Shoulder dystocia is a clinical emergency during vaginal delivery, where one or both of the baby’s shoulders intertwine. It is serious and should be diagnosed and treated as soon as possible for both the mother’s and the child’s wellbeing. Nurses play significant roles in the prevention and treatment of this clinical emergency. They have to apply their knowledge in medicine and experience to ensure they approach it calmly for safe delivery. If they fail, serious health issues like paralysis, arm weakness, or death can occur. Nurses’ different roles include being aware of and reporting risk factors for shoulder dystocia. They must provide important care and follow up with both mother and child after the birth. Nurses’ roles in preventing and treating shoulder dystocia are discussed in this research paper.
Detecting signs or risks of having shoulder dystocia is nurses’ first and most important role before delivery. This generally protects the mother and child by ensuring health personnel are ready to deal with the emergency. Because of shoulder dystocia, it is hard to get the baby out during vaginal delivery. Even if the shoulder is rotated beyond its normal range, the anterior shoulder cannot be delivered with normal lateral traction under the symphysis (Rodis, 2018). If these complications come as a surprise during delivery, the child may lack oxygen and die, which may also endanger the mother’s life. Therefore, it is essential to recognize the risk factors of shoulder dystocia early to prepare for prevention and treatment.
Another role nurses play is to actively participate in the prevention and treatment. For example, when shoulder dystocia happens, some pregnant women may have their doctor or midwife apply light physical pressure to the head of their fetus (van de Ven et al., n.d). This allows women to push their posterior fetal shoulder deeper into their sacrum, allowing their anterior shoulder to pass under their pubis so that they deliver. They also need to keep a record through this delivery process, showing they did everything they could to save the baby and mother. If they fail, they could face legal consequences and serve jail time (Glasper, 2018). Therefore, a delivery record should be kept that shows what happened, how it happened, and what the next steps should be taken to keep the mother and baby safe if it is still alive.
Nurses also advise pregnant women on healthy living during pregnancy so that delivery is safe. For example, the nurse advises pregnant women on losing weight and keeping their blood sugar in check. This includes explaining, reinforcing, monitoring, and coaching them to continue doing what they have been doing if it promises a safe delivery. Pregnant women with diabetes and obesity may be extremely grateful for the assistance of a nurse in obtaining the proper care (Santos et al., 2018). As nurses play this role, they need to ensure they do not force their patients to do anything. Some may not afford the lifestyles proposed by nurses because they do not have enough money. However, nurses can be creative, finding cheap alternative ways to keep their patients safe for delivery.
Another nurses’ responsibility is to be aware of any antepartum risk factors that may make childbirth difficult. The nurse closely observes the woman’s dilation and descent and other risk factors in her history and physical examination. They may use the Friedman curve, recommended by the American College of Obstetricians and Gynecologists, to measure how quickly labor progresses (Macones & Gherman, 2020). If there are any changes in pain or if the size of the caput succedaneum grows, the nurse should immediately inform the doctor. When the child’s head comes out of the birth canal, and there is some resistance in the patient’s anterior shoulder, nurses do various things. The fetal monitor should display how the head looks and moves. It is possible to reconstruct the delivery events for the final record to correspond (Macones & Gherman, 2020). Keeping track of time and reporting on the fetus’s heartbeat, the doctor or midwife may be able to help stabilize the situation. Nurses need to be observant when playing this role, ensuring all the machines are running properly and the records taken are accurate as delivery continues.
Keeping a close look at the mother and improving her comfort is another important role for nurses. It is critical for the mother to be checked out and stabilized as soon as the baby is born. According to Macones and Gherman (2020), Severe bleeding and bladder damage are considered, and treatment is initiated if necessary. Nurses should be attentive in the first four hours of delivery, solving any issue that may arise. Intravenous fluids or blood products may be administered based on lab tests. Macones and Gherman found that uterine massage keeps the woman stable and monitors her vital signs, responses, intake, and output (2020). Nurses who have been trained in pelvimetry assist the patient and her family in understanding what is going on. They can talk to the patient, ensuring that everything will be okay. The family, especially the husband, may need information if the delivery process is prolonged, and the nurse in charge should ensure he is fully informed.
Even the most composed and experienced doctor or midwife becomes concerned when the baby’s head emerges with shoulders stuck. The most important job of a nurse is to respond calmly and help solve the emergency (McArdle et al., 2018). Shoulder dystocia specialists want to remove the baby’s shoulders from the mother’s pelvic cavity safely for everyone. It does not take long after shoulder dystocia is corrected for vaginal and cesarean deliveries. It is the responsibility of the delivery provider to ensure that the baby is born on time and safely. There are numerous effective treatments for shoulder dystocia, so it is critical to be aware of them. It is determined by the baby’s location in the pelvis and the doctor’s or nurse’s level of experience. When one move fails, it must be possible to switch to another quickly.
Overall, when dealing with shoulder dystocia, nurses begin by alerting everyone on the obstetrics care team. They then execute primary operations, assist the provider with secondary interventions as needed, and keep the team informed of the time elapsed. Nurses also share information about steps taken while treating dystocia, including the order and time they were completed. Nurses also play an important role in reducing the stress and confusion experienced by women and their families during and after childbirth. Every healthcare facility should have a plan for dealing with and caring for patients suffering from shoulder dystocia. Even if shoulder dystocia is uncommon, nurses must be prepared to deal with it. When shoulder dystocia is discovered, they only have a few minutes to safely deliver the baby and save the mother if it is possible. Preparing for shoulder dystocia entails staying current on obstetrical best practices.
References
Glasper, E. A. (2018). Promoting honesty and truthfulness when things go wrong during care delivery for sick children. Comprehensive Child and Adolescent Nursing, 41(2), 83-88. Web.
Macones, G. A., & Gherman, R. B. (2020). Shoulder Dystocia. Protocols for High‐Risk Pregnancies: An Evidence‐Based Approach, 581-586. Web.
McArdle, J., Sorensen, A., Fowler, C. I., Sommerness, S., Burson, K., & Kahwati, L. (2018). Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(2), 191-201.
Rodis, J. F. (2018). Shoulder dystocia: Intrapartum diagnosis, management, and outcome. U: UpToDate, Lockwood CJ ur. UpToDate [Internet]. Waltham, MA: UpToDate.
Santos, P., Hefele, J. G., Ritter, G., Darden, J., Firneno, C., & Hendrich, A. (2018). Population-based risk factors for shoulder dystocia. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(1), 32-42.
van de Ven, J., van Deursen, F. J., van Runnard Heimel, P. J., & Mol, B. W. (n.d). Effectiveness of team training in managing shoulder dystocia.