Hello Jan, Janet, Joy and list
I've recently joined the list - two responses-ten years ago I helped a woman
with her planned homebirth of twins in a regional hospital. The plan
included the obs and paed being there for the births and no intervention
unless a problem arose. Baby 1 slipped out before they arrived, mother
kneeling upright. Obs and paed arrived as baby 2 head settled into pelvis.
FHS fine, coming to midline. Obs ruptured membrane baby 2 and baby slipped
out soon after. During birth baby 2 obs heard to murmur....would be a good
position for breech birth. Times change don't they.
To Joy, 5 or so years ago a primip came into local rural hospital in labour.
On VE fully dilated -5pm-but wasn't acting like it. Rang doc who slowly
made his way in. At 6pm he agreed fully, still not acting like it, he had
a coffee, went and got something to eat. All obs fine, head in pelvis, no
sign of a push. At 9pm he asked what I thought-is she stuck??? I and MUM
thought fully but not ready yet. He went off home murmuring about caesar in
the morning... Woman continued with 2-3 min contns, all obs fine.
Encouraged hourly toilet trips, finally at 11pm when she lifted her leg to
get on bed baby shifted she said and soon after she felt a pushing urge.
NVB a short while later. Cheers Leigh Pettingill
----- Original Message -----
From: "Jan Robinson" <[EMAIL PROTECTED]>
To: "Janet Ireland" <[EMAIL PROTECTED]>
Cc: <[EMAIL PROTECTED]>
Sent: Monday, August 20, 2001 7:52 AM
Subject: Re: Twin policies.LONG
>
> 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
>
>
>
>
>
>
> --
> __________________________________________________________________________
> 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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