Wow an ob who not only avoided a caesar but one who repositioned the baby (?) usig his fingers?? Denise ----- Original Message ----- From: "Sandi" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, December 17, 2003 3:13 PM Subject: Re: [ozmidwifery] Brow presentations
> Dear Marilyn > I also cared for a woman recently with a brow presentation, 2nd baby normal > labour but I > thought it was a a bit slow and really noisy behaviour. Her husband assured > me this is how she was first time > around and wasn't bothered. i actually called her GP as she was obvoiusly > fully and just not progressing. > He asked me to check dilation which I did and we encouraged her to push, > suddenly there was head on view, but it didn't look right (I work in the > dark). The GP thought it looked breech and called the obstetrician, who > promptly > diagnosed the brow, called for the vaccum,pushed baby's head back slightly, > then used the vacuum to rotate baby's > head, rapid birth with a generous epis and all well. On checking my books > later I discovered that the brow will not be discovered on VE unless there > is a high index of suspicion, ie you go looking for it. Mum very happy to > have avoided a section. > > Hope this helps > Sandra > ----- Original Message ----- > From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Wednesday, December 17, 2003 1:37 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.
