In this post, you will read about Shoulder dystocia nursing interventions & nursing diagnosis
Shoulder dystocia is a medical emergency that can occur during childbirth. It happens when the baby’s shoulders get stuck behind the mother’s pubic bone after the head has been delivered. Shoulder dystocia occurs in about 1-2% of vaginal deliveries and is more common in larger babies or in women with diabetes or gestational diabetes.
When the baby’s shoulders get stuck, it can put pressure on the umbilical cord, which can cause the baby to become deprived of oxygen. This can lead to serious complications for the baby, such as nerve damage or brain damage. Shoulder dystocia can also cause serious complications for the mother, including severe bleeding and tears in the vaginal wall or perineum.
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Shoulder dystocia nursing interventions
Managing shoulder dystocia requires prompt and efficient action by the obstetric team. It may involve various maneuvers, such as applying suprapubic pressure, performing the McRoberts maneuver, or rotating the baby to reposition the shoulders. In severe cases, the obstetrician may need to perform an emergency cesarean section.
After shoulder dystocia has been successfully resolved, post-delivery care plans are also crucial. These involve closely watching the mother and the baby for any potential injuries caused by this condition, such as bruising on either party, as well as monitoring the fetal heart rate frequently until it has stabilized once more at normal levels. Furthermore, mothers may require additional pain management depending on the severity level experienced due to not only physical but also emotional stressors, which must be taken into account when developing individualized treatment plans tailored specifically to their needs.
Nursing diagnosis for shoulder dystocia may vary depending on the specific needs of the mother and baby. Some possible nursing diagnoses that may be applicable in this situation include:
1. Risk for ineffective tissue perfusion: related to impaired circulation from prolonged shoulder dystocia and fetal distress.
2. Risk for injury: related to nerve damage, brachial plexus injury, or other birth trauma during shoulder dystocia.
3. Anxiety: related to fear and uncertainty of the situation, potential complications for the baby and mother, and pain associated with shoulder dystocia management.
4. Deficient knowledge: related to lack of understanding of shoulder dystocia, the management procedures, and potential risks and complications.
5. Risk for impaired parenting: related to the emotional impact of shoulder dystocia on the mother-baby bonding and the potential long-term effects of birth trauma on the baby’s development.
6. Risk for bleeding: related to lacerations or tears in the vaginal wall or perineum during shoulder dystocia management.
These nursing diagnoses can help guide the nursing interventions and care planning for the mother and baby during and after the shoulder dystocia episode. It is essential for the nurse to closely monitor and assess the mother and baby’s physical and emotional status and provide appropriate interventions to ensure the best possible outcomes.
Nursing Interventions and Rationale
There are several nursing interventions that may be necessary in the management of shoulder dystocia. These interventions and their rationales include:
1. Alert the obstetric team: The nurse should immediately notify the obstetric team, including the obstetrician, anesthesiologist, and neonatologist so that they can be prepared to provide assistance and support. This is essential in ensuring prompt and effective management of shoulder dystocia.
2. Position the mother: The nurse should help the mother assume a modified lithotomy position, which can facilitate the delivery of the baby. The mother’s legs are flexed and abducted, and her feet are placed in stirrups. This position can also help decrease the pressure on the baby’s shoulders and reduce the risk of injury.
3. Apply suprapubic pressure: The nurse should apply suprapubic pressure to help move the baby’s shoulders out of the birth canal. This is done by placing the heel of the hand just above the mother’s pubic bone and pushing downward. This maneuver can help release the baby’s shoulders and facilitate delivery.
4. Perform the McRoberts maneuver: The nurse should perform the McRoberts maneuver, which involves hyper-flexing the mother’s thighs to her abdomen to widen the pelvic outlet. This can increase the space available for the baby’s shoulders to pass through and reduce the risk of injury.
5. Use rotational maneuvers: The nurse should assist the obstetrician in performing rotational maneuvers, such as the Rubin maneuver or the Woods’ screw maneuver, to reposition the baby’s shoulders and facilitate delivery. These maneuvers can help release the baby’s shoulders and reduce the risk of injury.
6. Prepare for neonatal resuscitation: The nurse should be prepared to provide neonatal resuscitation in case the baby experiences birth trauma or distress. This is essential in ensuring the safety and well-being of the baby.
7. Provide emotional support: The nurse should provide emotional support to the mother and her partner throughout the procedure. This can help alleviate anxiety and stress and promote a positive birth experience.
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The above nursing interventions can help ensure the prompt and effective management of shoulder dystocia, reduce the risk of injury to the mother and baby, and promote positive birth outcomes. It is essential for the nurse to work closely with the obstetric team and monitor the mother and baby closely to ensure their safety and well-being.
Shoulder dystocia is a medical emergency that requires prompt and efficient management by the obstetric team. As a crucial member of the team, the nurse plays a vital role in providing essential nursing interventions and support to the mother and baby during and after the procedure.