Dear Janet, Carolyn and list
Have been unable to contribute much to the list because of my
practise keeping me busy and the continued faxes and phone calls
connected to the PI insurance chase.
Last week after a 3 day marathon primi labour ending in CS ...
followed by 2 days of a similar labaour ending in vacuum extraction,
I had one night's sleep followed by a day that will be a highlight in
my career - WATERBIRTH OF TWINS - Olivia and Brianna ..... and guess
where?
in their LOCAL STATE HOSPITAL!!
The couple had their first baby with me in KGV Birth Centre. Once we
knew twins were on the way the management care plan changed slightly.
KGVs protocols insist that IPMs twins and breech births take place in
their labour ward. The same provision of obstetric care exists and
the staff specialist (bless him!) saw my client on two occasions
after the twins were diagnosed and arranged ultrasound studies and
reviewed and agreed to the couples birth plans. Arrangements were
made for the staff specialist to be contacted when the woman came
into labour ..... but circumstances decreed otherwise for the birth
of these twins.
My client came into labour early last Friday morning after achieving
39 weeks gestation - no mean feat with a toddler to care for.
Trying to get through the peak hour traffic from the western part of
Sydney is hazardous at the best of times and with the arrival of the
twins eminent, we decided to stop off at the Bankstown-Lidcombe
Hospital which is en-route to KGV.
Within a short time the twins were born thanks to the facilitation of
the labour ward MUM and the O&G Registrar whose kindness and empathy
for the couple having their birth plans met will be remembered by the
couple and myself forever. Donna and Waafa are two really SPECIAL
people.
The couple and I were assigned a room with a nice deep bath and a
liasion midwife who organised equipment, note-taking and medications
and left us alone to get on with the good births.
The first twin was born slowly into the water, intact in her sac.
Passed to mother sitting upright (supported by husband sitting on lip
of bath behind her.)
Olivia then rested, comfy on her mother's fundus, her little head
stimulating nipple nerve endings.
Twin 2's FHS were OK and we could see her oblique lie changing to
longditudinal as she began to movedownwards. FHS also clearly moving
downwards and into the midline (aren't hand-held Dopplers
wonderful?) so we let nature take it's course.
While waiting, Olivia's cord blood was collected (mother Rh -ve).
After pulsations ceased, baby separated and clamp removed to let
placenta drain fully - (we knew the twins were dizygotic from the
ultrasound).
Bloodstained water in front of the mother allowed to drain down the
plug-hole while warm water continued to flow into the bath from the
shower nozzle behind her, leaving nice clean water for twin 2 to be
born into)
With an urgent urge to push, Brianna almost flew out (flying fetus,
face presentation). She burst through her sac and was retrieved and
passed to her parents. She had her cord blood collected and then
separated from her placenta (after she had gained plenty of good
nutritive value from it). Parents full of admiration for her dramatic
entry, but her poor little face was contused and lips a little
swollen after her unusual mechanism through her mother's pelvis.
Mother was exhausted by this time as she had been sleepless and
vomiting for most of the night beforehand, so twins were warmly
wrapped and placed in the one clear basket on the floor nearby so
they could be seen and heard while waiting for the placenta.
We tried a physiologic approach to the third stage, sitting on seat
under the shower, sitting on the toilet, all fours, squatting etc
but the placenta did not get a good push from the contracted fundus
as it kept falling to one side. There was an additional problem of
keeping up the mother's falling energy levels. Gaiteraide was sipped
between contractions. There was also lots of labial and perineal
swelling and I assumed there may be some in the lower birth canal as
well.
I suggested that we could 'tuck the mother into bed for a sleep, and
the placenta would plop out the next morning' as suggested by Vicki
Chan some time ago on this list... but that was not the mother's wish
..... so she was assisted to a position of comfort on to the labour
ward bed (first time she had used it) and after some hours with both
babies breastfed, and no further results from maternal effort, IMI
oxytocin 10iu was given and the placenta was removed with controlled
cord traction. (Mother had no energy left and just wanted to get
some well earned rest!)
So there you go folks, no interference, unassisted water births for
both twins, no drugs except for the oxytocin to assist the placenta
to be born.... and no, this is not a fairy story just to make us all
feel good after what we have been hearing about twin births on the
list.
I would love to see a retrospective matched study be carried out on
medically managed twins outcomes compared to midwife managed twin
outcomes in terms of safety, cost and maternal satisfaction.
Anyone interested in doing a Masters?
Jan
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Jan Robinson Phone/fax: 011+ 61+
2+ 9546 4350
Independent Midwife Practitioner e-mail:
<[EMAIL PROTECTED]>
8 Robin Crescent www:
midwiferyeducation.com.au
South Hurstville NSW 2221 National Coordinator, ASIM
__________________________________________________________________________
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