Q: Is it possible to "diagnose" a nuchal hand before birth (other than with an ultrasound in labor)? Is there anything one can do to help keep the mother from tearing when there is a nuchal hand?
Any other useful information on the topic of nuchal hand/arm is welcome.
A: My first indicators of a nuchal arm have always been fresh blood flow at +2 station of the vertex. Upon presentation of said flow, I perform a repeat Leopard's Maneuver in addition to a rectal exam. (I was trained as an L&D nurse in the 70s, and rectal exams were the standard.)
Rule 1: Apply counter-pressure to shearing force's.
Rule 2: Birth is a clean procedure--triple glove and use lots of arnica and tramulin, oral or ointment form, As the arm/hand delivers, follow it out the introitus and peel off offending gloves as you go.
Rule 3: Always support the perineum and make the lips stretch.
Rule 4: Make sure you can fix the perineal outcome while you learn these skills.
What do you do for "skid-marks?"
What products would you use and why? (Think about household astringents and "the like.")
2nd degree--Pull out your thread and prepare your client. If you are still unsure of your suturing skills, bind her at the knees and do perineal washes at bathroom breaks. Begin pelvic floor exercise ASAP; reevaluate at 10 day visit.
3rd degree or sucal/cervical tears: Call backup and establish a plan of care and location of repair site.
-Anon.
Reprinted from Midwifery Today E-News (Vol 2 Issue 1, Jan 7, 2000)
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