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I can understand not waiting too long when you feel
there is dystocia, however it seems that many Drs are interpreting that as not
waiting for restitution AT ALL. In normal mechanics restitution happens
soon after the birth of the head and internal rotation of shoulders with the
next contraction, unless the contractions are a great time apart i.e. as in
uterine inertia, the healthy baby can certainly afford to wait a minute or two
between head and shoulders, it is usually only that. I do remember
one birth when the contractions had slowed right down in 2nd stage to about
7 minutes apart and had become quite weak, the ob was in the room and we did get
a bit stuck on the shoulders but he performed manual internal rotation and the
baby came out OK. I thought then that the shoulder dystocia was more
2' to the poor uterine effort in that instance, had the contractions been
expulsive and frequent I don't think it would have happened.
And, as we've been discussing, the placenta may be
beginning to separate, but it is still supplying O2 rich blood.
I found the points about stillborn baby with normal
Ph and -what we have all seen many times- babies with no apparent signs of
distress in labour coming out 'flat' to be very thought provoking.
An interesting thread indeed
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"
Edmund Burke
----- Original Message -----
Sent: Friday, November 18, 2005 10:16
AM
Subject: Re: [ozmidwifery] question
Remember the placenta is beginning to separate at
the point of the head being born so the baby is dying of hypoxia and acidosis.
ALSO are probably correct on not waiting for restitution. The signs of
shoulder dystocia are evident before the head is crowned and then the 'turtle'
sign appears and clinches the diagnosis so it is full steam ahead and get that
baby born. You could wait all day for restitution and end up with a dead baby.
Jenny
Jennifer Cameron FRCNA FACM
President NT branch ACMI
PO Box
1465
Howard Springs NT 0835
08 8983 1926
0419 528 717
----- Original Message -----
Sent: Thursday, November 17, 2005 2:32
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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