I think I just hurt a patient and now I'm freaking out

[Alaskahatesme]

So I'm on my OB rotation and the teaching has been subpar to say the least. A lady was in labor today and terrified about having a laceration so as she was pushing (2+ station) I was doing some posterior pressure with perineal massage. Now at this point it is just me and the labor nurses. The doc is no where to be found then pops her head in and says she is swollen stop applying pressure. She then leaves again only to return as the baby is rocketing out of the patients uterus. Baby is delivered fine and the OB ran away again not to be seen. But now this mom had the worst vulvar swelling I've ever seen. I'm pretty sure it is my fault because after extensive research and a comment of the doc to the postpartum nurse (not to me) over the phone. So now I'm freaking me out that I injured this woman, failed my OB rotation and I am blaming myself. I used a technique I was taught in family med because no one on OB teaches me. Has anyone dealt with anything like this? I feel so guilty and nervous about seeing my attending tomorrow

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[MrChance2]

1. If you messed up try and learn from it. 2. Do you have a few hours free to go have a beer with friends?

 

[22031 Alum]

I think it's sucky that you were put in that situation, but I hear lots of talk from colleagues about the good old days when students got to deliver babies completely unsupervised. Sounds like your experience is closer to the latter. REGARDLESS. Plenty of women get swelling like that from pushing, even if you never touch them during the second stage. So don't beat yourself up over this.

 

[evilbooyaa]

When this story started, I thought you were going to end it with one of the following:

1) You dropped the baby, headfirst, from a standing position
2) Your posterior pressure caused a grade 4 vaginal laceration
3) You drop kicked the father while he was holding the baby

Vulvar swelling? I'm honestly not sure what the long-term issues with that are, but can't be as bad as #1 - 3 above.

Try not to freak out about it. You're probably not going to fail the rotation. Your attending Ob may give you some grief about it, but **** them, they're miserable b/c they are in Ob. You used a technique that you learned, can defend the use of, and you stopped when you were told to stop. It's not like you were manually widening the vagina using your hands in an attempt to have the baby come out faster or something.

All this being said, I have no idea what posterior pressure is. I also don't care, so whatever.

I'd be like "damn, I got to catch a baby all by myself, that's pretty cool".

 

[Psai]

I'm guessing that pushing a baby out caused more edema than your posterior pressure

 

[bc65]

If there was a preventable injury ( it sounds like there probably wasn't ) it wasn't your fault, it was the fault of the attending who left you alone.

But get used to feeling like you made a mistake. You'll feel it again. And again.

 

[Gambler 101]

I can't believe they left you alone to do a delivery. Was the nurse a certified midwife? If not, the attending or resident should have been present. We aren't qualified to do these deliveries alone. I won't even do a cervix check without a doctor present...


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[da8s0859q]

I guarantee you that you will have moments in residency where you will think you did far worse than that.

All will be well.

 

[Merely]

When this story started, I thought you were going to end it with one of the following:

1) You dropped the baby, headfirst, from a standing position
2) Your posterior pressure caused a grade 4 vaginal laceration
3) You drop kicked the father while he was holding the baby

Vulvar swelling? I'm honestly not sure what the long-term issues with that are, but can't be as bad as #1 - 3 above.

Try not to freak out about it. You're probably not going to fail the rotation. Your attending Ob may give you some grief about it, but **** them, they're miserable b/c they are in Ob. You used a technique that you learned, can defend the use of, and you stopped when you were told to stop. It's not like you were manually widening the vagina using your hands in an attempt to have the baby come out faster or something.

All this being said, I have no idea what posterior pressure is. I also don't care, so whatever.

I'd be like "damn, I got to catch a baby all by myself, that's pretty cool".

number 3 is just hilarious