The mum was instinctively doing front to back rocking on the floor mattress, throughout labour and while she was pushing. I debriefed with her and her partner today which was really good for all of us. What is interesting, Belinda, is that this woman also has a family history of c/s, 3 sisters had all c/s and one a forceps with a not too good outcome which was why she opted for the c/s even before the ob agreed it was a brow and didn't think forceps/vacumm were an option. I am thinking there maybe something physical midpelvis/at the spines which caused the baby to deflex, but who knows maybe it was just the ARM in this particular situation??
Interesting re the palp: I thought there was no head above the brim as did the PHO but ob thought she felt some face, but her hand was on the opposite side to where the face was on delivery, on delivery the baby's hand popped out where ob thought the face was. Baby was not deep in the pelvis i.e.didn't need to be pushed out of the vagina to be delivered abdominally but the brow was definetly at the spines, no more though. I do think c/s was the only option for safe delivery of this baby. marilyn ----- Original Message ----- From: "Lynne Staff" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Monday, December 15, 2003 7:38 PM Subject: Re: [ozmidwifery] Brow presentations > I tend to agree with Marilyn. Rupturing the membranes may have contributed > to the babe coming down deep into the woman's pelvis in a deflexed position, > also making it more difficult for it to flex and rotate with no > 'cushioning'. An hour in the tub with some oblique pelvic stretches and > front to back rocking - don't ususally see this in labour, but it may help > in times like this - may also have assisted with flexion and rotation. > > ----- Original Message ----- > From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Wednesday, December 17, 2003 6:01 AM > Subject: Re: [ozmidwifery] Brow presentations > > > > Yes, Denise: I wonder if an hour in the tub would have helped?? There was > no > > synto augmentation involved 4cm to fully in 4 hrs seemed like a lovely > > active birth was about to happen. Yes also: those Midwifery Today > > suggestions are great to try in a homebirth situation/independent practice > > but please tell me if there are any of you out there who would push a baby > > gently out of the pelvis and try to rotate and flex the head in a hospital > > birth suite? Also once I called in the consultant it became her call, > > however to be honest I kind of felt if I had said I was prepared to try to > > use my fingers to deflex the head she just might have let me(in the OT of > > course). I must admit I am a tad intimidated in the hospital but also I > have > > never encountered a brow presentation before: it has all been academic. > So, > > I await your wise counsel. > > > > marilyn > > > > ----- Original Message ----- > > From: "Denise Hynd" <[EMAIL PROTECTED]> > > To: <[EMAIL PROTECTED]> > > Sent: Monday, December 15, 2003 6:13 PM > > Subject: Re: [ozmidwifery] Brow presentations > > > > > > > Dear Marilyn > > > Thank you for sharing your reflections and cogitations. > > > > > > This is my beleif, experience that midwives do reflect on all that > inputs > > > into a labour and the possible interplay rather than jumpimg to blame, > > > denouncement of specific action of another or the woman and baby like > an > > > edict of an all knowing being !! > > > > > > In this particular insistance or similar I also wonder about the ramming > > (?) > > > effect of ARM and maybe other things that may have startled the mother > or > > > baby in the hospital?? > > > > > > I take it there was no synto also pushing the hole along? > > > . > > > I understand and have seen floating in tubs to help unstick some > > asynclitic > > > babies I wonder if it would help relax a non rigid brow back to a face > or > > > vertex?? > > > > > > Also Midwifery Today & other midwifery texts talk of pushing stuck > babies > > > back and other maneovers trying to unstick them but that would be easier > > > with intact membranes? > > > > > > Denise > > > ----- Original Message ----- > > > From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > > > To: <[EMAIL PROTECTED]> > > > Sent: Tuesday, December 16, 2003 11:37 PM > > > 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. > > -- > 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.
