That family hitory head work is fascinating isnt it i agree as with my woman a cs was the answer in the end ----- Original Message ----- From: "Marilyn Kleidon" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, December 17, 2003 6:05 PM Subject: Re: [ozmidwifery] Brow presentations
> 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. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
