I agree with you Andrea. I think many babies are literally strangled during
true shoulder dystocias. As for cord ph - I can clearly remember a baby
having a lovely normal cord ph following his death during a shoulder
dystocia (????). Provided me with yet more ammunition against the hospital's
policy of routine cord gas analysis following all births.
Rachel
From: Andrea Quanchi <[EMAIL PROTECTED]>
Reply-To: [email protected]
To: [email protected]
Subject: Re: [ozmidwifery] question
Date: Thu, 17 Nov 2005 17:22:52 +1100
You only have to watch the colour change to the head to know whether
circulation is compromised or not. Some ( most ) babies stay pink and or
only slightly dusky but others go almost navy blue and even get
subconjuntival haemorrhages similar to those that occur in hanging victims
which to me indicates that circulation to the head has been compromised for
at least some time. Babies can tolerate this for a period but eventually
it must have an effect. Just from observation I would say this has little
to do with cord compression but compression of the foetal neck by maternal
structures which would occur more severely in true shoulder dystocia. Of
course prevention is better than cure and encouraging 25% increase in space
within the maternal pelvis is likely to reduce the number of cases where
this will be a problem.
Andrea Quanchi
On 17/11/2005, at 4:02 PM, Susan Cudlipp wrote:
Good point Anne!
I did quite a thorough search last night and have printed off some good
articles which I will pass on. However I could not find the answer to why
EXACTLY babies die in shoulder dystocia. If it is asphyxia, then (obs
point of view) this proves that the cord is not sustaining them. The ob
said to me that if the cord WERE sustaining them there would be no urgency
to deliver the body, also quoted from the ALSO course that the fetal Ph
drops 0.04 (?) per minute after delivery of head therefor we should not
be waiting for restitution but delivering body ASAP. (I didn't even go
there!!)
My feeling is that it is more to do with probable cord compression,
(although I cannot picture why this should necessarily be so as the body
and hence, presumably, the cord, would still be above the pelvic brim) and
trauma to the neck usually caused by mis-management (panic) in trying to
deliver the shoulders than asphyxia, but it is true that they become
asphyxiated within a short time if truly stuck. Any answers on that one?
Thanks
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"
Edmund Burke
----- Original Message -----
From: Anne Clarke
To: [email protected]
Sent: Thursday, November 17, 2005 5:54 AM
Subject: Re: [ozmidwifery] question
Dear Susan,
You could say to them if this is so why do they rely so much on cord ph's
? One would think when the baby was born and the pulsating cord was
still not supplying the baby effectively the cord blood (venous and
arterial) was null and void to provide an estimation of oxygenation for
the babe.
Regards
Anne Clarke
Queensland
----- Original Message -----
From: Susan Cudlipp
To: midwifery list
Sent: Wednesday, November 16, 2005 9:30 PM
Subject: [ozmidwifery] question
I have a question for you wise ozmidders.
I was having a discussion today with one of our obstetricians regarding
cord clamping, and the benefits to the baby of delaying this until
pulsations cease. When I mentioned the benefit of the baby recieving
oxygenated blood via the pulsating cord which could assist it's
transition to independent respiration particularly if it was compromised
(etc etc) the obs was of the view that the pulsations could NOT be
providing oxygenated blood because the uterus would have contracted down
and the placenta could no longer be getting oxygen from mother's
circulation.
Now I know that I have read reams on this and this is stated to be one
of the benefits, but I could not answer that particular question
physiologically and convincingly.
The point was also raised that in shoulder dystocia, babies die of
asphyxiation, which (obs opinion) would not happen if they were
recieving oxygen via the cord.
I did print off George Morley's excellent papers for this Dr to read but
would very much welcome anything that can show that the baby would still
be receiving oxygenated blood post birth.
TIA
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"
Edmund Burke
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