Monday, October 4, 2010

If It Scares Us It Must Make Us Stronger...Right?

Every nurse has experiences that they never forget....shoulder dystocias are some of those experiences. Not going to go into detail....but all 7 nurses and the doctor were shaking pretty bad after a very cute and chubby baby destined to be a linebacker came out safe and sound. Scenarios like that are what put lots of things into perspective:
~the high acuity of what I get to do every night
~the great teamwork we have as a unit
~and why home birth is such a bad idea in my book!
This mom didn't push very long, nobody would have guessed after a recent sono showed a <7# baby that he'd be a tight fit!! If this mom had tried to deliver at home, the outcome would not have been good.....for her or baby.

On a less tense note...I got to deliver a baby for one of my friends from church this week. Those are so fun! Not only do I get to help Mom and Dad welcome their new baby but I get to watch her grow up over the next couple years. It's like a premature ending when I deliver a baby and then move them over after 2hrs and maybe see them one more time. I don't usually get to see the "continuing project" over the next few years! This is the fun way to do it!

It feels like maybe our crazy summer is winding down. The last few nights at work have been a little more relaxed. Several deliveries, but not the crazy non-stop, no more rooms, no more nurses pace we've been running all summer. A total of 339 babies in September! Waiting for the 2 sets of triplets to come in any day this month.....

Babies this Month:1m

Babies total: 111M/122F = 233
Vag:82M/94F = 176
C/S: 29M28F = 57
Babies 'caught' = 2f1.5m


  1. ooh, i hope you can (vaguely) post about the triplets!

  2. I LOVE seeing the children as they grow up! Too bad that we rarely get to see them beyond the first few hours of life :-(

  3. out of interest, I'm wondering what you had at hospital that a home birth wouldn't have?

  4. But honestly, if it was a homebirth, mom would definitely not have been pushing in the lithotomy position, she probably would have been squatting or on hands and knees, both of which open up the pelvis wider to make the baby fit through easier. I've seen 7 pound SDs in the hospital in lithotomy, and 13 pound perfect births hands and knees at home. It's all about the position.

    And if an emergency did occur at home, a midwife is very trained to handle it. Please don't put down homebirth, as it really is a safe option for most moms.

  5. Out of curiosity, was your shoulder dystocia mom laboring without medication, or did she have an epidural? One big advantage of homebirthing is that the moms are always unmedicated, and therefore are laboring and birthing upright (which can prevent a lot of shoulder dystocia) and when SD does occur, they can flip right over into the Gaskin maneuver which resolves almost all SD immediately or with greater ease than trying to resolve SD on a prone mama. Does your hospital use the Gaskin maneuver, or only McRoberts and suprapubic? I'm interested in hearing about your protocol, as my experience is solely with homebirth. Thanks for the blog! I'm really enjoying reading about your experiences.

  6. Baloney homebirth is safe....most labors are low-risk----until they aren't!---and do you want to be the one? Dead or brain-injured babies are the downside that no one wants to talk about, even MANA hides the data it gathers. If said data were unquestionably good, they would be shouting it from the rooftops.

  7. Seeing as how you've never seen a homebirth, and admittedly don't know much about htem, then how can you say they aren't "safe" based on one birth?

    A woman comes to the hosptial, has AROM, then a cord prolapse. maybe i can say that hospital birth isn't "safe" based on that one birth?

    and, some things to think about-
    1. ultrasounds aren't accurate in determining size near term. shouldn't be used to make a decision that a baby is "too big" to come out.

    2. did the SD mom have an epdiural? was she pushing on her back? did the doctor use a vaccuum? all of these are risk factors to shoulder dystocia that would not occur at home

  8. I have seen 2 Sd in homebirths, both babes were delivered using the Gaskin maneuver. It works better IME than mcroberts with suprapubic pressure. I have had half a dozen sd's in the hospital to compare it to. The Gaskin is nearly impossible in the hospital because of stirrups, cords, and epidurals but it works better than anything I have seen in the hospital. Homebirth is the safest option imo for a healthy low risk mom.

  9. Also, when mom can hold up her own weight you don't need nearly as many people or special equipment to get her into various positions. I don't think anyone thinks home birth with an epidural would be safe, and when a complication arises, mom being able to move and support her own weight makes a huge difference.

  10. I really love your blog! I want to be a Labor and Delivery nurse as well. I'm in college working my way toward Nursing School. Reading your blog keeps me motivated and excited for my future job

  11. Here's a nice video showing clips from a workshop on resolving different types of shoulder dystocia:

    It looks *very* interesting! [And I love the props she uses.]

  12. About 2 weeks ago we had a severe dystocia - thank God one of the most experienced docs was on. As the NICU nurse was very traumatizing. I have seen lots of shoulders before but this was the worst. I swear I thought I was watching the baby die in front of my eyes. But he didnt - spent the night in the NICU and did well.....but I cried all the way home that night out of sheer relief and adrenaline dump.

  13. BTW - I know the McRoberts - I know the Zavanelli (heck, worked with the man!) but I dont know the GAskin maneuver....can someone explain it so that a NICU nurse would understand? Thanks

  14. Wow! Too many babies are born on September, eh. Ah, L&D is quite a stressful job yet a very happy one. Just by looking unto those newly born babes is enough evidence that nursing is a very rewarding job. :)

    Take care,
    Peny@dickies uniforms