rob&lucy

I did something awful at work the other night and can't stop thinking about it. Basicaly i was caring for a just teenager (huge sexual abuse history) in labour. Not surprisingly she was all over the place when it came to transition then pushing. Anyway i had a second midwife with me as she was on the morning shift. I got her to control her pushing and we delivered the head, it restituted and i felt cord round neck so i looped it over. Colour of babys head was not nice as it was grey/blue. In my head i am thinking oh shit. Got girl to open legs (i am kneeling between them) went to pull baby out and it was stuck. We both then pulled and nope no baby. The 2nd midwife then helped me get her legs back (mcroberts) and no baby. Then it was suprapubic pressure and the emergency bell. I ended up doing an internal rotation of the babys arm and co-ordinated it with the second midwife using the suprapubic pressure when i heard a "click". Got baby out needed resus (Apgar 4 at 1 and 8 at 2)and off it went to the SCN. I went round later and was told that the baby had a fractured clavicle. I said i had done it and let the parents know too and explained how/why this had happened. Now i know it is a risk with the manoeuvres etc but i feel so bad and hear the sound when i broke the clavicle. I know it will heal and the baby was not having any problems with the arm etc. Just wondering if i could have done any better or some feedback from anyone else...

Tass

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Ok , lets read this again.Using your words ,

Not surprisingly she was all over the place when it came to transition then pushing.

Already a lot of diplomacy needed and I imagine a very hard case . Fling you in at the deep end !

Anyway i had a second midwife with me

If you had done or were doing anything MAJORILY wrong you had another professional there with you who could have intervened at any point.

i felt cord round neck so i looped it over. Colour of babys head was not nice as it was grey/blue. In my head i am thinking oh shit. Got girl to open legs (i am kneeling between them) went to pull baby out and it was stuck. We both then pulled and nope no baby. The 2nd midwife then helped me get her legs back (mcroberts) and no baby. Then it was suprapubic pressure and the emergency bell. Got baby out needed resus (Apgar 4 at 1 and 8 at 2)and off it went to the SCN.

mmmmmm, let's consider the options here. You sound TOTALLY in control of the whole thing and delivered a LIVE birth with the minor complication of a # clavicle.Without a doubt you did absolutely everything you could to save the baby and any futher complications for the mother. In the eyes of the NMC or the trust you work for , there can be no wrong doing on your behalf.
I know it's hard when you know it's you that done it , but it sounds like an EMERGENCY situation and you know that you did really well to achieve the outcome you did.If it had been a home birth or a less experienced midwife you could not have garaunteed it would have all worked out so well.
Try not to dwell on the negative , focus on the good and learn from the mistakes. ( although I still can't see that there was any mistakes here ).

Hope this helps and makes you feel a wee bit better.
Does your unit offer debriefing either in formal or ( usually & better ) an informal manner.

Tass

undefined

Ok , lets read this again.Using your words ,

Not surprisingly she was all over the place when it came to transition then pushing.

Already a lot of diplomacy needed and I imagine a very hard case . Fling you in at the deep end !

Anyway i had a second midwife with me

If you had done or were doing anything MAJORILY wrong you had another professional there with you who could have intervened at any point.

i felt cord round neck so i looped it over. Colour of babys head was not nice as it was grey/blue. In my head i am thinking oh shit. Got girl to open legs (i am kneeling between them) went to pull baby out and it was stuck. We both then pulled and nope no baby. The 2nd midwife then helped me get her legs back (mcroberts) and no baby. Then it was suprapubic pressure and the emergency bell. Got baby out needed resus (Apgar 4 at 1 and 8 at 2)and off it went to the SCN.

mmmmmm, let's consider the options here. You sound TOTALLY in control of the whole thing and delivered a LIVE birth with the minor complication of a # clavicle.Without a doubt you did absolutely everything you could to save the baby and any futher complications for the mother. In the eyes of the NMC or the trust you work for , there can be no wrong doing on your behalf.
I know it's hard when you know it's you that done it , but it sounds like an EMERGENCY situation and you know that you did really well to achieve the outcome you did.If it had been a home birth or a less experienced midwife you could not have garaunteed it would have all worked out so well.
Try not to dwell on the negative , focus on the good and learn from the mistakes. ( although I still can't see that there was any mistakes here ).

