Shoulder Dystocia and Student Nurses

April 21, 2018
This post is late as we did not have good enough bandwidth to access the blog while in Baglung.

On this day we started off our morning with two women in labour. One was being induced with oxytocin and one had been transferred from another community to give birth. We were excited to catch some babies. The local obstetrician was called in to assess both women and one was taken to the operating theatre for an emergency cesarean section. Both mom and baby were well.


The other women progressed quickly and soon was pushing. She was supported by two women and was coping well. Here they keep the women in the labour room until the head is visible on the perineum. The woman was standing and pushing fully dressed and it was difficult to assess her progress as we could not see what was happening.

labour ward

After some time we moved to the delivery room. Together with Cathy we practiced slow delivery of the head over many contractions. There were many SBAs and student nurses in the room watching. It is so very different from what we are used to in BC.

delivery room

The baby's head came very slowly so we knew we should be prepared for a shoulder dystocia as the baby also appeared that it may be larger than average by the size of the mother's abdomen and the slow descent of the head.

This is on the wall of the delivery room

Once the head was born we checked for a nuchal cord (cord around the neck) and there was one. We also moved the mother from lying on her side to her back because we were anticipating needing to perform some manouvers for resolve shoulder dystocia.

We flattened the bed and put mother into McRoberts position to open the pelvic outlet, followed by Rubin's to reduce the anterior shoulder.

See Perinatal Services BC guidelines for shoulder dystocia.

Baby was born and was placed on mother's abdomen and dried and stimulated. We left baby skin to skin while we waited for the placenta to be delivered. Both mom and babe were well when we got them settled in the postpartum ward.

In the afternoon we hosted a video session for the nursing students. After working with them through a difficult birth it felt good to get together for an evening of fun. They are in their third and final year of nursing school. They have been so helpful to us while we have been in Baglung. We had so much fun sharing some videos from the Global Health Media Project about giving good care in labour, immediate care of the newborn, keeping baby warm, and initiation of breastfeeding. We also demonstrated different positions for labour and pushing along with some comfort methods. It was so much fun to share and practice with them.