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#1 of 19 Old 06-02-2007, 05:40 PM - Thread Starter
 
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I am an L&D rn and have been there for 18 months now (came from being a homebirth midwife assistant)
Is it normal practice to section a hand presentation? It just seemed weird when I got back to work and a pt. I had admitted for induction that morning had got to complete (a multip) and was sectioned because of a hand.
I never experienced this in the homebirth arena and now have seen it twice at work.
If you weren't to section, how do you deliver a hand presentation?
thanks
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#2 of 19 Old 06-02-2007, 05:58 PM
 
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Wow. I've heard of a lot of births that had nuchal hands. I've personally seen two, and I've not been at that many births.

The way they were delivered was just like any other delivery, except that there was tearing with both. HTH!
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#3 of 19 Old 06-02-2007, 07:47 PM
 
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Was the baby not descending with pushing or something? It seems like a weird call to make if everything else was progressing normally.

My dd was born with her hand by her head--no one realized it until hand/head were coming out together. Other than the second midwife jumping in to hold her hand/arm in place until her shoulders were out (to avoid her arm/shoulder getting injured and me tearing), there wasn't any difference between hers and my other births. She came out so quickly that I didn't even notice the second midwife wasn't a few feet away until after I was holding her. She was perfectly fine other than a small bruise on her arm that developed the over the next day or two (either from my pelvis or the midwife's hand) and I had no tearing.

Scary to think that I might have ended up with a c-section instead if the wrong dr. had noticed in advance.
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#4 of 19 Old 06-02-2007, 07:59 PM
 
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My son was born at home with a nuchal hand, and MWs here are very regulated so if it was something considered risky AT ALL she'd've been obliged to transport me for at least a consult. My girlfriend says she was watching him get born, saw the hand and didn't understand what she was seeing, so she said, "what's that?" I guess the MW didn't register it right away either, becuase my friend said that she took a moment, then went, "oh, it's a hand" and took hold of it an pulled it forward.

I didn't tear at all. And he was 8lbs5oz with big bones, so not a "little" baby, either.

So yeah... that seems pretty darn weird to me.

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#5 of 19 Old 06-02-2007, 08:24 PM
 
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I wouldn't think that would normally be a go to for a cesarean, a good friend had a baby with a nuchal hand 7 years ago and although she did have a 3rd degree tear, there was never any talk of a cesarean. MY 3rd was born with his hand across his chest with his elbow over his chin area, that was a very interesting crown/pushing feeling but I didn't tear and he was fine. I would think that in most cases a hand wouldn't be discovered until imminent and waiting to trasfer the mother into the er would be more dangerous than proceding with eerything. Although I can see where any amount of intervention can be considered routine in some hospital situations.

My youngest was UC and he was a face/brow presentation, his face was immediately maroon/purple and he had bruising for about a month ( even with arnica and ruta). We transfered to the NICU and the doctors there (excluding the residents) were confident that he would have had the same presentation at the hospital and the same outcome ( looking like a baby racoon).
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#6 of 19 Old 06-02-2007, 08:49 PM
 
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ds was born with with a nuchal hand at a hospital with a mw... pushing hurt more than labor with that hand and I had multiple 3rd degree tears. c/s talk never came up, thank god!
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#7 of 19 Old 06-02-2007, 09:27 PM
 
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Quote:
Originally Posted by purplepaisleymama View Post
I would think that in most cases a hand wouldn't be discovered until imminent and waiting to trasfer the mother into the er would be more dangerous than proceding with eerything.
Also I can't imagine having TIME. If the mama is unmedicated and her body is doing the pushing, that is. For me, I'm a bystander when the pushing starts, my body just GOES like a freakin' freight train and I'd like to see any ER be prepped and ready before I had that baby's hand AND head out, if not the entire body. I mean, by the time they found his hand, with the next push his head was out. So how do they have time to section?

Oh that gives me another thought - OP was she having trouble pushing?
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#8 of 19 Old 06-02-2007, 09:40 PM
 
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My DD was born in a hospital with a compound presentation (hand at check). I did have a 4th degree tear. No one mentioned a section.

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#9 of 19 Old 06-02-2007, 11:13 PM
 
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Yeah, I've seen tears with nuchal hands, but even mentioning a section has never come up. And I live in a VERY high c/s rate area.

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#10 of 19 Old 06-02-2007, 11:44 PM
 
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I have never heard of a c section for a nuchal hand. Not ever. How odd.
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#11 of 19 Old 06-03-2007, 12:59 AM
 
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*blinks* My son was born in the hospital and had a nuchal hand (as well as a fat head), and other than a relatively long pushing phase and a second degree tear, nothing unusual happened. I'm pretty convinced I wouldn't have torn if it wasn't for the hand, but I forgive him
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#12 of 19 Old 06-03-2007, 03:38 AM
 
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My dd was born with a nuchal hand. I had a homebirth, and she was 9lbs. 8 oz. I had no tearing and she came out in seconds. She is my fourth child, though, and my 3rd VBAC.
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#13 of 19 Old 06-03-2007, 05:11 AM
 
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My dd was born with a nuchal hand, no tearing but- you know. I definitely knew I'd given birth
I was having this discussion with a friend, actually- a friend of hers had a child born with a nuchal hand and it was diagnosed as shoulder dystocia. (baby did need some help after she was born.) Apparently the mum has been told that if she has more children she will need an elective c-section.

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#14 of 19 Old 06-03-2007, 12:39 PM - Thread Starter
 
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Just to affirm-we always go to section-this wasn't just a nuchal hand, It was full hand extended above head. She had an epidural, but a multip, they made it to section. I wanted to know if any midwives out there can give me reasoning into what a Doc is thinking?
I asked a more experienced RN and she said it was because of tear risk and injury to arm risk.
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#15 of 19 Old 06-03-2007, 12:45 PM
 
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ds was born with a nuchal hand (mw thought he was actually sucking on it while coming out)... i ended up tearing more than with ds1 (no sutures though, large 1 degree tear) and had bad back pain while pushing (due to his elbow). i pushed for a third of the time as with ds1...can't imagine having a c/s for that. that's sad.

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#16 of 19 Old 06-03-2007, 12:48 PM
 
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You might want to repost in the Birth Professionals forum... lots of MWs there.

My DS had a "nuchal hand" but my MW said he came out like superman, so maybe it was more than just a nuchal hand.

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#17 of 19 Old 06-03-2007, 02:58 PM
 
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Was it a nuchal hand, or was it a hand presentation alone? In the latter case, could it be that they concluded the baby was transverse? It's the only thing I can suggest, since a compound presentation by itself shouldn't call for a C-section. I've attended several, at home and in the hospital, and they were pretty straightforward.
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#18 of 19 Old 06-03-2007, 06:52 PM
 
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My last was at home a UC and he had his hands over his head when he came out. No problems. I guess he was scared. He slept that way when he was a baby also.
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#19 of 19 Old 06-05-2007, 12:20 AM
 
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It depends. I've been involved with a couple: one had a nuchal hand but if we pinched the hand the baby pulled it back up. With several hours of pitocin augmentation the head finally came down and she progressed....


...until things came to a screaming halt and the mother vowed and declared soemthing was wrong. OB didnt believe her but caved to her demands for a c-section (previous birth had been vaginal and rapid so she was convinced something was wrong). On c-section it was obvious her uterus had ruptured and the baby's other hand was sticking out the uterus. Lucky OB listened to the mom this time.


The next one was a hand presentation with high head. I monitored well and checked vaginally frequently til I knew I was also feeling a foot - sure enough the baby was coming down sideways. Cord got in the way and we had a crash c-section - both mother and baby well.
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