Hope this helps and makes you feel a wee bit better.
Does your unit offer debriefing either in formal or ( usually & better ) an informal manner.Find someone you trust to bounce it all off and then hopefully it will make it all a bit easier.
Take care , post again if you need to , the virtual world is listening.
All the best ,
Tass.
Karma sent.

Tass

OOPS , Sorry the 3 rd entry is the right one !

rob&lucy

Thanks for that. I think it's because i heard the snap and it was a baby and my first that makes me feel so bad. I do feel a bit better now and re-read my ALSO coursebook on shoulder dystocia so ok there. There was no hope of a debreif that morning as we had 2 crash caesars and a full unit. My boss is an remarked that she's not working nights with me as i had a PPH one night and a shoulder dystocia the next!!

tiredwithtwins

Im sure this only demonstrates what a skilled, competent, calm professional you are - and a caring one to go and check on the babe later.
remember what accountability is - as long as you can account for your actions in a certain circumstance, you have no worries.
unfortunately we live in a litigious society, which makes any nurse/midwife/healthcare practitioner permanently nervous!
chin up.....you did a fantastic job!

davepoole

Im not a midwife but an AE nurse and if it was my kid id rather he have a fractured clavicle than brain death from lack of Oxygen, sounds like that baby need to get out of the mother as quick as possible, so thumbs up for quick thinking and actions,

ireland

Hi Lucy not a midwife but you did brillant as any mother would tell you and from a nurse point of view you did your job and did what was expected of you and delivered a live baby in the circumstances (cord around the neck) well done love ireland

Tass

Hi Again !
I think the fact that the boss joked about working with you again is a great sign. If she really meant it you would have known about it ! Jokes like that are usually only made when you have a "re assurance " that the nurse / midwife is worth their weight in gold.
You'll never forget it either which can be a positive because you'll be able to offer support to the next one that does it.
All the best ,
Take care ,
Tass.

rob&lucy

Thanks everyone for your support. I'm doing another night tonight so who knows what will come in. I reckon it was her thrashing around that brought the shoulders down together instead of one by one and hence a problem. I just need a nice straight forward delivery to put my mind at rest i think. Also i have to collar the medical student who was observing as i only had a brief chance to see if she was ok before she was off to theatre. Will have butterflies but hey who wouldn't

lynnlovessun

Well done - i'm not a midwife but by the sounds of things you have done very very well - A similar birth was covered on a gritty hospital drama on TV, and the obstetrician also had to break the baby's clavicle to get it out - its that or the baby dies. You have been able to justify all your actions and best of all you had a witness too so you are fine.

Good on ya,
Lynn

jimtrish

hi lu,

as i said earlier, we do get this on scbu, and all the parents will say they would rather a live baby than a hypoxic baby or dead. you did a fab job and the girl will be thankful that such an experienced and caring nurse cared for her and her baby at such a traumatic time.
take care mate

Trish
xx

lynnlovessun

Hi Scuba nurse

jimtrish

nearly missed you lynne, was out on the reef
how are you hun?

lynnlovessun

Seen any big fish lately!!??? Must be lovely working out on the reef for a living!!!!!!! I envy you

I'm good anyway - just getting peed off waiting, but only being impatient - it will be 9 weeks on thursday since the visa went in - obviously cock up with the meds (Dr had them on her desk for 2 months till I found out, they are now getting sent Saturday, so much for frontloading/ sending meds unrequested!!! ) but still on track timeline wise.

Good luck for the exam results on Friday.

Sorry to temporarily hijack thread Lucy

Lynn x