If you drew an upside down "3" on the mother's abdomen, with the small part of the 3 over her pelvis, you get the picture? Hard to describe if you are visual! ----- Original Message ----- From: "Belinda Maier" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, December 16, 2003 1:22 PM Subject: Re: [ozmidwifery] Brow presentations
> 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. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
