Shoulder Dystocia and Birth Injury: A Comparison of Physicians’ and Midwives’ Management, Documentation and Outcomes

2.50
Hdl Handle:
http://hdl.handle.net/10755/150430
Type:
Presentation
Title:
Shoulder Dystocia and Birth Injury: A Comparison of Physicians’ and Midwives’ Management, Documentation and Outcomes
Abstract:
Shoulder Dystocia and Birth Injury: A Comparison of Physicians’ and Midwives’ Management, Documentation and Outcomes
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Camune, Barbara, RNC,CNM,WHNP,DRPH
P.I. Institution Name:University of Texas Medical Branch
Title:Clinical Instructor
Shoulder dystocia is a birth experience where the fetus becomes entrapped by impaction of its shoulders against the maternal pelvis and is prevented from expelling the rest of the body. It is a medical emergency that currently is diagnosed by the birth attendant (physician or midwife) at the time of delivery. Because 3% to 22% of births worldwide may be affected, many authors have investigated birth/death certificates and chart reviews to ascertain antepartum and intrapartum risk factors. Although it seems obvious those very large fetuses could be at risk, diabetes, birth order, maternal pre-pregnant weight and weight gain can increase the risk of shoulder dystocia. Birth injuries related to this problem include clavicular fracture, humeral fracture, brachial plexus injuries (temporary and permanent) and cerebral palsy as a result of this event. The purpose of this study is to investigate seven domains related to shoulder dystocia. These include recognition of risk factors, definition of the event, management techniques used to dislodge the fetus, training/education received in order to manage the event, documentation in the medical records, maternal and fetal outcomes, and the legal ramifications encountered after a birth injury. A community survey of 1,789 Obstetricians, Family Practitioners, Certified Nurse Midwives and Direct Entry Midwives currently delivering babies in Texas was mailed in fall 2000. A second mailing was sent in January 2001. The instrument was developed, validated and piloted by the author, consists of a cover letter and a 67 item questionnaire covering the domains cited above, also including a section on demographics. The prospective participants were selected by membership directories from the American College of Nurse Midwives, the American Academy of Family Practitioners and the American College of Obstetricians and Gynecologists. The Direct Entry midwives were selected from midwives registered with the Texas Board of Midwifery. A response rate of 33% was obtained. Results indicated that the respondents were representative of the population as were their clientele. Obstetricians tended to work in more urban settings, while family physicians and certified nurse midwives tended to care for rural populations. All midwives were less likely to use invasive methods to extract the infant, while physicians were more likely to use invasive methods, which produced more events of injury. There was a difference in the data documentation between physicians and midwives. Midwives tended to use “tight shoulders” and document time frames from head to body delivery. Physicians tended to write “shoulder dystocia” followed by maneuvers. Fractured clavicles were encountered much more frequently by physicians, as were fractures of the humerus and transient brachial plexus injuries. Permanent brachial plexus injuries were similar between the groups of clinicians. Asphyxial events were also similar. Further study needs to be done comparing education preparation for managing shoulder dystocia as a team, parental reaction to an injured child, how information is communicated to the parents following injury, program development for training in management techniques, evaluation studies on documentation at the staff nurse level, and intervention studies to compare sequences of invasive and non-invasive techniques in shoulder dystocia management. Information from this study could add valuable knowledge to this difficult experience and possibly help develop standards of care.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleShoulder Dystocia and Birth Injury: A Comparison of Physicians’ and Midwives’ Management, Documentation and Outcomesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150430-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Shoulder Dystocia and Birth Injury: A Comparison of Physicians&rsquo; and Midwives&rsquo; Management, Documentation and Outcomes</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Camune, Barbara, RNC,CNM,WHNP,DRPH</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Texas Medical Branch</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Instructor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">bcamune@utmb.edu</td></tr><tr><td colspan="2" class="item-abstract">Shoulder dystocia is a birth experience where the fetus becomes entrapped by impaction of its shoulders against the maternal pelvis and is prevented from expelling the rest of the body. It is a medical emergency that currently is diagnosed by the birth attendant (physician or midwife) at the time of delivery. Because 3% to 22% of births worldwide may be affected, many authors have investigated birth/death certificates and chart reviews to ascertain antepartum and intrapartum risk factors. Although it seems obvious those very large fetuses could be at risk, diabetes, birth order, maternal pre-pregnant weight and weight gain can increase the risk of shoulder dystocia. Birth injuries related to this problem include clavicular fracture, humeral fracture, brachial plexus injuries (temporary and permanent) and cerebral palsy as a result of this event. The purpose of this study is to investigate seven domains related to shoulder dystocia. These include recognition of risk factors, definition of the event, management techniques used to dislodge the fetus, training/education received in order to manage the event, documentation in the medical records, maternal and fetal outcomes, and the legal ramifications encountered after a birth injury. A community survey of 1,789 Obstetricians, Family Practitioners, Certified Nurse Midwives and Direct Entry Midwives currently delivering babies in Texas was mailed in fall 2000. A second mailing was sent in January 2001. The instrument was developed, validated and piloted by the author, consists of a cover letter and a 67 item questionnaire covering the domains cited above, also including a section on demographics. The prospective participants were selected by membership directories from the American College of Nurse Midwives, the American Academy of Family Practitioners and the American College of Obstetricians and Gynecologists. The Direct Entry midwives were selected from midwives registered with the Texas Board of Midwifery. A response rate of 33% was obtained. Results indicated that the respondents were representative of the population as were their clientele. Obstetricians tended to work in more urban settings, while family physicians and certified nurse midwives tended to care for rural populations. All midwives were less likely to use invasive methods to extract the infant, while physicians were more likely to use invasive methods, which produced more events of injury. There was a difference in the data documentation between physicians and midwives. Midwives tended to use &ldquo;tight shoulders&rdquo; and document time frames from head to body delivery. Physicians tended to write &ldquo;shoulder dystocia&rdquo; followed by maneuvers. Fractured clavicles were encountered much more frequently by physicians, as were fractures of the humerus and transient brachial plexus injuries. Permanent brachial plexus injuries were similar between the groups of clinicians. Asphyxial events were also similar. Further study needs to be done comparing education preparation for managing shoulder dystocia as a team, parental reaction to an injured child, how information is communicated to the parents following injury, program development for training in management techniques, evaluation studies on documentation at the staff nurse level, and intervention studies to compare sequences of invasive and non-invasive techniques in shoulder dystocia management. Information from this study could add valuable knowledge to this difficult experience and possibly help develop standards of care.</td></tr></table>en_GB
dc.date.available2011-10-26T10:24:18Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:24:18Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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