Hi Di,
Just a point on fluids in labour - if a woman is overloaded with
fluid (via a drip) her system, vasopressin (antidiuretic hormone)
will kick in to stop her body being flooded with fluid. This hormone
is produced from the same source as oxytocin (posterior putuitary
glad). Perhaps this was why the contractions dropped off.
Why not let the woman herself dictate what she was drinking? As a
rough guide, about 1 cup of fluid per hour is often suggested. The
ketones in her urine (unless they are alarmingly high) are a sign
that her body is working well and mobilising her fat stores to give
her energy etc for labour.
I agree that the "rest and be thankful" stage is often misunderstood
- if a woman is lucky enough to get a break, especially in a strong
labour, then she should not be robbed of it! I deliberately put this
stage on the new Birth Day panels that I developed for teaching about
second stage, because it is often
glossed over in classes and women don't know about it.
It is fantastic that you are seeking answers to these questions -
that's the best way to learn - from experience!
Warm regards,
Andrea
At 07:24 PM 5/10/2006, you wrote:
Hi Wise women,
Just want to throw this out there for comments/suggestions. Had a
birth the other night that was a bit worrying at the time. Good
outcome lovely 4200g baby girl. Mum (primip) had SROM at clinic
visit at 830 am then went home and established at about 1630, came
in contracting moderately at 1900hrs was 4-5cm , I took over her
care at 2000hrs. Lovely very motivated mum, well read and attended
classes, well supported by partner and mum and mum in law and
sister. Ctx hotted up to 3-4 minutely and stronger, was drinking
well but had a few small vomits, and next UA showed small ketones
and SG 1.030, but was still drinking well and ctx remained strong
and regular so didnt want to put in a cannula. VE at 1130 showed an
anterior lip, still a bit thick. Wasnt able to wee again after that
but head was well down.
Was actively pushing with some ctx at 0100 with signs of full
dilatation (nice purple line!) Contractions really started to drop
off, became about 4minutely and only about 20secs of good strength.
Mum getting quite tired at this stage but more focussed and excited
than earlier. At this point I did put up some fluids as I thought
with the ctx dropping off combined with her fatigue she might need
some hydration. She pushed babe up to on view (birth stool) but made
little more progress over next 20mins or so. Fluids running in flat
out but no sign of increased ctx. Babes HR started to drop to around
80 which at first had good recovery , so I wasn't too worried but
after a while were staying there for a minute or so each time before
climbing back to 100. At this point with encouragement she managed
to push bub up to almost crowning and that was the last of the
contractions!!! Obviously not easy to get FH at this stage but was
quite low and staying there. She had not much strength left as she
had done much of the work without help of ctx.
With a few position changes she got a little more head out but then
seemed to only move millimeter by millimeter....colour was ok....
eventually after what seemed like 10 minutes I managed to push the
peri back to get a chin...then nothing no ctx...mum managed to push
a little and I got her to move from kneeling to standing then one
leg up on bed....still nothing... went onto bed and there was some
movement with maternal effort (the last of it!) the body birthed
over almost three minutes, it was a pretty tight fit with the
shoulders coming in the lateral position, when a shoulder appeared I
gave it a push with two fingers to the anterior it moved just a
little into the oblique but then was finally out far enough for me
to get a little finger under the arm and finally managed to get her
out! Apgars 7 and 10. but as it was so slow and there were no ctx
to assist with her being a big bub too, It was a bit hairy for a
little while. Lucky she didnt have big enough ears or they might
have ended up a little stretched!! LOL. Second stage was only 1hr
45min but I felt it was just way too slow birthing that head and
those shoulders! Perhaps I should have been more trusting?? I
hesitated in calling the Doc after an hour of pushing cause was on
view at this stage and I thought he would have been too late by the
time he came in. Probably would have been better to have him on
standby just in case, I suppose. I just felt quite helpless and know
that things ended up quite stressful for everyone in the room. I
think I would have prefered to deal with a shoulder dystocia at
least then I would have had a practiced sequence of events to go through!!
Thought she might get away without a tear as birthed sooo slowly but
peri went with the shoulders, 2nd degree peri tear (no too big) and
a anterior labial that wasnt too bad either.(thank goodness, was
after 3am by then, that time of night where you see double!) Did
have synto at birth but needed to get her to squat to get placenta
and had a constant trickle and (surprise surprise) a relaxed uterus,
which was fine after another shot of Syntometrine (450 loss).
My feelings are I probably should have been a little more pro active
in getting the fluids up, maybe I erred on the non intervention side
a little too long. Any other suggestions, how do you get a bub out
with no Ctx and a tired mum? She did try nipple stimulation with
little effect too.
Cheers
Di
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