Wednesday, May 14, 2008

Shoulder Dystocia

A few weeks ago we had a non-English speaking woman come in for induction. Her midwife had told her that she recommended a C/Section due to her last delivery being a bad shoulder dystocia (risk factor #1). The patient refused and they proceeded to induce her early in the hopes of preventing a replay. She progressed very very slowly (risk factor #2) and went into the next shift where "worry-wart midwife" took over care. She and the new physician on call talked to her several times about risks. She wanted to continue on vaginally. Everyone (the physican, NICU, anesthesiologist, scrub tech, and all the nurses on that night) was notified of the potential problem. She got complete and started pushing. Now, keep in mind she is a multip without a block. Normally pushing doesn't take very long. We kept the interpreter at bedside (which pissed her off). When she got crowned up we had a circulating RN, two other Birthing Center RN's, a scrub tech, the physician and Respiratory Therapy at bedside. She pushed and pushed and pushed and the head inched out (risk factor #3). She was reminded of the plan of care. It was horrible. I was up on my stool WAY before the head delivered, ready to start suprapubic pressure. McRoberts had already been done and I started suprapubic with the complete delivery of the head. I rocked on that pelvis for what seemed like forever, stopping at the physician's direction (the midwife handed over care midway through the delivery of the head when we all realized that it WAS going to be a replay of her last experience). He ended up delivering the posterior arm, breaking the humerus in the process and baby went straight to NICU. The physician told her again that she should NEVER have another vaginal delivery. We'll see.


AtYourCervix said...

The mother took on the risks when advised, so try and at least think of that. You did all you could as the nurse, and you were all well prepared for the possible outcomes.

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