OB case: textbook with the wrong treatment?

[DwayneEMTP]

That's AFTER the baby is completely out of the birth canal and the cord isn't being squished by the baby and mama's vagina and all those contractions. After the baby is completely out, then the cord is basically a large hose through which blood passes...

Make sense? Cord + baby inside vagina = squished cord and no flow. Cord + baby outside vagina = no squish on cord.

Wendy

CO EMT-B

JINX...Next time I see you I get to punch you in the arm...

Dwayne

[crotchitymedic1986]

OK first of all, lets clarify what the book is saying. The quote is cord wrapped around baby's head, not neck (maybe it means head out with cord around neck, maybe it means cord is protruding out first, before the baby's head -- while it is crowning). Need to know which one we are talking about.

Regardless, you will be lucky to deliver 7 or 8 babies in your career, and probably half of those will be delivered before you arrive on scene, so this is a statistical improbability that you will encounter this problem. Nonetheless, if the head is delivered with the cord around its neck, and you can not remove it, I would cut the cord with trauma shears (not razor knife). I hope you have two OB kits or two sets of clamps, as you may have a few feet of cord that will need to be cut again.

Sidenote: I usually left my cords a little long, so that I could cannualize the cord with an IV needle if needed.

[Doczilla]

If you have a nuchal cord, reduce it. If you can't, then clamp and cut it. Same thing goes for a cord around the baby's head that is preventing delivery.

'zilla

[spenac]

OK first of all, lets clarify what the book is saying. The quote is cord wrapped around baby's head, not neck (maybe it means head out with cord around neck, maybe it means cord is protruding out first, before the baby's head -- while it is crowning). Need to know which one we are talking about.

Regardless, you will be lucky to deliver 7 or 8 babies in your career, and probably half of those will be delivered before you arrive on scene, so this is a statistical improbability that you will encounter this problem. Nonetheless, if the head is delivered with the cord around its neck, and you can not remove it, I would cut the cord with trauma shears (not razor knife). I hope you have two OB kits or two sets of clamps, as you may have a few feet of cord that will need to be cut again.

Sidenote: I usually left my cords a little long, so that I could cannualize the cord with an IV needle if needed.

I've delivered in the ambulance at least 6, plus a bunch more at the hospital while waiting for doctor to arrive. In the ambulance at least 2 of those had cord wrapped around neck. Thankfully was able to pull it over head and off neck so did not have to cut. So based on my stats there is a 33.3333% chance you will deliver a baby with cord around neck.

I agree 1 OB is not even good for 1 normal delivery. Every ambulance should have at least 2 kits and lots of towels.

I hope none of you are cursed to deliver in an ambulance. It is a slippery slimy messy process. You actually do nothing but clean up on a normal delivery. If you want to deliver do a shift in the OB department where you have room and people to help control the mess.

[firedoc5]

Nobody left me anything to say. :? I can only repeat that you do clamp and cut the cord if wrapped around the head/neck after attempting to remove it. You just don't automatically cut the cord just because it is wrapped.

[ERDoc]

Nuchal cords occur in 25% (Tintinali) of all births. Using crotches numbers (without any reference) that means that you will see 2 nuchal cords in your career. I would not describe that as a statistical impossibility but something that you should be prepared to deal with. Your OB kit should contain 2 clamps and a pair of scissors (if not, get a better OB kit). You will only need to cut once. Once you have a cut, both ends can be removed without any difficulty. Multiple loops do occur and should be treated the same as a single. Reduce all loops. If you find one that cannot be reduced, clamp and cut and the rest should fall away.

[crotchitymedic1986]

Spenac that is why you make a conscious choice: Can i make it to the hospital, if not, deliver at home, and let them clean up the mess. It is way to messy for the back of an ambulance, and god forbid if you are in a van.

[WolfmanHarris]

Umm... if we have an imminent delivery and there's no cord prolapse or limb presentation we deliver on scene.

Now Spenac's got a longer transport time than many of us (if I recall correctly) and it's more likely that a delivery becomes a lot more imminent on route.

[mshow00]

Let me clarify a little here, and apologize for the confusion. Our discussion was about the head having delivered with the cord wrapped tightly around the baby's neck. After a couple of attempts at manual manipulation the cord is still around the baby: so you have a baby who can not breath on their own due to the compression of the chest from the vagina and the strangulation due to the cord. So thats where the question comes into play: do you use your fingers to attempt to relieve pressure and "run like hell" to the hospital, or do you clamp and cut, around the neck, and pray for no more complications? It seems that there is no real pattern (ie old school vs new school) to being taught to clamp and cut.

*Clamp and cut is/was talked about as a last ditch effort*

[Doczilla]

"Clamp and cut" is a pretty simple, safe, noninvasive way to correct the problem you describe. Unless you run into a monster shoulder dystocia as well (sorry about your luck), the infant should deliver easily within a few seconds after doing this. I would prefer the medics clamp and cut than spend any time thinking about transporting with a nuchal cord that is unrelieved.

'zilla