Re: Emporia obstetrics unit to close
From: Anna Meenan, MD (annam@uic.edu)
Sun Dec 5 08:51:23 2004
An OB ER doc.....I've never seen that. The funny thing is, the ER docs
here are perfectly comfortable being up to their elbows in bloody trauma
cases, but if a woman in labor appears at the door, they go pale and
rush her up to L&D.
--
Anna Meenan, MD
P.S. My very first shoulder dystocia was an 11lb3oz baby when I was a
resident. The attending OB was called and he just stood in the doorway
of the delivery room and said "Pull! Pull harder! Thank God that kid
didn't get a BPP. Just a cracked clavicle, as I recall.
At Sun, 5 Dec 2004, Len2976@aol.com wrote:
>
>Anna--
>
>I know exactly how you feel. In 28 years of midwifery practice, I have had
>a few cases of mild to moderate shoulder dystocia--one about 9 years ago was
>an 11# 2 oz, VBAC (#2) scheduled for IOL (cervidil at that time--but no
>longer!) by the obstetrician I worked for at that time. I finally (after about 1
>min) was able to rotate the shoulders obliquely--baby fine. Her first baby
>was a C/S due to a breech presentation, which weighed 8 1/2 #. Her second
>delivery was a 9 # VBAC. The EFW with this one (by U/S) was 9#. When I told my
>boss the weight (and reminded him that we induced an 11+# VBAC) the next
>morning, his face got very pale.
>
>Last November I had a case of severe shoulder dystocia. The patient was a
>42 y/o G5, P4. She was scheduled for IOL by the OB I work for. I had never
>seen the patient before--she was followed exclusively by the obstetrician.
>When I arrived on the ward in the morning, the IOL was already in progress. I
>reviewed the prenatal record, which was totally negative. I went to the
>room, introduced myself, and had a discussion about past deliveries and plans for
>analgesia or anesthesia. The response was that her last delivery was so
>fast that she had no time for any meds for pain relief.
>
>She was 4 cms. dilated and fairly comfortable when I examined her. I left
>the room to go to write up her admission note and 15 min.later was called to
>the room that the patient was pushing. The usual scenerio with SD occurred
>and the normal protocol followed: McRoberts, suprapubic pressure, called for
>help (my employer OB, "any OB" in house, the ER doc, the RT team), episiotomy
>(although I doubt that really helps). I was not able to rotate the shoulders
>at all. Finally delivered baby after rotating mom to hands and knees--which
>did not work--but when I rotated her back was able to deliver the posterior
>arm and then the baby--after 8 minutes--with initial apgar of 0. Baby was
>immediately bagged and tubed. At that point the OB I work for arrived.
>
>Later I learned:
> The ER doc who came, watched, but offered NO help was an obstetrician!
> The patient volunteered that this had occurred with two other
>deliveries. She had been told that her oldest child (now 22 y/o) would never be
>normal--according to her, he is. With the delivery prior to this (that had
>progessed so "fast") there had also been "problems" with delivery of the shoulders.
>She just neglected to say anything during her prenatal visits--since they
>were OK now she didn't think it important.
>
>The baby was transferred to a high risk center as we didn't have a NICU at
>that time--we do now. I anticipated being told he had died, but learned 2
>days later he was off oxygen and discharged about a week later. The weight of
>this baby was about 7 1/2 #-- right about the same as her other 4. At the
>time of 6 week check--and at 6 months according to the pediatrician--baby doing
>"fine"--which I find hard to believe after being born with a 0 apgar.
>
>After 13 months I still wait daily to be served with papers. Luckily the
>hospital paid for all OBs and CNMs to have NICA coverage.
>
>Lenora McCall, CNM
