The other thing that comes to mind is whether this woman truely was pushing involuntarily or that she had that feeling that she was going to need to push ( like I feel like I need to vomit, not actually happening but feel like I will have to) and needed to be encouraged to breathe through it for a while longer until the head was able to move down further. Always difficult to comment coz we werent there and I know hopw difficult it is for you and the woman when you take over at such a late stage in labour.
Andrea Quanchi
On 12/07/2005, at 10:50 PM, Narelle Crane wrote:
Now that I've broken the ice and made my initial post I have a question. Has any one else experienced an "ascending head"? I'll explain. Recently I took over the care of a primip who was starting to have some involuntary pushes with contractions. She was lying on the bed and was attatched to a monitor as there was mec liquor. She was complaining of a lot of back pain and had been given Pethidine an hour previously. She did not want to get off the bed or even change position. Her partner was rubbing her back. After about an hour the involuntary pushes were much stronger but the woman was too scared to really "let go" and despite my reassurances she wanted to know if she was fully dilated. A very quick PVE confirmed that she was fully dilated and the head was at +1 - +2. With this knowledge the woman was happy to try different positions and to "listen to her body". Within 15 minutes her partner and I could see a small amount of head with involuntary pushes while she was kneeling. For the next 45 minutes the woman changed positions frequently but was mainly standing and rocking and rotating her pelvis while she involuntarily pushed with contractions. After 45 mins or so I started getting anxious that despite lots of poo I was seeing very little sign of further descent and suggested that I should recheck the position of the baby. I couldn't believe what I was feeling - The head was now at or above the spines and there was caput +++. I was unable to feel sutures or fontanelles. I asked the doctor to review but as he was very busy it was another 15 mins before be came. In the meantime the woman recommenced doing full pelvic circles and pelvic wiggles - I encouraged her to "do what feels right". She also continued to push with contractions. When the doctor reexamined her the head was OA and at +2. He insisted that she be made to "push properly" and asked for synto to be started as "those piddling pushes weren"t getting her anywhere". After 30 mins of minimal coaching on my part and a sniff of synto
a very heallthy girl was born. On examination the baby had a large amount of caput over the right side of her head!
Has any one else seen anything like this? I have told many of my collegues aboout this and some have said it was impossible for the head to go back and that I must have been mistaken when I did the initial PVE. Others, like me believe that anything is possible when it comes to labour and birth allthough noone has seen anything like it. Was this another wonderful case of mother and baby working together to give birth? What do you think?
Narelle
