I had a very similar experience recently with a friend.Her history was that her 5 sisters all had private obst, induction's epidurals 4 sections and one forceps. So this woman was really keen for a vaginal birth with no intervention but all of this head work to do. She saw a great anesthetist who did hypnosis on her to stimulate her labour when she was 3days srom no labour. This worked as did the relaxation stuff and she laboured very well over the day with synto. (after 24 hours spurious labour) I used intermittent monitoring to enable her to be more mobile and because with her very large tummy it was too difficult to get a good trace without all our attention being on achieving that. She was in the bath rocking etc and got to 7cm in about 6hours. I hadn't palped her because of the large abdomen and don't think I ould have picked up a brow because of that. Brows are very difficult to palpate and you don't thankfully get them very often. I have felt a brow on palp before by feeling the position, then when you push with your fingers to feel the head the first part you feel on an OA position is the side opposite to the back, a brow generally what you feel first is on the side of the babys back. military you tend to feel both at once. I wish I could draw it I am not sure I am being clear. My friend ended up with a section as he was an acynclitic brow presentation (the first eye I have ever felt, not a pleasant surprise!!). She had laboured with no drugs for pain relief. As soon as the synto was turned off the contractions stopped which is indicative of malpresentation as was the early srom no labour. Unfortunately at section her baby was very flat and extremely bruised with his jaw wide open which made resus difficult and he ended up in NICU for the night. She is quite devastated at this and of course wonders if she should have gone for a section straight away and not tried for natural birth (which in her family is not common). She is coming to terms with it all, even if we knew it was a brow we would have tried to se if contractions would turn him to a face so he could birth. Your woman needed to try coz it may have turned more to a face which could have birthed but everything is easy in hindsight. It is interesting that my friend at 7cm looked at me and said what happens if her is stuck? I knew then oh oh, women who labour well no drugs who say that to me flag bigs signs of knowing something is not right instinctively. My friend is breastfeeding well now and has lots of worries which is her nature anyway. Maybe next time? Belinda ----- Original Message ----- From: "Marilyn Kleidon" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, December 17, 2003 2:07 AM Subject: [ozmidwifery] Brow presentations
> What do you all know about brow presentations? I was with a lovely woman > yesterday who wanted a natural birth and so i spent the morning with her and > her partner on the floor, in the shower and she dilated to fully within 4 > hrs, just lovely and I am sure (so sure) I palped a posterior fontanelle > such that baby was direct OA, but almost military poition; I was trying so > hard to follow her through a physiological 2nd stage but after an hour and a > half with no sign of baby's head I did another VE and she had pushed down a > small anterior lip, which obligingly slipped back but now there was a > central anterior fontanelle with caput just inferior to the fontanelle, so > consultant called in and an emergency c/s due to brow presentation(not > emergent emergent, baby was just fine and mum was exhausted but not > physiologically compromised). Baby had great apgars, which is good as I had > not identified any fetal distress, I just want to know if there is anything > we could have done differently. Mum spent most of her labour and 2nd stage > on all fours on the floor over a bean bag, with regular partner dancing, > pelvic rocking ie very active and effective first stage after 4cm. She had > had a prolonged early first stage with a significant hind leak and > intermittent contractions for almost 24 hrs before presenting to to birth > suite yesterday for IOL and antibiotics. She was then 4cm dilated and ARM of > forwaters to induce baby ROL at this time (this happened before my shift > thankfully as I have a hard time supporting ARM and just hate that > compromised feeling). Anyway she moved rapidly into an effective active > first stage as described above. > > I am wondering if anyone thinks preserving those forewaters might had > avoided the malpresentation. Also should I have re-examined her earlier? Do > you think I mistook the posterior fontanelle for the anterior one on my > first 2nd stage VE? I was so convinced, I mean it felt like a text book > palp.I just hate to think I encouraged this woman to work so hard for one > and half hours when I could have saved her that exhaustion. And I don't mean > "saved" in any metaphysical sense, just can't think of a better word. I know > hindsight is often 20/20 and am not beating myself up, just trying to > understand. There was some veiled criticism from the ob regarding not having > "effective analgesia" on board: however it was realised when the woman > elected to have a GA that having an epidural or narcotics was never part of > her plan. > > I have looked up all of my texts and am pretty satisfied that a c/s for > brow presentation is the best alternative, but would welcome other ideas. > > thanks > marilyn > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
