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Dear Susan,
My understanding was with true shoulder dystocia
(which is a bony problem not a soft tissue problem) the outcome of the babe was
influenced by cord compression. This of course does vary depending on how
long the cord compression lasts. I believe also that the acidocsis
increases during the 2nd stage however well healthy babes a quite capable and
have adequate reserves in coping. I also think that after the babes
head is born there is a drop in ph (don't know the average rate though) as I
remember reading about it somwhere. Maybe someone else can enlighten
us.
However, well, full term babies have a
remarkable store from a high haemaglobin level that is saturated
with oxygen - unless there has been an assault that has not revealed
itself.
Breech's are the same - it is usually due
to cord compression, but they all seem to bounce back very quickly
(breech/shoulder dystocia) in my experience unless there has been that
underlying problem that had not revealed itself at any other
time.
I am sure that we all have a story that a baby was
born without any obvious problem during labour and second stage but is flat as a
tack when born and takes sometime to respond to resucitation. I remember
an intensive care nurse saying to me that there may have been an assault,
who knows days, weeks, months before and therefore this baby has been fine
during labour and 2nd stage but when they have to do it all by themselves after
birth they cannot cope, as the normal birth process has taken so much of their
'non' reserves due to a previous assault.
Regards
Anne Clarke
Queensland
----- Original Message -----
Sent: Thursday, November 17, 2005 3:02
PM
Subject: Re: [ozmidwifery] question
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 -----
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 -----
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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