Obstetrical Emergencies BC

I was wandering around on the Internet and I stumbled across a Workshop Presentation by  Perinatal Services BC in May 2010.

 It's a great presentation by an RN and 3 MD specialists - one of which I knew as a Resident when I was working as an L&D RN at a particular Hospital.  She was fabulous and when she decided to go into Obstetrics as her specialty....we were all thrilled (Yay Jen!).  The hospital that has her practicing there is very lucky. 

Also, in the audience, I recognized at least 3 of my former co-workers.  

Here is the presentation.

  It is at least 3 hours long, if you have the time - it is well worth a look.  Hopefully, if you are in the USA, you are able to view it.  It is a great presentation for student nurses as well as RNs.  I would use a little caution if you are a pregnant mom and have no medical background because some of the things discussed, you may not want to hear.

The first part by the RN was a bit of a snooze - but a good refresher nonetheless - the physiology of a Normal Delivery.   Following her are 2 Obstetricians and a Neonatologist giving very interesting presentations backed by numerous studies.

  Here are a few of the highlights in case you are interested : 


- You don't need to do an episiotomy to deliver a shoulder dystocia.  It is not a 'muscle' or 'tissue'  problem but a bone on bone problem.  You also don't need to do an episiotomy for an assisted delivery.  Studies have shown that increased peritoneal trauma occurs with routine episiotomies.  Be patient!!!  Allow the perineum to stretch on its own!

-  Mom pushing on all fours is desirable and is helpful in a dystocia and also with malpresentations.  Delivering on all fours is generally a good idea.

-  Second stage starts when a woman is fully dilated AND has the urge to push.  Take care when diagnosing prolonged 2nd stage -  2nd stage is diagnosed incorrectly if woman is pushing without the urge to push.

-  Physiologic pushing is best and we should modify how we encourage moms to push.  In other words, shorter pushes without breath-holding  - which the mother does instinctively -  until the very end.   We need to do away with those 2 hours of 10 second-breath-holding-counting-to-ten pushes with each contraction.  All it does is exhaust the laboring mom.

-  "Rotisserie" of mom is a good thing.  In other words....keep changing positions throughout labor.  Moving and mobilization is desirable and is proven to be beneficial to mom and the delivery of babe.  There is a drop in interventions in labor when a woman is allowed to mobilize.

-  Mom is the best incubator if you have to do a transfer to another hospital.

-  With careful case selection  and management, it is reasonable and safe to deliver breech.  Vaginal breech delivery is now an option for some Canadian women.

-  Low dose asa is being revisited as a treatment for prevention of preeclampsia.

-  It is beneficial to delay cord clamping.

-  IV oxytocin should not be given IV push post partum unless mother is on a cardiac monitor.

-  Treat a mother presenting with intrauterine demise (IUD) as a DIC unless proven otherwise.


Most of the information above doesn't surprise a lot of us L&D RNs....except that it is coming from Obstetricians.   In BC we are lucky to have a Perinatal program that seeks to optimize Neonatal, Maternal and Fetal health care throughout the Province.