Zavanelli Maneuver

There’s a super moon coming tonight. Where I live it will most likely not be seen because of the overcast skies, but its effect will definitely be felt on the L&D floors.

Of course there is no proof this is true. In fact, it has been scientifically proven that a full moon does not affect hospital admissions, ER visits, or births. However, the majority of medical professionals will disagree.

I can remember many times working the 3pm-11pm shift, looking up at the sky when I left and shaking my head – no wonder it was such a crazy night. I would be covered in sweat and not having peed or sat down all shift and those were the good parts of the evening…….

During a Harvest Moon in 2004, a woman came into the L&D unit. She was an ER walk-in, which meant she had not visited a doctor her entire pregnancy.    

This would be her 4^th child, and she was giving the baby up for adoption. She had a social worker with her to facilitate the adoption and the adoptive parents had flown 300 miles to be there for the birth. This was very odd. I could not help but wonder how she could do all this planning and not go to a single doctor’s appointment. In my opinion, it was bordering on child abuse.

There are obstetricians (OBs) that work for the hospital and take ER calls. This means that any pregnant woman that comes to the ER is their responsibility. Most OBs resent doing this because the majority of the time they do not get paid for it. Most women coming in through the ER haven’t even seen a doctor. These deliveries can be unpredictable and dangerous.

The OB on call that night examined the patient and reported that she was 3 centimeters dilated. He then left the building thinking she had a while before she would have to push.

Not surprisingly, as with most women who have had other babies, the labor went very quickly. The mother was screaming that she needed to push about 10 minutes after the OB left.

Things went kind of haywire after that.  Birth can’t be stopped. The patient started pushing, and I could already see the baby’s head. I ran to the door and screamed, “HELP!” So many people came in the room; I felt a little bit of relief.

As I lifted the sheet, I could see that the baby’s head was completely outside of the mother. One of the residents tried to deliver the baby. Nothing but the head would come out. The baby’s shoulders were stuck behind the mother’s pelvis.

I jumped on the bed and straddled the mother’s chest and began pushing down on the top of her belly. Hopefully, this added pressure would help deliver the baby. It didn’t work.

We tried turning her, putting her legs up to her ears and turning the baby side to side. Nothing worked. The baby’s face turned blue.

At that moment, the OB walked in the room. He immediately grabbed some forceps and tried breaking the baby’s clavicle bone. The bone would not break. That was our last hope of avoiding a very extreme and dangerous procedure.

Our last resort was performing the Zavanelli maneuver, and there are less than ten cases of its use per year. The doctor flexed the baby’s neck completely back and pushed him back inside the mother. We ripped the cords out of the walls and pushed the bed out in the hall running towards the operating room (OR). I was on the end of the bed holding the baby inside the mother with my hand.

As soon as we got to the OR, one of the nurses put the fetal monitor back on the mom and we all cried out as we heard the familiar “beep beep beep”. The baby’s heart beat!

Since the mother was going to be having a C-section, she would need anesthesia. The anesthesiologist gave the mother some medication in her IV. This is normally not enough for a surgery. The OB could not wait and started making the incision. The mother’s painful scream was like nothing I have ever heard before.

After what seemed like an eternity, the healthy baby boy was delivered. He weighed 13 pounds 6 ounces. One visit to the doctor and this all would have been prevented. The doctor would have known how big the baby was and scheduled a C-section for her.

Although there is no evidence that the full moon has an impact on medical care, I know what I believe.  What about you?