:
did anyone ever come? Oh, and how big was the baby? Was it really LGA? and either way, premonition or being prepared, you got the job done quickly and safely. awesome job!
What a great job you did. And it is amazing that you knew something was going to happen. That is the true sign of an excellent nurse.
Have you ever read Elizabeth Davis's "Heart and Hands"? She talks about one birth in particular in which she got a sudden, strong feeling (hours before the birth) that there would be a severe shoulder dystocia - and indeed there was. Very similar to your story.
Great work, as always! Thanks so much for your blog!!!
Great job! I think that we nurses are a supersticous bunch. We make sure our cords aren't tangled (in case we have a stat), we print c/s paperwork to banish the demons, we have chairs and stepstools in the room just is case.
I hate it when no one comes to help. You did great though! One minute on the perineum is not too bad!
Wow. I would love to have you in the room if something happened, the overwhelming feeling would be also tempered by trust for you knowing what you are doing (just like my midwife this past time when she told me to stop vocalizing and push, I knew she wasn't playing). Good job.
Blessings!
Dawn
Ina Mae Gaskin has a great maneuver for shoulder dystocia
http://www.inamay.com/?page_id=30
Amen to that!
It's all in a days work!
Preparation gives you "premonitions." It's all part of being an experienced, well-educated, childbirth provider who loves what she does. Great job! Where was the staff you summoned, though? Were there any issues raised with why no one came stat when you yelled out "shoulders!"? This description was my last delivery, minus the experienced nurse, resident, McRobert's maneuvers, and suprapubic pressure. I was terrified. To this day, 2 years later,I'm still traumatized by the sub-standard care I received. Gratefully, my baby was delivered - yanked out forcefully - and suffered no serious injuries.God was watching!
What was the weight of the baby?? :)
I've found shoulders to be one of those pre-intuitions that is consistently reliable, for me anyway.
In your setting are you able to manage SD in any way other than McRoberts?
I'm curious about the size too! Wow, that was a nail-biter. Good job!
I just love reading your blog though I often am behind and need to get caught up on the posts :) I've been a NICU nurse for 6 yrs and just switched jobs to mom/baby couplet care, I am so thankful that there are awesome L&D nurses like you out there to help Moms have the birth experience they wants and deserve!!
If mama doesn't have an epidural, the Gaskin maneuver is the way to go!!!Its our go to for SD in the homebirth setting. If straight up hands and knees doesn't do it then get one knee up in a runners starting pose.
As an RN, licensed midwife, and CPM, one minute on the perineum is appalling. If the attendant WAITS until the next contraction, 2-3 minutes, then baby will almost always do the invisible work of lining up and birthing with little effort. IMO, your birth team caused an "emergency" where none existed, creating trauma for all involved, most importantly, mom, dad, and baby. In your schooling and clinical training, please focus on a calm managment of "sticky shoulders" versus a true shoulder dystocia. You will better serve families with more knowledge about this discinction.
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