The simulated experience of Amelia Sung’s case made me feel a little bit anxious but overall in control of the situation. Labor and birth in humans are two events that can easily go wrong with long-term adverse consequences. For this reason, I had to be careful about each decision and make sure that it is correct and reasonable. I think that overall, my responses were justified, especially, my decision to educate the patient because from there, we could work together, and Amelia was not as confused about the course of actions. McRoberts’ maneuver helped the patient deliver the child, despite its initial head retraction.
The birth of Amelia Sung’s child was complicated with shoulder dystocia – an event when the baby’s anterior shoulder becomes stuck above the woman’s pubic bone. Because of this disadvantageous position, the baby’s head became retracted back into the vagina as evidenced by the “turtle sign.” Unfortunately, due to gestational diabetes, the patient had higher chances of birth complications, to begin with. Women with diabetes have a 4-6x risk of fetal demise and 2-3x risk of shoulder dystocia, as compared to women with no such condition (Hussain et al., 2020). Shoulder dystocia is fairly difficult to predict, which is why it is the nursing actions during delivery that impact the outcome (Hussain et al., 2020). There are several maneuvers that a nurse can use to help the patient deliver, such as the McRoberts maneuver with suprapubic pressure that was applied in the present case. Sung’s legs were hyper flexed to her abdomen; the nurse’s fist was placed above the maternal pubic bone to push the impacted shoulder in the direction of the other one.
About every tenth birth complicated by shoulder dystocia results in brachial plexus injury (BPI), which can lead to a loss of strength and movement in the arm below the impacted shoulder. Another possible long-term consequence is Erb’s Palsy caused by the stretching of the nerves in the baby’s upper arm and shoulder area. As a result, the baby is likely to suffer from arm function impairment and even total paralysis of the impacted shoulder. Among other consequences are arm or shoulder fractures and oxygen starvation (Hussain et al., 2020). In turn, the mother may experience vaginal or perineum tearing, uterine rupture, and heavy postpartum hemorrhage (Hussain et al., 2020). Apart from that, birth complications can traumatize the mother emotionally and even contribute to postpartum depression.
Managing Amelia Sung’s may require the involvement of an interprofessional healthcare team. An ob-gyn should continue seeing the patient and make sure that she is healing well if complications, such as vaginal or perineum tearing, take place. It is not uncommon for women who suffered birth complications to require psychological counseling. The baby may need a visit from a pediatric orthopedist and a neurologist to assess the state of its impacted shoulder and arm function. The patient safety checklist should include points such as antepartum documentation (assessment of pelvis, history of prior shoulder dystocia), intrapartum documentation (mode of delivery, maneuvers utilized, etc.), and postpartum/neonatal documentation (perineal assessment, hemorrhage monitoring).
Reflecting on Amelia Sung’s case, I would not remove the fetal monitoring device to keep up to date with all the changes. Given that induced labor is a risk factor for shoulder dystocia, I would think twice about this decision. In some cases, waiting for labor to begin on its own may prevent further complications. The case taught me that when it comes to labor, risk factors play a major role in shaping the mother’s and the baby’s outcome. I will study medical history to identify risks before making any decisions.
References
Hussain, S. A., Smith, A. M., & Cross, J. A. (2020). Diabetes, Fetal Demise, and Shoulder Dystocia: The Importance of Glucose Screening to Prevent Catastrophic Obstetric Outcomes. Case reports in obstetrics and gynecology, 2020, 8142109. Web.