----- Original Message -----
Sent: Friday, October 06, 2006 6:16
PM
Subject: Re: [ozmidwifery] No
Contractions
Along the theme of slow labours:
I just had a labouring mum with very slow
contractions today. She came in in the night thinking she'd SROM'd but
had not - was niggling all night with backache.
This morning I reassessed and found intact
forewaters and a posterior cervix which was a really stretchy multips os which
could open easily to 6-7 cms. I encouraged food and walking/shower etc and she
very reluctantly walked a bit but wanted to lie down instead despite the
chronic backache. Explained that bub was OP and she needed good
contractions to bring the head down but she was very half-hearted about it.
Even gave her an enema!! (her choice)
After a few hours I re-examined and did an ARM as
she just wanted to get on with it - plus the OB would have come along and done
that soon if I had not! Cx now up to 8cms and better applied, still
OP.
3 hours later and still only contracting
+-12minutely, we discussed synto as she was by now really 'over it' and
refusing to get active. 30 minutes of synto at very low dose and we had
a 9lb baby who rotated to OA in the final few minutes.
She was drinking and eating as desired but was
not keen to take much of either.
I am not comfortable with weak, infrequent or no
contractions as it heightens the risk of uterine inertia post birth,
shoulder dystocia and a compromised baby - The docs maintain that the fetal Ph
drops (I think) 0.5 per minute sitting at crowning, which they learned at the
obstetric emergencies seminar, so i also know that any of our obs will get
very edgy if there is prolonged crowning. Sometimes you have to
compromise what would be normal physiology with what you know would
happen if obs took over. I wondered how I would have managed this in a
home situaion, probably encouraged her to rest until things were
established, and left alone - but we were not at home! So I agree
with the points raised about hospital midwifery care and empathise with all
who work withing similar restrictions.
How would a homebirth midwife support this sort
of labour?
Sue
-- Original Message -----
Sent: Friday, October 06, 2006 10:10
AM
Subject: Re: [ozmidwifery] No
Contractions
Hi Di,
This reminds me of scenario that a cousin of mine had with her second
bub. Her contractions basically stopped I think when she was fully and
she did end up having some synto to get them going again. But what had
happened was that the midwife (who said she could have bitten her tongue as
soon as she said it!) said to her that she would probably have to work hard
as she had a good size baby on board. My cousin said that she became
really frightened and the contractions just died. I wonder if there
was anything holding your woman back? Although you said she seemed
excited and focussed.
As far as her pushing without contractions, I think if you have a fetal
bradycardia and possibly a compromised bub then it becomes priority to get
the baby out. It might just be head compression, but it might not.
Cheers
Michelle
diane <[EMAIL PROTECTED]> 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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